Buttock Fat Transfer

  • Eric Swanson


Buttock appearance is undeniably important to human attraction. A low (0.70) waist-to-hip ratio in women is regarded as ideal. Today, the Brazilian Butt Lift is one of the most requested cosmetic surgical procedures, even though it is a misnomer.

Buttock implants were popularized over a decade ago. However, despite greater experience with this technique, problems persisted, including infection, seroma, wound dehiscence, and implant malposition, causing an unnatural and often asymmetric buttock appearance.

Liposuction is an extremely popular cosmetic operation. Rather than discarding the aspirated fat, it may be transferred, reducing the role for thermal methods that destroy fat cells. The buttock is a suitable recipient site because it expands easily. Large syringes and cannulae have reduced the operating time. Centrifugation is unnecessary.

A study using ultrasound to measure fat thickness found that the calculated fat retention is about 66%. Local complications such as infection, seromas, or oily cysts are rare.

Overaggressive liposuction can produce contour deformities at the fat donor sites, and these problems are best avoided. Patients may benefit from a subsequent touchup fat injection procedure to achieve more volume.

Flap transposition, sometimes done at the time of a body lift, provides no net increase in buttock volume but adds to the operating time and blood loss. Fat injection is a simpler option and can provide lateral gluteal augmentation.

The most serious complication of buttock fat injection is fat embolism, which is often immediately fatal. This problem is caused by deep penetration of the cannula, with trauma to the gluteal veins. Surgeons may reduce the risk by injecting tangentially to the muscle, staying within the subcutaneous plane. The author does not use an incision in the gluteal fold and prefers side-to-side positioning in surgery.


