Thanks to celebrities like Kim Kardashian, Nicki Minaj, and Jennifer Lopez, we're officially in the era of glorified glutes. The proof is in the posterior: Music, movies, and magazines constantly praise famous backsides and celebrate belfies. And, is it just us, or is every other Instagram post dedicated to some sort of squat routine?
But the truth is, it’s not always coming from genetics or the gym. According to an American Plastic Surgery Statistics report, at least 14,705 buttock-augmentation procedures using fat grafting, a popular option, were performed in 2015 — an increase of 28% from the previous year. And butt implants increased 36%, from 1,863 procedures in 2014 to 2,540 in 2015. And that's not even touching upon dermal fillers.
We believe every body is beautiful — and whatever you choose to do to enhance it is your choice. But considering the risks associated with this procedure, we decided to uncover the ins and outs of butt augmentation today, straight from experts like Simon Ourian, MD, a Los Angeles-based cosmetic dermatologist who specializes in non-surgical techniques. (He's also the doctor who's been praised as the best in the biz by Khloé Kardashian and who is credited with giving Kylie Jenner her fuller lips.)
Interested in learning more? We'll go over the three main options for enhancing your rear, ahead.
The following options are available today: a fat transfer, also dubbed the Brazilian Butt Lift, that harvests your own body fat and injects it into your butt; FDA-approved dermal fillers, a non-surgical procedure ideal for patients who may not have enough body fat for a transfer; and lastly, surgical implants.
Do a little research and you’ll find that most doctors refer to fat transfers as the industry’s go-to. “Most surgeons are transitioning from implants to fat transfers, which have minimal recovery time compared to the former,” says Dr. Z. Paul Lorenc, MD, a board-certified plastic surgeon based in New York. “Liposuction is used to take fat from a part of the body, like the abdomen, and insert it into the buttocks to shape the area. It’s more of a sculpting procedure and looks more natural.”
That brings us to our next point: If you choose surgery, do your due diligence on who’s performing your procedure. Implants, transfers, and even fillers are serious procedures that require professional expertise. After all, not too long ago, many curve-craving patients flocked to the black market for butt augmentation — only to find that illegitimate doctors (and those posing as doctors) had put unknown, oftentimes dangerous substances into their bodies. In short, just don’t skimp on your research.
“I strongly recommend consulting with an experienced, board-certified plastic surgeon if you are considering a buttock augmentation,” says William Bruno, MD, a board-certified plastic surgeon in Los Angeles. “An in-person exam is needed to determine if you are a good candidate and to review all the risks and benefits.”
Adds Dr. Lorenc: “Butt augmentation is real surgery. Although the actual surgery isn’t very long, there can still be complications, so be fully aware of everything before going in. Keep yourself safe by finding out the qualifications of both the surgeon and facility. You should always seek advice from a surgeon who does all types of procedures to get a more trustworthy response.”
And if any doctor recommends silicone-gel injections, run! “It’s illegal and very, very dangerous,” stresses Darshan Shah, MD, a board-certified plastic surgeon and founder of Next Health. These red-flag injections shouldn’t be confused with silicone gluteal implants, which are commonly used in implant augmentations today.
Understanding what you really want, shape- and size-wise, is important, too. Aside from that — and investigating all the possible implications of each procedure (more on that in a sec) — it’s also crucial to set reasonable expectations. Dr. Ourian suggests posing the following questions to yourself: “Are my expectations realistic? Am I doing this procedure for myself or to make someone else happy? Am I physically healthy and ready to make the lifestyle changes necessary to ensure the best result, like quitting smoking?” Dr. Shah also warns that the final result may not exactly be a carbon copy of a celebrity's body.
“The amount of fat that can be placed into your buttocks is limited by the amount you have on your body,” he says. “Even if you see a photo of someone’s that you like, that may not be a realistic outcome for you.”
Lastly, you and your doctor should thoroughly assess your surgical candidacy. “A patient must be a healthy individual and someone who has evaluated the procedure,” says Dr. Lorenc. “It’s also important that they are someone who will benefit from the surgery.”
There’s some gray area when it comes to this method because fillers are technically only FDA-approved for other uses. Dr. Bruno, for one, advises against injecting anything but fat into your backside because the product isn’t specifically approved for buttock augmentation.
That said, many experts, including Dr. Ourian, still use fillers off-label. “I will recommend fillers when it’s the appropriate option for a certain patient,” he says, explaining that that doesn't mean it's an option for every patient. Sculptra, his filler of choice, is commonly used to restore the loss of facial volume by stimulating collagen, so some physicians, like him, repurpose the product for butt injections. “Sculptra, which contains a substance called poly-L-lactic acid, is the only one I recommend," Dr. Ourian says. "It’s important to note that while Sculptra is FDA-approved, its use for butt augmentation is considered off-label.”
Dr. Lorenc agrees that it's an option, but that the technique has other challenges: “Theoretically, using fillers has been done [for butt augmentation], but the problem is it requires at least 300 syringes, so it would be truly expensive,” he explains.
Your best bet is to research all the options, including the costs, benefits, and risks of each one, to figure out what you feel comfortable doing. It is not a bad idea to do multiple consultations with reputable doctors to get a variety of opinions.
