Join Plastic Surgery Practice Co-Chief Editors Alison Werner and Keri Stephens as they talk to Alexander Zuriarrain, MD, FACS—a board-certified plastic surgeon and owner of Zuri Plastic Surgery in Miami—about the rise of Brazilian Butt Lift (BBL) reversals. The podcast, which follows Zuriarrain’s PSP article about the subject, reveals why most surgeons shy away from the procedure and whether the BBL era is truly over like one article recently claimed.
Podcast Transcript
Keri Stephens:
Hello, my name is Keri Stephens, and I’m joined today by my co-host Alison Werner. We are the co-chief editors of Plastic Surgery Practice. Thank you for joining us for today’s podcast. Today we are joined by Dr. Alex Zuriarrain to discuss the rise of Brazilian butt lift reversals. It’s a topic he recently covered in an article for PSP. Dr. Zuriarrain is the founder of Zuri Plastic Surgery in Miami, where he specializes in aesthetic procedures of the face and body, including the facelift, eyelid surgery, rhinoplasty, breast augmentation reduction, abdominoplasty, liposuction, and the Brazilian butt lift. Dr. Zuriarrain, thank you so much for joining us today.
Dr. Zuriarrain:
Thank you so much to both of you for having me on.
Keri Stephens:
Yeah, we love having you on, and we’re so glad you’re back. To start, can you talk about what’s leading to the rise of BBL reversals? And like people are saying on Twitter or-
Alison Werner:
Instagram.
Keri Stephens:
… can you talk about what’s leading to the rise of BBL reversals? Is it really the end of the BBL era, like some are saying?
Dr. Zuriarrain:
Yeah, there’s a lot of talk out there about the end of the BBL era. Some of my colleagues have referenced that a couple of times in the not to distant in past. I think that what’s happening is that we’re seeing a lot of patients that are getting BBLs that are just very over the top, overly done. They just look disproportionate.
Dr. Zuriarrain:
And I think people are getting a sour taste in their mouth for the BBL just because it just doesn’t look aesthetic a lot of times. And I think that people are not attracted to that. I have a lot of patients that come from out of Miami. And they come to visit, or they come to have surgery with me, maybe not for BBL, but just for maybe a breast augmentation. And they can’t help to comment to me how many people they see walking in Miami with really outrageous BBL results. That they specifically do not want those results when they come to see me.
Alison Werner:
Well, from a surgical perspective, how exactly is a reversal performed?
Dr. Zuriarrain:
A reversal is technically extremely challenging. It is so much easier to inject fat into the buttock. You can do that with much more precision. You can use a wireless ultrasound device, which by the way, hot off the press, here in the state of Florida, you are now required to use a wireless ultrasound to inject fat, which I’ve been doing for the last five years. But now it is Florida law. I can’t speak to the rest of the 49 states, but here where I practice it is now law for safety reasons.
Dr. Zuriarrain:
I could argue that we’re the number one state in the country for BBLs and for the amount of BBLs that we do. Obviously, I think Miami’s number one in the nation for that. But removing fat is very, very complicated. Reason being is that it’s very imprecise. There’s a lot of tissue laxity that can occur afterwards and skin laxity that can lead to some very poor cosmetic outcomes.
Alison Werner:
So, if a plastic surgeon is talking to a patient about a reversal, what would you want them to say to the patient? Or what are you saying to your patients?
Dr. Zuriarrain:
Yeah, first of all, I would start from the beginning. If you’re thinking about having a Brazilian butt lift, really do a good job to investigate what kind of surgeon you’re going to. There are surgeons, just like there are breast documentation surgeons that just love to put in big implants and that’s just their style, you want to look at the BBL before-and-after results for the surgeon that you’re going to contemplate on having surgery with. Because you may see a pattern in his or her before-and-after results where the buttocks are just very large, or a lot of hips, very, very wide hourglass shape. Some patients are really looking for that particular aesthetic. But I find myself talking to a lot of patients that don’t want that. A lot of patients are moms that have a few kids. They just want to look good. They want to reverse some of the signs of aging, but they don’t want to go over the top. So, that’s one thing.