Buttock Fat Transfer Injection Brazilian Gluteal Implant Ultrasound Embolism 


  1. 1.
    Heidekrueger PI, et al. The ideal buttock Size: a sociodemographic morphometric evaluation. Plast Reconstr Surg. 2017;140:20e.CrossRefPubMedGoogle Scholar
  2. 2.
    Wong WW, Motakef S, Lin Y, Gupta SC. Redefining the ideal buttocks: a population analysis. Plast Reconstr Surg. 2016;137:1739–47.CrossRefPubMedGoogle Scholar
  3. 3.
  4. 4.
    Mendieta CG. Gluteoplasty. Aesthet Surg J. 2003;23:441–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Swanson E. Buttock augmentation with silicone implants: a multicenter survey review of 2226 patients. Plast Reconstr Surg. 2013;132:681e–3e.CrossRefPubMedGoogle Scholar
  6. 6.
    Swanson E. Prospective controlled study of buttock fat transfer using ultrasound and photographic measurements. Plast Reconstr Surg Glob Open. 2016;4:e697.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cárdenas-Camarena L, Bayter JE, Aguirre-Serrano H, Cuenca-Pardo J. Deaths caused by gluteal lipoinjection: what are we doing wrong? Plast Reconstr Surg. 2015;136:58–66.CrossRefPubMedGoogle Scholar
  8. 8.
    Mofid MM, Teitelbaum S, Duissa D, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthet Surg J. 2017;37:796–806.CrossRefPubMedGoogle Scholar
  9. 9.
    Mendieta CG. Classification system for gluteal evaluation. Clin Plast Surg. 2006;33:335.Google Scholar
  10. 10.
    Centeno RF, Mendieta CG, Young L. Gluteal contouring in the massive weight loss patient. Clin Plast Surg. 2008;35:73–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Garibyan L, Sipprell WH III, Jalian HR, Sakamoto FH, Avram M, Anderson RR. Three-dimensional volumetric quantification of fat loss following cryolipolysis. Lasers Surg Med. 2014;46:75–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg. 2009;33:482–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Raposo-Amaral CE, Ferreira DM, Warren SM, Magna LA, Ferreira LM. Quantifying augmentation gluteoplasty outcomes: a comparison of three instruments used to measure gluteal projection. Aesthetic Plast Surg. 2008;32:333–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Swanson E. Photographic measurements in 301 cases of liposuction and abdominoplasty reveal fat reduction without redistribution. Plast Reconstr Surg. 2012;130:311e–22e. discussion 323e–324e.CrossRefPubMedGoogle Scholar
  15. 15.
    Cárdenas-Camarena L, Arenas-Quintana R, Robles-Cervantes J-A. Buttocks fat grafting: 14 years of evolution and experience. Plast Reconstr Surg. 2011;128:545–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Swanson E. Prospective study of lidocaine, bupivacaine and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012;130:702–22. discussion 723–725.CrossRefPubMedGoogle Scholar
  17. 17.
    Rohrich RJ, Morales DE, Krueger JE, et al. Comparative lipoplasty analysis of in vivo-treated adipose tissue. Plast Reconstr Surg. 2000;105:2152–8. discussion 2159–2160.CrossRefPubMedGoogle Scholar
  18. 18.
    Ramirez-Montanana A. Buttocks: safety guidelines for fat injection. Paper presented at American Society for Aesthetic Plastic Surgery Cruise Meeting; July 22, 2017.Google Scholar
  19. 19.
    Swanson E. Avoiding fat emboli. Paper resented at: ASPS Aesthetica Symposium; March 2–4, 2017; New Orleans, LA.Google Scholar
  20. 20.
    Wolf GA, Gallego S, Patrón AS, et al. Magnetic resonance imaging assessment of gluteal fat grafts. Aesthetic Plast Surg. 2006;30:460–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Rosique RG, Rosique MJF, De Moraes CG. Gluteoplasty with autologous fat tissue: experience with 106 consecutive cases. Plast Reconstr Surg. 2015;135:1381–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Abboud MH, Dibo SA, Abboud NM. Power-assisted gluteal augmentation: a new technique for sculpting, harvesting, and transferring fat. Aesthet Surg J. 2015;35:987–94.CrossRefPubMedGoogle Scholar
  23. 23.
    Roberts TL III, Toledo LS, Badin AZ. Augmentation of the buttocks by micro fat grafting. Aesthet Surg J. 2001;21:311–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Murillo WL. Buttock augmentation: case studies of fat injection monitored by magnetic resonance imaging. Plast Reconstr Surg. 2004;114:1606–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Restrepo JCC, Ahmed JAM. Large-volume lipoinjection for gluteal augmentation. Aesthet Surg J. 2002;22:33–8.CrossRefGoogle Scholar
  26. 26.
    Guerrerosantos J, Gonzalez-Mendoza A, Masmela Y, Gonzalez MA, Deos M, Diaz P. Long-term survival of free fat grafts in muscle: an experimental study in rats. Aesthetic Plast Surg. 1996;20:403–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Carpaneda CA, Ribeiro MT. Study of the histologic alterations and viability of the adipose graft in humans. Aesthetic Plast Surg. 1993;17:43–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Carpaneda CA, Ribeiro MT. Percentage of graft viability versus injected volume in adipose autotransplants. Aesthetic Plast Surg. 1994;18:17–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Lee JH, Kirkham JC, McCormack MC, Nicholls AM, Randolph MA, Austen WG Jr. The effect of pressure and shear on autologous fat grafting. Plast Reconstr Surg. 2013;131:1125–36. discussion 1137–1138.CrossRefPubMedGoogle Scholar
  30. 30.
    Ozsoy Z, Kul Z, Bilir A. The role of cannula diameter in improved adipocyte viability: a quantitative analysis. Aesthet Surg J. 2006;26:287–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Erdim M, Tezel E, Numanoglu A, Sav A. The effects of the size of liposuction cannula on adipocyte survival and the optimum temperature for fat graft storage: an experimental study. J Plast Reconstr Aesthet Surg. 2009;62:1210–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Fiaschetti V, Pistolese CA, Fornari M, et al. Magnetic resonance imaging and ultrasound evaluation after breast autologous fat grafting combined with platelet-rich plasma. Plast Reconstr Surg. 2013;132:498e–509e.CrossRefPubMedGoogle Scholar
