Beyond The Brazilian Butt Lift: How Fat Became A Very Creative Surgical Tool

What hath Kim Kardashian wrought?

Last week the American Society of Plastic Surgeons (ASPS) announced that butt augmentation surgery is up 16%. Butt wait, there's more: The smaller American Society for Aesthetic Plastic Surgery (ASAPS) outdid their colleagues by calling it 44% growth. Whichever group is right, one thing is clear: We, as a people, would like our rears rounded. The Brazilian Butt Lift has never been more popular.

What the numbers dont tell you, however, is that what's driving real change in the cosmetic surgery landscape is not our collective desire for big bottoms, as Spinal Tap famously sang about, but something many of us are already far too familiar with: fat. As science allows doctors to use fat in new ways, they are flexing their creativity and employing fat to enhance areas that they might otherwise treat with implants, dermal fillers, and injectables with brands names such as Juvederms Voluma and Restylane.

Weve taken away the need to go to a foreign substance, and were injecting fat. Its a change in how were thinking, says Dr. Robert X. Murphy, president of the American Society of Plastic Surgeons.

While fat, specifically too much of it, has most typically been a problem consumers have sought to address with cosmetic surgery procedures such as liposuction, laser fat removal, and the freezing of fat through minimally invasive alternatives like CoolSculpting, more and more doctors are starting to view the stubborn substance differently. Instead being part of the problem, fat is becoming part of a solution. Though its true that newer fat grafting procedures such as the Brazilian Butt Lift account for only a fraction of the 15.1 million minimally invasive and surgical cosmetic procedures performed in 2013, according to ASPS data, with just 10,000 instances of butt augmentation reported last year, fat grafting is an increasingly hot topic in an industry that continues to grow. As for just how much its growing, thats up for debate, with estimates ranging from 3% to 6.5% last year, according to the ASPS and ASAPS, respectively. Still, doctors are changing their minds about fat and its role in the wider cosmetic and aesthetic surgery landscape.

All of fat grafting has gotten more interesting, says Dr. Jason Pozner, a Boca Raton-based surgeon. Instead of doing just liposuction, we ask the patients if they would like us to recycle the fat. Its become more the routine consultation. I think this is a paradigm shift.

Yes, its a kind of cosmetic surgery upsell, but theres another reason that more doctors are offering patients the option to re-use fat taken from one part of their body to enhance another during routine consultations. Fat, it turns out, may be the perfect candidate for the job of plumping up what goes south, one capable of benefits that injectables--a category that ranges from collagen to poly-L-lactic acid (PLLA) and hyaluronic acid--are less likely to achieve.

An ideal substance would be readily available, inexpensive, long-lasting, natural-feeling, and would not cause adverse immunologic reactions, writes Dr. Thomas J. Gampper, vice chairman of the Department of Plastic Surgery at University of Virginia School of Medicine.

Fat, he concludes, has the potential to hit all of those marks, though, for the moment at least, its not necessarily a less expensive option because of the labor involved in removing it, processing it, and injecting it back into the body. (One doctor estimates that a typical procedure involving fat costs between $2,000 and $6,000 depending on the area injected, with additional costs for services such as anesthesia.) That said, doctors have access to better methods for saving and re-appropriating fat today than they did a decade ago, whether its for lip plumping at the time of a lipsuction procedure or a breast enhancement down the road.

The fat transplantation is changing, says Dr. Barry Weintraub, a plastic surgeon with practices in Manhattan and in the Hamptons. Fat can now be cryogenically frozen. When I do a liposuction on someone, I can use that fat not only in that setting, but it can be called for at a later time with no diminution.

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Beyond The Brazilian Butt Lift: How Fat Became A Very Creative Surgical Tool