Using a filler like Sculptra is fairly straightforward: The area is numbed using a local anesthetic, and the process takes 15-30 minutes, although you’ll likely require additional treatments depending on the desired outcome. Fat transfers and implants, however, are understandably more complex. “A fat transfer is done under general anesthesia,” says Dr. Bruno. “The method involves liposuction to remove fat from a few areas of the body — for example, your abdomen, love handles, or thighs — and re-injecting that same fat into the hips and buttock. It takes between two to three hours and is done on an outpatient basis, meaning you go home the same day.”
Implants also require general anesthesia, although you’re normally allowed to go home that day as well. Depending on an individual’s needs, doctors decide on the shape and size of implants, which are typically made of a soft yet solid piece of silicone. “The implants, one in each butt cheek, are inserted through an incision at the upper end of the buttock cleft, either above or below the muscle, depending on the size and placement of the implant,” says Dr. Ourian. “The surgery takes about three hours.” According to Dr. Lorenc, the vertical incision heals well, so scars are usually not an issue.
The cost for each procedure, which normally includes anesthesia and facility fees, varies by region and doctor. “All of them range from $8,000 to $20,000, depending on the technique used and the amount of augmentation required,” says Dr. Shah. “Fillers are even more expensive due to the high cost of the substance required.” At Dr. Ourian’s office, for example, injections can range from $15,000 to $40,000, while fat transfers and implants start at $10,000. Meanwhile, Dr. Lorenc places the latter procedures in the range of $5,500 to $7,500.
Fair warning: Depending on whom you ask, rumor has it that even giving birth doesn’t compare to the agony of butt-implant augmentations (ouch). “It’s definitely more painful than a transfer because we are moving muscle,” says Dr. Lorenc. Dr. Ourian agrees, adding, “Butt augmentation with implants can be significantly painful and is considered one of the most painful plastic surgeries.” And remember — early on, it will be uncomfortable to walk, bend, and move around, so you may need help with some basic everyday tasks.
While all procedures come with side effects, some are worse than others. Even fillers might cause possible bruising and swelling at the injection site, as well as the development of small, non-visible bumps under the skin.
Fat transfers and implants are surgical procedures, so both can trigger adverse reactions to anesthesia, infection, and excessive bleeding. According to Dr. Bruno, the former’s potential side effects include: fatty necrosis (hard areas of fat that do not survive the transfer), fat emboli (fat injected into a blood vessel), and contour irregularities (uneven skin in areas where the fat was harvested).
To make things even more complicated, “implants can also be ‘rejected’ by the body,” explains Dr. Shah. This procedure comes with the highest incidence of complications, including swelling, scarring, numbness, and the risk of displacement or rupture. Adds Dr. Bruno, “Gluteal implants can change position or develop hard scar tissue. Even the incision used to insert them can develop wound-healing problems.”
Doctors are generally more relaxed when asked about allergic reactions to any of these procedures. “Silicone is an inert substance, so it’s almost unheard of to have an allergic reaction,” says Dr. Lorenc. “A patient can be allergic to pain medication, but this has nothing to do with the actual surgery.” In the rare instance that an allergy happens, your doctor will likely prescribe an antihistamine or other counteractive medication to control the reaction. If you have a reaction to the implant itself, you will likely need to have the implant removed. That, as you may expect, can cause disfigurement and a variety of other issues.
All of these side effects are uncommon. However, when considering any procedure, you should ask your doctor about the risk of each one, and also ask how each one is managed, to make an informed decision and to get a clear picture of what will happen if something does, unfortunately, go wrong.
While the use of fillers means you can walk out the door almost immediately, Dr. Ourian says that the other procedures take you out of commission for some time. “You’re up to two weeks out of work and four weeks until resumption of normal activities,” he explains. “If you opted for implants, you’re not allowed to sit on your butt for a couple of weeks.” In fact, it may take six to eight months until the implants feel normal.
“Recovery time depends more on positioning after and avoiding pressure on the area,” says Dr. Lorenc. “Ambulation is right away. When sleeping, you have to lie on your stomach for one to two weeks with an implant so as to not displace it.”
The same goes for a fat transfer, but for a different reason. “It's important to avoid direct sitting for a few weeks after surgery to allow the fat cells an opportunity to survive,” says Dr. Bruno. “Most patients take off about one week from work to recover.”
While fillers provide the benefit of minimal recovery time, they’re also the most temporary method, lasting anywhere from a few months to up to two years. (If Sculptra is used, the product is eventually absorbed by your body.) The results are often more subtle than statement-making.
On the other hand, fat transfers provide immediate results, but tend to shrink over the years. “This option is very technique-dependent, and patients can expect a 30% or more loss of volume within the first year,” says Dr. Ourian. According to Dr. Bruno, this means that “the amount of fat that survives, usually around 60-70%, is permanent.” Though your newly augmented rear end should feel like perfectly natural, normal tissue once it’s healed, the area may change in appearance as you age. “Fat transfers last for years, but will gain and lose weight just like the rest of the fat on your body,” says Dr. Shah.
Of all three procedures, implants are the most permanent unless removed in a second surgery. Because they’re made of a more cohesive gel, the silicone tends to remain the same size and stay put, though they boast a higher incidence of problems. “As with breast implants, they should be replaced approximately every ten years,” advises Dr. Ourian. The results typically look natural, though they feel a little firm to the touch. “I usually tell patients it feels like a soft eraser head on a pencil,” explains Dr. Lorenc. As with fat transfers, Dr. Shah says that implants can take on a different look over the years, sagging with time and the effects of gravity.
“You can have more fat injected to enhance your volume, or if you are not happy with the implants, you can change their size or have them removed,” says Dr. Bruno.
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