  33. 33.
    Smith P, Adams WP Jr, Lipschitz AH, et al. Autologous human fat grafting: effect of harvesting and preparation techniques on adipocyte graft survival. Plast Reconstr Surg. 2006;117:1836–44.CrossRefPubMedGoogle Scholar
  34. 34.
    Charles-de-Sá L, Gontijo de Amorim NF, Dantas D, et al. Influence of negative pressure on the viability of adipocytes and mesenchymal stem cell, considering the device method used to harvest fat tissue. Aesthet Surg J. 2015;35:334–44.CrossRefPubMedGoogle Scholar
  35. 35.
    Kim IH, Yang JD, Lee DG, Chung HY, Cho BC. Evaluation of centrifugation technique and effect of epinephrine on fat cell viability in autologous fat injection. Aesthet Surg J. 2009;28:35–9.CrossRefGoogle Scholar
  36. 36.
    Gerth DJ, King B, Rabach L, Glasgold RA, Glasgold MJ. Long-term volumetric retention of autologous fat grafting processed with closed-membrane filtration. Aesthet Surg J. 2014;34:985–94.CrossRefPubMedGoogle Scholar
  37. 37.
    Fisher C, Grahovac TL, Schafer ME, Shippert RD, Marra KG, Rubin JP. Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg. 2013;132:351–61.CrossRefPubMedGoogle Scholar
  38. 38.
    Del Vecchio DA, Del Vecchio SJ. The graft-to-capacity ratio: volumetric planning in large-volume fat transplantation. Plast Reconstr Surg. 2014;133:561–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Hörl H, Feller A, Biemer E. Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann Plast Surg. 1991;26:248–58.CrossRefPubMedGoogle Scholar
  40. 40.
    Swanson E. Malar augmentation assessed by magnetic resonance imaging in patients after facelift and fat injection. Plast Reconstr Surg. 2011;127:2057–65.CrossRefPubMedGoogle Scholar
  41. 41.
    Khouri RK Jr, Khouri RK. Percentage augmentation: the more meaningful index of success in fat grafting. Plast Reconstr Surg. 2015;135:933e–5e.CrossRefPubMedGoogle Scholar
  42. 42.
    Moscatiello F, Aznar-Benitah S, Grella R, Jover JH. Gluteal augmentation with cryopreserved fat. Aesthet Surg J. 2010;30:211–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Everett M, Morales R, Newall G, et al. Safest practices for autologous buttock augmentation with fat grafting using a roller pump injection technique. Aesthet Surg J. 2017.
  44. 44.
    Treatments. web site: Accessed September 9, 2017.
  45. 45.
    Chajchir A, Benzaquen I. Fat-grafting injection for soft-tissue augmentation. Plast Reconstr Surg. 1989;84:921–34. discussion 935.CrossRefPubMedGoogle Scholar
  46. 46.
    Matsudo PKR, Toledo LS. Experience of injected fat grafting. Aesthetic Plast Surg. 1988;12:35–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Gonzalez R. It’s all about that bass. Presented at the American Society for Aesthetic Plastic Surgery Cruise Meeting, July 25, 2017.Google Scholar
  48. 48.
    Mofid MM, Gonzalez R, de la Peña JA, Mendieta CG, Senderoff DM, Jorjani S. Buttock augmentation with silicone implants: a multicenter survey review of 2226 patients. Plast Reconstr Surg. 2013;131:897–901.CrossRefPubMedGoogle Scholar
  49. 49.
    Senderoff DM. Buttock augmentation with solid silicone implants. Aesthet Surg J. 2011;31:320–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Mendietta CG. Why I stopped using buttock implants. Presented at Aston Baker Cutting Edge Symposium; November 30–December 2, 2017; New York City.Google Scholar
  51. 51.
    Centeno R. Dueling perspectives: thighplasty. Presented at ASPS Breast and Body Contouring Symposium; August 10–12, 2017; San Diego, CA.Google Scholar
  52. 52.
    Senderoff DM. Revision buttock implantation: indications, procedures, and recommendations. Plast Reconstr Surg. 2017;139:327–35.CrossRefPubMedGoogle Scholar
  53. 53.
    Daniel MJB, Junior IM. What is the durability of gluteal prostheses? Qual a durabilidade da prótese glútea? Rev Bras Cir Plast. 2012;27:93–6.CrossRefGoogle Scholar
  54. 54.
    Sinno S, Chang JB, Brownstone ND, Saadeh PB, Wall S Jr. Determining the safety and efficacy of gluteal augmentation: a systematic review of outcomes and complications. Plast Reconstr Surg. 2016;137:1151–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Hunstad JP, Repta R. Purse-string gluteoplasty. Plast Reconstr Surg. 2009;123:123e–5e.CrossRefPubMedGoogle Scholar
  56. 56.
    Srivastava U, Rubin JP, Gusenoff JA. Lower body lift after massive weight loss: autoaugmentation versus no augmentation. Plast Reconstr Surg. 2015;135:762–72.CrossRefPubMedGoogle Scholar
  57. 57.
    Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier E. The lipo-bodylift: a new circumferential body-contouring technique useful after bariatric surgery. Plast Reconstr Surg. 2017;139:38e–49e.CrossRefPubMedGoogle Scholar
  58. 58.
    Bertheuil N, Carloni R, Herlin C, Chaput B, Watier E. Lower body lift after massive weight loss: autoaugmentation versus no augmentation. Plast Reconstr Surg. 2016;137:476e–7e.CrossRefPubMedGoogle Scholar
  59. 59.
    Sozer SO, Agullo FJ, Palladino H. Split gluteal muscle flap for autoprosthesis buttock augmentation. Plast Reconstr Surg. 2012;129:766–76.CrossRefPubMedGoogle Scholar
  60. 60.
    Swanson E. A retrospective photometric study of 82 published reports of mastopexy and breast reduction. Plast Reconstr Surg. 2011;128:1282–301.CrossRefPubMedGoogle Scholar
  61. 61.
    Swanson E. The Ruth Graf technique: measurements do not support the efficacy of an inferior pedicle and pectoralis muscle loop in mammaplasty. Plast Reconstr Surg. 2013;132:168e–70e.CrossRefPubMedGoogle Scholar
  62. 62.
    Condé-Green A, Kotamarti V, Nini K, et al. Fat grafting for gluteal augmentation: a systematic review of the literature and meta-analysis. Plast Reconstr Surg. 2016;138:437e–46e.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

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