about the buttocks liposculpture procedure
Some women may have fullness of the buttocks, which they may (or may not) consider disproportionate to the rest of their body. Liposculpture of the buttocks can reduce the volume of the buttocks and bring them into proportion with the remainder of the body. This may make it possible to wear a greater variety of clothes “off the rack” and therefore fit into standard sizes.
A procedure called “Brazilian Butt Lift” (“BBL”) has been popularised by certain celebrities. This involves injecting fat into the buttocks (gluteal augmentation) that has been removed from other parts of the body.
Liposculpture of the hips and outer thighs may be the preferred option for some individuals to change the periphery (outside shape) of the body. That means removing fat with liposculpture and not injecting fat into the gluteal (buttocks) region. Dr Heckenberg does not perform gluteal augmentation.
Using the tumescent local anaesthetic technique and microcannulas, buttocks liposuction can reduce the size and shape of the buttocks. Microcannulas are considered less than 3mm in diameter and at Be Sculptured, only 2mm and 3mm cannulas are used for all procedures. This allows for smoother results. Extra time may be required to remove fat with microcannulas but more finesse and precision is achievable this way with this type of liposuction procedure.
The goal of buttocks liposuction is to achieve uniformly smooth results with a pleasing reduction in size and bulk. Excessive buttocks liposuction should be avoided in order to produce a natural, well-proportioned result and reduced sagginess of the skin of the buttock. Liposuction cannot be expected to lift or elevate the buttocks. The skilled liposculpture proceduralist can remove fat uniformly throughout the volume of the buttocks and thereby reduce the weight of the buttocks. Too much liposuction will leave an unacceptable degree of ptosis and residual skin irregularities. The banana-roll fat pad is located under the buttock on the upper posterior thigh. It’s important not to remove too much fat here and this will produce a redundant or double gluteal horizontal crease with excessive liposuction.
Statement on Patient Safety During Gluteal Fat Grafting from the American Society of Plastic Surgeons (ASPS), The Plastic Surgery Foundation (PSF), The Aesthetic Society, and the Aesthetic Surgery Education and Research Foundation (ASERF) are available here as a Joint Safety Statement.
In 2018 and 2019, two multi-society safety advisories raised awareness of the risks associated with gluteal fat grafting and called on ASPS members and the public to approach the procedure with extreme caution. Following those advisories, the Florida Board of Medicine mandated new standards of care for gluteal fat grafting that sought to reduce patient harm by requiring that fat be injected only into the subcutaneous space, above the gluteal fascia.
The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review and Recommendations are available here:
The BBL had been cited as having the highest rate of death for any aesthetic procedure. This is because the fat has been inadvertently injected into the buttocks muscles themselves (instead of the subcutaneous superficial tissue layer) and the large veins in these areas siphon the fat globules into the lungs and ultimately the heart, potentially causing instant death. As many as one in 3,000 patients had been reported dying as a result of the BBL surgery, but in 2020, that figure has been reduced to 1 in 14,952 due to significant improvements in the procedure by subcutaneous fat grafting only, avoiding muscular injections, the use of thicker cannulas >4mm in diameter, and avoidance of downward direction of the cannula.
Recommendations in improvements of the BBL are reported in an international peer reviewed medical journal. This is made available to you and may be accessed below.
Rios, L. A., & Gupta, V. (2020). Improvement in Brazilian Butt Lift (BBL) Safety with the Current Recommendations from ASERF, ASAPS, and ISAPS. Aesthetic Surgery Journal, 40(8), 864–870.
Frequently asked questions
Liposculpture is a refinement in the technique of liposuction. Firstly, liposculpture is performed under local anaesthetic which makes it easier to achieve a regular, more even result, by assessing the patient at a later stage of the procedure. This is because it is possible to move into different positions and to stand up toward the end of the procedure which allows the effect of gravity to be seen on the areas that had liposculpture. This enables a much more predictable result to be achieved as more liposculpture is done to refine the areas and try to establish symmetry.