Dr. Zuriarrain:
If you’re talking about BBL reversal, that’s a whole other thing, a whole other process. Very few surgeons do it. Most surgeons shy away from it. You want to go to a surgeon who has a history at least of being able to do them relatively successfully. I say relatively because I have never seen a BBL reversal that I’ve really thought was great. And so, that’s always a concern. You always want to ask also about skin tightening when it comes to the BBL reversal. Because once you start removing fat and you start losing volume, the skin will many times sag. So, is the surgeon using any type of radio frequency skin tightening or any other technology?
Alison Werner:
Okay. So this isn’t a procedure that can really be done in isolation?
Dr. Zuriarrain:
Yeah. Yeah, I would combine liposuction with skin tightening. And there’s a lot of name brand skin tightening devices out there on the market that all are based basically on radio frequency type of skin tightening. But I would always add that to the liposuction for the fat removal, just to try to get a tighter skin envelope, get a better result. And I would definitely use wireless ultrasound when removing the fat as well, because just because you’re taking out fat doesn’t make it all the less dangerous as when you’re injecting the fat. A misplaced cannula can push fat that’s already there into structures that we don’t want them to end up in, like big arteries, big veins. So, that’s very important.
Keri Stephens:
So, to talk about it, how risky is this procedure then?
Dr. Zuriarrain:
The BBL itself is very risky. There are numbers out there where they’re quoting one and 3000 mortality rate regarding BBL. That study is a little old, but we don’t really have anything more recent than that to look at mortality. There was a very important Aesthetic Society task force that was multidisciplinary that looked at cadaver dissections. And it’s probably the best that we have as plastic surgeons regarding safety techniques when performing BBL. This is now why the ultrasound is being pushed as well as a safety measure. And also, got to remember, in regards to the BBL reversal, that a lot of the surgeons, up until these laws came about about not injecting fat into the muscle, a lot of these surgeons were injecting fat directly into the muscle. And if you want a BBL reversal, but the vast majority of your fat is inside the muscle, there is nothing you can really do about that. Wow,
Keri Stephens:
Wow. Okay.
Alison Werner:
That’s interesting.
Dr. Zuriarrain:
You won’t be able to reverse it.
Alison Werner:
Oh, okay.
Keri Stephens:
Wow. So, who is not a good candidate then for a BBL reversal?
Dr. Zuriarrain:
I would say a candidate who went to a surgeon who was well-known for injecting fat into the muscle, that’s not going to be a great candidate. A candidate that has maybe gained a lot of weight and then maybe lost a lot of weight. Maybe a candidate who has had multiple pregnancies. All because of the skin laxity that happens due to those physiologic life-changing processes that are going to set you up for a bad result. It’s going to set you up for skin sagging. And of course, the skin isn’t going to sag at the top of the buttock, it’s going to sag at the bottom. And it’s not going to be very attractive at all.
Dr. Zuriarrain:
Also, if you’re trying to reduce a very, very large buttock, it makes it even more challenging versus maybe a tighter, smaller buttock. You can do minor adjustments. You can take out 400 ccs or milliliters, 500 on each side, and you could get a decent result out of it if the buttock isn’t a very large, large buttock. But yeah, it’s a very specific patient population that is going to actually benefit from any type of reversal.
Keri Stephens:
Yeah, that’s interesting. So how does that make you… And just again, the end of the BBL era, which I think a lot of people disagree with. But with the maybe rise of BBL reversals, how does that make you approach current or prospective BBL patients? Does it make you pause a bit or not really?
