Hello, this is Dr. Perry. Today we’re going to be doing the virtual Brazilian butt lift consultation. The Brazilian butt lift is a liposuction of fat transfer. What we’re doing with the Brazilian butt lift is changing storage locations for calories. Fat is a storage compartment. If you take in calories, you don’t burn them the very second you take them in, they’re stored as fat. Everyone is born with a certain number of fat cells in certain concentrations in certain locations. The concentrations that have the highest number of fat cells store the most calories. These are called our problem areas. Our areas where we gain weight first and lose weight last, are the areas that have this higher concentration of fat cells. What we’re doing with liposuction is trying to get a even concentration of fat cells. The absolute perfect liposuction we leave an equal concentration of fat cells head to toe, so if you gain a pound you gain it evenly.

Liposuction works because fat cells don’t replicate. We’re all born with a certain number of fat cells in certain locations. If we gain weight, each cell gets bigger and if we lose weight, each cell gets smaller, but the number stays the same. If fat cells replicated, liposuction would never work. If you took one cell away and another one go right back in this place, you’re back to square one. So perfection in liposuction is an equal concentration, head to toe. It is not perfect to take all the fat cells from one place because if you take all the fat cells from one place, you’re condemning someplace else to gain weight. Theoretically, if you took all the fat cells, you know, from the shoulders down from the body, legs, arms, if someone gained weight, they gain all the weight in their neck or their head and that would be a disaster. So perfect is not taking all the fat cells from a place, perfect is getting an even distribution.

If I can get the same concentration of fat cells in the back, waist, and hips, then it will have a smooth curve. If you gain weight, it would go here, but this…the curve will be intact because the concentration’s the same, you’re going to gain weight the same. If you lose weight, you go…get smaller, but the curve will stay. Now when we do a fat transfer, what we’re doing is we’re increasing the concentration of fat cells in the buttocks, so now we’re making it the problem area. We’re going to make it the place that gains weight first and loses weight last. What we’re doing physically when we do this transfer of the buttocks is a nonvascularized tissue graft. It’s like a skin graft. We’re taking the blood vessels away from the body where they have a blood supply. We’re putting them in the buttocks where they have no blood supply.

The fat cells that get a blood supply will live and give a permanent result. The fat cells that don’t, die. Best case scenario, 70% of what we put in will live and give a permanent result. We’re going to lose 30% no matter what you do. If you float in the sky, if you sit on your head, you’re still going to lose 30%. Now in my patients, I see that loss of 30% in the first three weeks. So I think whatever is there at three weeks is there. You know, I think after three weeks, sitting, moving will not affect the cells. I think they’re either alive or dead. Now what we ask after surgery is that we don’t sit for 10 days. 10 days is really an arbitrary number, just greater than 4 or 5 days. Blood vessels start to grow when wounds are healing at day four.

So the first four or five days is when the fat’s the weakest. After that, it’s getting stronger and stronger. There is no difference between day 9 and day 11. There’s no magic day where the cells live. It’s just that day 11, the cells are slightly stronger than day 9. I think the time that it doesn’t make any difference is three weeks. So, you know, from 10 days to 3 weeks we can start to sit. But we don’t sit for hours. We sit for 30 minutes, stand up for 10 seconds, move left, move right. Don’t keep pressure on that same area, on one area for the entire time. So that’s kind of the idea of what’s happening, what we’re doing with the surgery so far as the liposuction and the transfer.

Physically, what are we doing? Physically we’re taking [inaudible 00:04:22] and we’re coring out fat cells. So we’re making a solid and make it into a Swiss cheese or a sponge. If you did a cross-section, would look like a sea sponge. So all the holes where we took the fat cells away, took the fat cells out, we’ll remove them, those are the holes where water fills up and that’s where the swelling is. The swelling physically is fluid in the holes where the fat cells were. The swelling goes away by all those holes healing and scarring closed. Each of those holes will scar closed. When it scars closed, there is no place for the water to go and that’s when the swelling goes away. So I always think of our post-op regime as collapsing a sponge. I’m going to put a tape garment on a tape cast. I’m gonna make a cast out of tape to squeeze you and collapse the sponge. We’re going to put a garment on you, squeeze you, and collapse the sponge. We’re going to have you do massage. I like to teach you how to do your own massage because my results are better when people do their own massage as opposed when they go out and get a lymphatic massage. But everything is about…all I’m trying to think about is collapsing the sponge. If I have tissue separated by water, it cannot scar together, so we have to push that water out and get it to scar together.

The swelling will be like an accordion. It’s going to go up and down throughout the surgery. You know what’s going to happen is maybe the first day 1% of the whole scar closed so that the swelling would come back 99%, the next day 98%, 97%, 96%. Three months later, it’ll be 100% scarred. If we start off with something this thick and liposuction something this thick as it scars, it will collapse into a pancake. So we might start off in liposuction with something 2 inches thick, it’ll collapse into a 1/4-inch. That’s what’s making the skin contract. That’s what’s making the skin change from this to that. It’s that collapse. And if you see, if you look at the muscle, the skin is very far away. Now the skin is very close. That’s when it contracts. And you can see the skin is always tighter when you do superficial liposuction. This contracting of the scar…of the scarring of that liposuction area is what’s doing that. That’s part of the reason why that’s happening.