Secondly, as no general anaesthetic is needed for liposculpture, the inherent risks associated with a general anaesthetic are avoided.
Thirdly, liposculpture involves the injection of fluid into the fatty tissues before the procedure is performed. This fluid contains the local anaesthetic (lignocaine) and also a medication which effectively constricts blood vessels (adrenaline). Adrenaline vastly decreases the amount of bruising that occurs with liposculpture while the local anaesthetic produces effective relief of discomfort during the procedure and for up to 12 hours afterwards (and longer).
Fourthly, liposculpture is day surgery. There is usually no need for the person having liposculpture to stay overnight in hospital or to have blood transfusions. You are encouraged to remain active following the procedure, walking soon after, and often returning to work after a few days to a week. Time off work and normal or vigorous activities is usually kept to a minimum. A week off work is advisable for most individuals.
Liposculpture takes time to achieve the desired outcomes. The average procedure lasts 4 hours, especially when liposculpture of a few areas is performed. Smaller areas may only take up to 2 hours to do. In contrast, liposuction performed under general anaesthesia must be done in a shorter time as longer anaesthetic time increases anaesthetic risks. The recovery period is usually shorter with usually less bruising and less discomfort. However, due to different procedures, different patients will heal differently, and have different pain thresholds and will therefore experience different recovery times for different activities. The subcutaneous fatty tissue is thoroughly anaesthetised (numbed) and vasoconstricted when using the tumescent local anaesthetic technique and this generally contributes to a reduction of pain after the procedure. Liposculpture is performed by many doctors from many specialties.
Dr Heckenberg is specifically trained in liposculpture. She is dedicated and will take the necessary time to strive for the desired results and performs only liposculpture and no other cosmetic surgery procedures. It is important to have these procedures performed by doctors who do the same procedures often, as with any surgery. Allowing enough time, using microcannulas and having patience are the most important factors when performing liposculpture.
Risks associated with liposculpture are reported in international peer reviewed medical journals. These are made available to you and may be accessed below:
Boeni, R., & Waechter-Gniadek, P. V. (2021). Safety of Tumescent Liposuction Under Local Anesthesia in 9,002 Consecutive Patients. Dermatologic Surgery, 47(5), e184–e187.
This recent 2021 study comprising of 9,000 cases, also concluded that liposuction using the tumescent local anaesthetic technique “is a reliable and safe procedure if it is performed by an experienced surgeon and the guidelines of care are strictly followed”.
Dixit, V., & Wagh, M. S. (2013b). Unfavourable outcomes of liposuction and their management. Indian Journal of Plastic Surgery, 46(2),377.
This detailed 2013 article compiles unfavourable outcomes, possible risk factors and their management associated liposuction and the importance of appropriate training in this procedure.
Hanke, C. W., Bernstein, G. S., & Bullock, S. (1995b). Safety of Tumescent Liposuction in 15,336 Patients. Dermatologic Surgery, 21(5), 459–462.
A landmark article in the prestigious Dermatographic Surgery Journal reported the survey results of over 15,000 cases of liposculpture performed in America between 1994 and 1995. Authors concluded that complications during the procedure were few, as were problems following the procedure, and the level of complications was much less. Bruising is minimal, but does occur in most cases. It usually lasts for 10 to 14 days. Infections may occur with any surgery, but are fortunately quite rare and antibiotics are given before and after the procedure. Local areas of numbness may occur, although these usually resolve within a few months but may take up to a year.
At Be Sculptured, Dr Heckenberg is trained specifically in liposculpture and she has a medical fellowship from The Australasian College of Cosmetic Surgery and Medicine (ACCSM) and a Lipoplasty Fellowship. Dr Heckenberg is dedicated to the procedure of liposculpture. It is the only cosmetic procedure she performs. Performing the same procedure often is necessary to acquire appropriate skills for any procedure. Dr Heckenberg has Specialist Registration in General Practice after gaining her Fellowship in 1997 (FRACGP) and a Diploma in Obstetrics and Gynaecology in 1996 (DRANZCOG) and has been performing contraceptive and reproductive out-patient gynaecological procedures since 1998. Her medical registration number is MED0001158434.
