Fast Company

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

Long considered a catalyst for elective cosmetic surgery, fat is fast becoming the go-to gunk for innovation, market growth, and more natural results in one of medicine’s most controversial realms, plastic surgery. Could this trend reach past simple nips and tucks?

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 don’t 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 Juvederm’s Voluma and Restylane.

“We’ve taken away the need to go to a foreign substance, and we’re injecting fat. It’s a change in how we’re 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 it’s 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 it’s growing, that’s 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. It’s become more the routine consultation. I think this is a paradigm shift.”

Yes, it’s a kind of cosmetic surgery upsell, but there’s 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, it’s 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 it’s 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.”

“It used to create some microcalcifications that were difficult to discern from cancer and, due to changes in technology and better trained mammographers, they’re able to tell the difference,” says Pozner.

Once it’s reintroduced to the body, just how long the results of grafted fat actually last has been a hotly debated topic, but recent research suggests that enhancing fat with stem cells before its transfer back into the body could prolong its effects while allowing enhancement of larger areas such as the breasts and butt.

At the same time, the discovery last year that fat contains stems cells capable of producing many different types of cellular tissues has further amped up the noise. Could something as seemingly self-serving as liposuction actually contribute to the creation of tissues and organs for use in a diverse array of medical situations? Stay tuned.

It’s important to pause here and note that fat grafting, which is the practice of using fat harvested from one source to enhance another part of the body, is hardly a new concept. There’s evidence of doctors using it as far back as the 1890s, and it has been central to numerous research studies over the last decade that have found it to be a safe treatment for adding volume to breasts and other body parts. Nor is it, for all the interest, a perfect solution--at least not yet.

It relies on a naturally occurring substance, yes. But transferring it from place to place is more labor-intensive and, often, more costly than equivalent procedures that rely on pre-packaged fillers. Who performs the surgery is also a factor, whether you’re talking lasers that eliminate fat or procedures that transfer it from one place to another.

“There’s almost been a circumventing of the physician and aesthetician providing the care and assuming that the machine just walks into the room and does the procedure. You’ve got to have a doctor that knows how to use it, and you’ve got to have the right technology for the patient, and then you’ve got to apply it appropriately,” says ASAPS president Dr. Jack Fisher.

But as medical techniques used to remove fat, preserve it and re-introduce it into the body become more widely studied, understood, and practiced, the idea of opting for fat instead of implants and fillers is gaining traction.

Along with data reported by board certified plastic surgeons to the ASPS and the ASAPS, interest is up among potential patients, reports RealSelf, a kind of Yelp for cosmetic surgery-seekers. January marked the fourth consecutive month of growth in visitor traffic specifically seeking out information on the Brazilian Butt Lift.

As ironic as it probably sounds, the interest may have everything to do with natural beauty. There’s something seductive about the possibility of boosting sagging cheeks (both kinds), lips, and breasts with a substance that’s already present in the body, especially one that has an authentically human texture and the potential to last longer than alternatives.

“What we see over and over again, " notes RealSelf founder Tom Seery, "is people saying, ‘I want natural looking results, so when I go to a cocktail party or a coffee shop to see a friend, they say, ‘You seem rested.’”

[Fat Image: PeJo via Shutterstock]

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