Dr. Zuriarrain:
Yes, absolutely. I think that a lot of patients need to understand that these fat grafting procedures, not only to the buttock, mind you, and we could talk a little bit about that too, but fat grafting to other parts of the body, once that fat survives, let’s say you inject fat into the facial area, let’s say the malar eminence or the cheek area or underneath the tear trough for the under eyes, even the lips; these are places that if you don’t really like your result, it’s very difficult, if not impossible in some areas, to take that fat out.
Dr. Zuriarrain:
So when counseling patients and having conversations with patients, I’m very specific about letting them know that “Yes, you’re going to probably lose 30% of the fat that I inject in your buttock at about six months, which means you’re going to keep about 70%. But that being said, we have to walk a fine line because if I put in too much fat, it’s going to be very difficult to come back from that and have a nice outcome.”
Keri Stephens:
Wow. Yeah.
Dr. Zuriarrain:
So I think a lot more patients are now becoming cognizant of that, they’re understanding that. A lot of patients, when I first started practicing, were much more concerned about the surgeon putting in max volume because they were really worried that they were going to lose 30%, and they were not going to have the result that they wanted. And so, they were really pushing hard for “Just put everything I got in there. Let’s go for it. No holds barred.”
Dr. Zuriarrain:
But that’s all changed now. People are becoming more educated as to the fact that, hey, if he overdoes it’s going to be hard to get this reversed.
Keri Stephens:
Well, and aesthetic trends change. Maybe one month it’s Kardashian look, and then the next month it could go back to this long, lean tiny [inaudible 00:11:15]. Looks change.
Dr. Zuriarrain:
Yeah. And their Kardashians changed themselves.
Keri Stephens:
Yeah, they did. They did.
Dr. Zuriarrain:
And they’re constantly evolving. And that’s the beauty of aesthetics, right? You’re never going to be really stuck, pigeonholed in one type of aesthetic, whether it’s buttock, breast, face, lips. All of this changes. There are a lot of nuances in all of it.
Keri Stephens:
Yeah, very true. And actually, I heard, speaking of the Kardashians, people are saying Khloe had her… Which I don’t buy into this, but people are saying, “I think Khloe had her BBL reversed,” so who knows.
Dr. Zuriarrain:
Yeah.
Alison Werner:
Well, as someone who operates in Florida, where a lot of patients do come to Florida for those BBLs, what else do you want to tell your fellow plastic surgeons about this rise of BBLs? What do you want your peers to know?
Dr. Zuriarrain:
Yeah, my peers should really recognize the danger of the operation. They should recognize the importance of continuing medical education, of training, of doing simulation procedures, of going to national meetings, local meetings, being on top of the technology, the newest technologies that come available for safety purposes, going to cadaver workshops, looking at the dissections of where the anatomy is. But I would really, really, really emphasize that it is a doable procedure. It is a procedure that I personally have been doing for the past five years. I’ve done more than a thousand gluteal fat grafting operations. And I’m going to knock on wood and knock on everything in this room, right now where I’m sitting. But I’ve never had, thankfully, a negative result with this type of operation. So it is very doable. You shouldn’t be scared of it. You should respect it. You should know your anatomy.
Dr. Zuriarrain:
You should practice in a situation where you’re not putting a patient at risk, but using… Now we have a lot of ways to practice that we didn’t have before. And I think that that’s really important. Read the most recent articles, and then counsel your patients about size, about that there is such thing as not being totally happy if your buttock is too large and that it’s not going to be easy to come back from that.
Dr. Zuriarrain:
Nobody wants a repeat operation. Nobody wants to have more than one surgery. But I always tell all of my patients, “Rome wasn’t built in a day,” and they didn’t get to the body that they have currently over the course of a week. These are years in the making, so it’s only fair that you consider more than one operation sometimes to get to where you really want to go.
Keri Stephens:
That was super helpful. Just thank you, Dr. Z, so much. This was very informative. And to our listeners, be sure to check back on the MEDQOR Podcast Network for the next episode of the Plastic Surgery Practice Podcast. And in the meantime, to catch up on the latest industry news, please check out plasticsurgerypractice.com. Until next time, take care.