Liposculpture is a body changing tool. Liposculpture is performed using Dr Klein’s “tumescent local anaesthetic” with micro-cannulas. The administration of the tumescent local anaesthetic makes it possible for the patient to stand up at the later stage of the procedure, allowing the effect of gravity to be visualised. Patients are also able to move themselves into the appropriate positions to adequately remove the fat from specific areas to change the body shape. It is this ability to visualise the patient’s body that provide a more predictable/favourable results.
As no general anaesthetic is needed, risks associated with a general anaesthetic are avoided. Sedation has its risks, such as excessive drowsiness, or inadvertent and unexpected deeper levels of sedation, but recommended dosing and monitoring during the procedure reduces these risks.
Liposculpture involves the injection of fluid into the fatty tissues before the procedure is performed. This saline solution contains the local anaesthetic drug (lignocaine) and also a medication which constricts blood vessels (adrenaline). Adrenaline decreases the amount of bleeding and bruising while the local anaesthetic reduces discomfort during the procedure and for up to 12 hours afterwards. These effects may last longer in some individuals.
Liposculpture is performed as a day procedure. There is rarely a need for the person having liposculpture to stay overnight in hospital, or to have blood transfusions. A half to ¾ of a day is required to perform the procedure and to stay in the hospital recovery. You are encouraged to remain active following the procedure, gentle walking soon after, and often returning to work after 1 week or possibly after a few days. Time off work and normal activities is usually kept to a minimum. More vigorous exercise may be resumed 3- 4 weeks after the procedure.
Liposculpture takes time. Taking the time to do the procedure is paramount. Small calibre cannulas (micro-cannulas) are used. The average procedure takes 2-4 hours. Liposculpture of the abdomen and waist takes approximately 4 hours.
Special lycra bodysuit compressive garments are used for about two weeks after the procedure. Double suits for the first week and a single suit for the second week.
Please take note
Liposculpture isn’t suitable for everyone. Only patients with a Body Mass Index of under 35 will be considered but only after they have been properly assessed during the consultation. Your BMI can be checked using the following online calculator:
Smoking increases the level of carbon monoxide in the blood, which deprives tissues of oxygen. Blood supply is a major concern during any surgical procedure. Combining smoking and cosmetic surgery can categorically result in increased pain, loss of skin, infections, death of tissue or fat cells, delayed healing, thick scarring, permanent vessel damage, or blood clots. Smokers should cease smoking 6 weeks prior to the procedure or consider to not have the procedure at all.
Patients with body dysmorphia disorder (BDD) are inappropriate for liposuction / liposculpture or any type of cosmetic surgery or procedure. Body dysmorphic disorder (BDD) is a mental illness. People who have this illness constantly worry about the way they look. They may believe an inconspicuous or non-existent physical attribute is a serious defect. They respond to this by performing repetitive acts such as mirror checking or comparing their appearance with others. The severity of BDD varies. For example, some people know their feelings and / or perceptions aren’t rational or justified, while others are almost delusional in their conviction. BDD causes severe emotional distress. It is not just vanity and is not something a person can just ‘forget about’ or ‘get over’.
The preoccupation of their appearances can be so extreme that the affected person has trouble functioning at work, school or in social situations. People who suffer from BDD can target any part of the body. They may seek out numerous cosmetic procedures to try to “fix” their perceived flaw. Afterward, they may feel temporary satisfaction or a reduction in their distress, but often the anxiety returns and the search for other flaws may resume, along with ways to “fix” them. Treatment of BDD may include cognitive behavioural therapy and medication after an assessment by a Psychiatrist.