This will be of interest to anyone who is considering a Brazilian Butt Lift (BBL) in Vancouver. In it’s most common form, the BBL is a two part procedure comprised of circumferential liposuction of the torso and fat transfer to the buttocks. Recently, several plastic surgery organizations have expressed their concern regarding the safety of the Brazilian Butt Lift procedure. A selected group of international experts was asked to review the matter and their findings and recommendations have recently been made available.  I would like to review these findings, the history and current state of BBLs in my practice and my thoughts on where we go from here.

My Experience

In my own practice, the BBL has been a safe and effective method of improving body shape and proportions. Over the past 12 months, BBLs have emerged as one of the most common procedures in my cosmetic practice. I’m not aware of any complications, in my own practice, that have been related to the fat grafting portion of the procedure.

Cause for Concern

During the last few years, the popularity of BBLs has grown rapidly, however, several fatalities, outside of Canada, have been cause for concern. Many of these cases have been reviewed. Here is what is known:

  • The mortality rate is approximately 1 in 3000 - the highest for any aesthetic procedure by a wide margin.
  • In all cases of BBL related deaths, the cause was a fat embolism - a complication where fat injected in to the buttock area enters a deep vein and travels to the heart and lungs.
  • In all cases of fat embolism, transferred fat was identified within and deep to the gluteal muscles, where these large veins are found.
  • There have been no identified cases of fat embolism when the fat is exclusively grafted in to the subcutaneous layer.

The recommendations that followed this review address technique and equipment in an effort to help surgeons avoid intra-muscular injections and fat embolism.

Impact On My Practice

I have reviewed my own practice so that I may offer the safest BBL possible. As before, I will continue to avoid intra-muscular injections of fat, however, inadvertent placement of fat in the muscle remains a possibility. Patients need to be aware of this issue and give it due consideration as they weigh the potential risks and benefits of surgery.

Given that intra-muscular injections are to be avoided, and given that the subcutaneous layer will only accommodate a finite amount of fat, there will be limitations to the amount of fat that can be grafted and therefore limitations to the degree of gluteal augmentation that can be achieved.

Part of my role is to clarify the balance of risks and benefits for each patient during the consultation so that it’s possible for patients to make an informed decision. I will continue to follow this issue closely in an effort to stay current with the best available evidence.

The Importance of Protein Supplementation for MWL patients undergoing body contouring

In a recent study published in the Aesthetic Surgery Journal, a simple regimen of protein supplementation was found to reduce the incidence of post-operative wound healing issues. I decided to summarize parts of the paper here in this month's blog because it has the potential to enhance the recovery for all of our massive weight loss patients who are undergoing body contouring procedures.
This study was published by a group working out of Mississauga, lead by Dr. Jamil Ahmad and Dr. Frank Lista. They recognized that for massive weight loss patients there are more wound healing issues following body contouring surgery in comparison to other body contouring patients. It's well known that post-bariatric patients experience higher rates of protein calorie insufficiency and the authors hypothesized that protein supplementation would help to reduce the number of post-operative wound healing complications.
Two groups of 23 massive weight loss (MWL) patients undergoing abdominoplasty (tummy tuck) were selected. The two groups were similar with regards to age, gender, BMI and other characteristics. Patients in the treatment group were asked to supplement their diet with 80 grams of whey-isolate protein powder for 4 weeks before surgery and 4 weeks after surgery. This was the only difference between the two groups.
The treatment group had a significantly lower rate of wound healing issues (0% vs 21.7%).
Protein calorie insufficiency is common amongst post-bariatric patients. In addition, protein requirements are increased during the healing phase following body contouring surgery. It's not unexpected then that the authors were able to demonstrate improved healing and recovery in the group who received protein supplementation.
"Based on this article, I would encourage all of my MWL patients to incorporate some protein supplementation in to their pre- and post-surgery diets."
Article reference:
Austin, Ryan et al. The Impact of Protein Nutritional Supplementation for Massive Weight Loss Patients undergoing Abdominoplasty. Aesthetic Surgery Journal; 2015, 1-7.