So physically that’s what we’re doing, you know, what we’re doing when we’re working on that massage and the swelling going away. And again, when we do the fat transfer, we’re adding those fat cells. They’re getting a blood supply, they’re living, they’re putting more…they’re putting…storing more calories in the buttocks where we want them.

Now recovery. First day hurts like sting. The first night is like you’ll be wondering why you did it. It really hurts. It’s throbby, achy, bruisy, burny kind of pain. The second day is starting to get better. Maybe 20% better. Day four, day five you start to turn a corner. Maybe the pain is down by 30%. Maybe it’s down by 40%. But then you get better and better. The key to getting better faster is eating, drinking, and moving. This surgery is…you think of it, it’s an injury. In order to heal from an injury, in order to make scar tissue, your metabolism will increase. So you need protein to heal also. So you’ve got to eat more than normal. You’ve got to instead of 40 grams of protein a day, now you gotta eat 50 ’cause you need that scar tissue to heal. If you don’t eat, if you don’t have protein, you cannot make scar, you can not heal the swelling, the swelling will stay. All the water, the only place in your body that stores water is your vascular system. That’s your blood vessels. So whenever you have swelling, the water is coming out of your vascular system. Swelling makes you dehydrated. So if you don’t drink, you’ll be…and if you don’t drink and you’re swollen, you’re going to be dehydrated. If you swell one gallon of water into your tissue, you got to drink one gallon. So the people who get better faster eat, drink, move, and don’t take a lot of pain medicine. If you’re taking a lot of pain medicine and you feel worse day four than day two, it’s the pain medicine, you know, so nothing wrong after the surgery with taking Motrin or Aleve. These are the people that get better faster.

If you stretch from day one, you never get stiff and you avoid pain. If you pull into a ball, then you just have pain and you keep pain. So that’s the things that we’re trying to do to get better. It’ll be 10 days without sitting, 2 weeks without exercise, mild exercise at 2 weeks, heavier exercise at 4 weeks, a garment day and night for 24 hours. Then you can start it back off. The activity and the garment, it’s trial and error. You can do anything that doesn’t make you have additional swelling. You can take the garment off when you take it off, you don’t have additional swelling, its fine to be off. So everything is a trial and error. If you take off the garment and you’re…and you get swollen afterwards, put it back on. If you do some treadmill and then you get swollen afterwards, stop doing the treadmill, come back and do it a week later, two weeks later. So it’s kind of trial and error. The only thing we’re judging by is that you don’t have additional swelling with those activities or with taking the garment off. It will take three months for you to have your best look. Nobody looks their best at one month. Everybody looks better at two months than one month. So you just have to let that areas…let those areas heal. Again, we’re going to have you doing self-massage that we’ll teach you. We’ll use body weight, we’ll use yoga rollers and we’re just going to collapse the sponge using those things. These are the people that have their best results.

Now that is essentially the recovery. The complications we have to be concerned about. This is general anesthesia. Whenever you have general anesthesia, the chance for blood clot for pulmonary embolism is there. When you’re in surgery, you’ll have a machine on your leg called a sequential compression device to squeeze your legs. That keeps the blood moving and prevents clots. After surgery, it’s moving and drinking prevents clots. The setup for a clot is a person who’s dehydrated and doesn’t move. If you’re dehydrated, the blood’s thick, it clots. If you don’t move, the blood sits still, it clots. The night of surgery you got to get up and move, you walk. Even just flexing your feet, tapping your feet, calf muscle contracts, moving your legs, the muscles contract, you are preventing a clot. That’s what we’re doing to do that. The signs of a clot, if…a clot, will usually start in your leg is a swollen…one leg swollen and painful, the other one normal. The dangerous thing is called a pulmonary embolism. Clot breaks from the leg, goes to the lung. That would cause chest pain or shortness of breath. Chest pain or shortness of breath is the 911 of this whole thing. If you have chest pain or shortness of breath, you don’t wait to call me, you don’t call mom, you call 911. That is the urgency of the whole situation.

Fat embolism, fat embolism is fat getting into the bloodstream when you do the fat injection. There’s nothing you do about that. It’s how I inject to decrease the chance of that happening. I inject with my hands, so it’s low pressure. I inject small amounts at a time. So when I inject small amounts, I’m putting… I might inject one CC, two CCs per injection. If I have a thousand CCs, it means I make 500 injections to put it in. That is how I get a better result and that is how I get a safer result. When I put small amounts in many places, I have a great surface area, greater surface area, better blood supply, better fat take. If I just put a glob in, the chance of me getting 70% fat take is not existent. The fact that all the fat in the inside of that glob will die because it has no blood supply. But by putting small amounts, forcing the vessel is very unlikely. The last thing that prevents that is I inject while withdrawing the cannula. If I’m near a blood vessel, I do not stand still and inject. I’m always going to be backing away when I inject, so I’ll never be in the same place for any period of time to force fat into the bloodstream and back into the body. Infection can happen within the operation, fever, pain, chills is a sign of infection. The last thing so far is the complications, have to do with anesthesia. This is general anesthesia. You might have an allergy to anesthesia. You might have atelectasis, lung collapse after anesthesia, you might have pneumonia after anesthesia, you could get laryngeal spasm after anesthesia. These are the complications of…