Plastic Surgery for Men - our top 8 cosmetic procedures

It's been my observation that men are less likely than women to disucss their plastic surgery needs with friends and family. As a result, there may be a dampened public awareness of all that goes on regarding men and plastic surgery. This was recently exemplified by the American Society of Plastic Surgery who reported, in their annual statistics, that 40% of all 'breast reductions' in the U.S. were performed on men. While the correction of gynecomastia is perhaps the most well known reason for men to stray in to a plastic surgeon's office there are in fact many other products and services that are designed for men.
Body contouring procedures that are popular with men include correction of gynecomastia, liposuction and abdominoplasty.
  • Male breast reduction surgery is covered in detail on a dedicated page and this is perhaps the most common reason for men to consult with Dr. Reid.
  • Liposuction can be a powerful tool for re-shaping the torso and reducing stubborn fat deposits. Treatment of the abdominal and 'love-handle' areas are most common. Minimal scarring and downtime help to make liposuction a popular procedure.
  • Men who choose to have a tummy tuck have often lost a significant amount of weight and this procedure is ideal for those who have loose skin in the abdominal area.
Above the neck, there are several treatment options for men. Some of them are surgical procedures that require anaesthetic, while others are conveniently offered in the office.
  • Lose the double-chin. Check out our page on Belkyra, a minimally invasive injectable treatment to remove submental fat to create a more athletic looking neck line.
  • For more challenging necks, a surgical neck lift with submental liposuction is powerful procedure that can restore, or create, a youthful looking neck.
  • A chin augmentation strengthens the look of a 'weak' jaw and can dramatically change a guy's profile and their overall look. It's often a great complement to the neck treatments listed above. Minor augmentations can be achieved in the office with an injectable filler, while more dramatic results require placement of an implant.
  • Women get Botox . . . . men get 'Brotox'. The product is the same, but the aesthetic goals are different. Botox should be considered by those men who have persistent creases and wrinkles affecting either the brow or forehead.
  • Aging men with loose upper eyelid skin should consider a blepharoplasty. This relatively minor surgical procedure removes redundant skin and aims to restore a crisp upper eyelid fold while maintaining a masculine look.
That concludes our run down of Dr. Reid's top 8 cosmetic procedures for men.

Back lifts - an important procedure for weight loss patients

Post-bariatric body contouring is an area of special interest for me. Through my interactions with weight loss patients in the office, and on, I sense that the treatment of loose skin in the mid back area is not understood all that well.  I do have a page on the site dedicated to this topic, but I will expand on that with this blog post, and hopefully answer any lingering questions.
Weight loss often results in the development of loose excess skin that accumulates in to folds and rolls that disrupt a person's normal body shape. It's common to have skin laxity in the lateral chest and mid back area.  This can result in one or more transversely oriented folds that extend from the breast around to the back. In more severe cases, this redundant skin can extend inferiorly where it also effects the contour of the waist, lower back and hips. Patients often complain that their bra doesn't fit well.
The removal of excess skin from these areas requires a Back Lift (also referred to as an 'upper body lift'). In a woman, the intended scar position mirrors the position of the bra strap. In a man, the incision parallels the textural lines in the skin. Excess skin is removed in a vertical direction. This will tighten the back and the lateral chest. In addition, there may be improvement in the contour of the hips and lumbar area as well. A back lift can be done as a stand alone procedure, but it is more commonly combined with a breast reduction, breast lift or correction of gynecomastia. A Lower body lift does not include a back lift. However, these 2 operations are often complimentary and they can be performed in any order.
In my own practice, the back lift procedure is less common than abdominal contouring procedures, about as common as arm lifts and more common than thigh lifts. Following a back lift, the level of discomfort is similar to that of a breast lift and less than an abdominoplasty. If drains are required, they are usually removed within a few days. A post-operative bra or compression garment is beneficial for about 3-4 weeks.
In summary, a back lift is a relatively less known body contouring procedure that can be very impactful for a large subset of weight loss patients.