Category Archives: BUTTOCKS SURGERY

Buttocks plastic surgery update

Buttocks plastic surgery update


buttock shapes

I recently saw a classification for buttock shapes. It turns out there are pear, apple, mandarin and tomato buttock shapes.  Funny but no one told me that during my training. It also appears that the citrus fruit among these, mandarin, is the shape most aspire to: two round balls for buttocks. Buttocks plastic surgery keeps on evolving and its time for a buttocks plastic surgery update!

From a cosmetic plastic surgeon’s perspective, there are three types of buttocks plastic surgery that can be performed: patients want their buttocks larger, smaller or just lifted.


Making buttocks bigger

The options for making buttocks larger are:

1. Silicone implants

In this outpatient cosmetic procedure, a 2-3 inch incision is made between the buttock cheeks and a solid silicone implant is placed under the buttock (gluteus) muscles.

  • Silicone implants used are different from ones used in breast augmentation and are firmer to touch
  • Implant have to be placed higher in buttocks, as you cannot sit on implants for fear of rupture; we all sit on the bone under our buttocks
  • Healing takes about 10 days and full recovery 1-2 months

2. Fat injections – Brazilian buttock lift

  •  Even though the Brazilian buttock lift has “lift” in its name, it’s a plastic surgery procedure that both enlarges and lifts buttocks
  • Liposuction of abdomen and hips is performed, and harvested fat is injected into buttocks
  • I typically inject about 800 cc into each buttock at one surgery for maximum effect
  • This is an outpatient cosmetic surgery requiring 3-4 days for recovery and 1 month for full healing
  • About 30% of  fat injections will naturally disappear, but some will remain permanently; everyone is different


Making the buttocks smaller

There is really only one cosmetic procedure to make buttocks smaller, and that is liposuction. In this procedure, three to four small incisions are made around either cheek and fat is removed, leaving behind a smaller buttock. The cosmetic danger is in removing too much fat and turning a plump cheek into a flat and droopy one—not a good idea.


Lifting the buttocks

There are two options for this cosmetic procedure, buttock lift surgery and, again, Brazilian buttock lift.

Buttock lift surgery

In this surgery, a scar is placed in a crease under the cheeks and the skin is turned in to give a modest lift.

The problem is that the plastic surgeon is trying to push and hold your skin and fat tissues in a high position against gravity’s force; given the weight of skin and fat, gravity wins. The scars are not great from this surgery, and I try hard not to perform it!

Brazilian buttock lift 
As above, fat injection will not only make a buttock larger but will also lift it, in the same way an empty bag is “lifted“ when full. With liposuction I can actually change the shape of the buttocks to to make them larger and lifted or smaller and lifted!

The concept to keep in mind with all these surgeries is that by changing the shape of the skin and fat around an area I can change the apparent shape of the area itself!

The update

I first wrote this blog in 2010. $ years later not much has changed other than…

I now perform a lot more Brazilian buttock lifts than before; it is a routine procedure now.

I do very few silicone implants these days

I have not done a simple lift with cutting of the skin in 4 years! – It is just not a good surgery.

We still do not know how come much fat cells survive in some areas and not in others as well!

Buttock enlargement without surgery

The other day a patient came to see me for a Brazilian buttock enlargement surgery. She told me that she had had buttock enlargement without surgery by taking a number of herbal medications that she had found on the internet.

Butt enlargement pills


She showed me these two pill and professed to being happy with her results. The irony of the fact that she was there to see me for an even larger buttock escaped all .


This herbal concoction that advertises larger buttocks by specific accumulation of fat in the buttocks. it retails for about $49.95 per bottle and “best results are after 6-9 months”.

There are the usual mix of great reviews and terrible reviews of the product- which mean nothing!

The ingredients include, Maca Root, Dong Quai, Saw Palmetto, Fenugreek, Wild Mexican Yam, Soy Extract, Rose Hips, Citrus Bioflavonoids, Dandelion, Watercress Extract, Tyrosine, Genistein

A nice disclaimer says

” Legal Disclaimer
GluteBoost is an all natural supplement which has not been evaluated by the Food and Drug Administration. GluteBoost is not intended to diagnose, treat, cure or prevent any disease. Results may vary.”

It is commonly sold as a package with another product called Major Curves Butt enhancement ( the white bottle above).

Major Curves Butt enhancement

This “2 x stronger than other supplements” promises a 31% increase in size. It retails for $49.95.

Major Curves Proprietary Blend: 1036mg Saw Palmetto Berries, Fenugreek Seed, Fennel Seed, Wild Mexican Yam (root), Blessed thistle (whole herb), L-Tyrosine, Kelp (whole plant), Dong Quai (root), Mothers’s Wort (whole herb). Other ingredients: Gelatin, Magnesium Stearate

This product is also marketed along with a pill to make your breasts larger, and a cream to rub on the buttocks for extra buttock enlargement ( another $49.95).

Buttock enlargement

I am a reasonable sort of person open to new ideas and technology. I even eat my “really raw Honey” to prevent seasonal allergies.

There are only one group of products that I know of that can cause localized accumulation of a specific type of fat and those are steroids. Patients on long term steroid use can develop a so called “Buffalo hump” on the back of the neck as a result of the specific action of steroids on that fat. This is not the usual nice yellow fat but a hard, dense  brown fat that accumulates. No one knows why that happens.

Estrogen can also increase breast size in both men and women, but that is to a great extent due to enlargement of the breast glandular tissue rather than just the fatty tissues around the breast.

The whole concept of a collection of plant extracts and supplements, none of which have ever been tested for efficacy, being able to work on just one area of the body is…stupid.

Even if these extracts were able to increase fat accumulation in the body, our bodies just do not have the ability to store fat selectively in an area that is not determined genetically. You cant change where your fat goes.

The nutritional supplement business in the US is a multi-billion dollar industry in a society that is forever trying to find the easy way out of problems.

Whenever you see a product that purports to be a god-send and cure all just ask yourself ” if it really works why are we all not taking it, and why is every doctor in the world not prescribing it?

Save your money for a Brazilian buttock lift!


Preventing Infections with Cleanliness, Part 1

What are infections and what can we do about them?


Admit it. You’ve been there. Once you are finished, you go to wash your hands. Do you turn on the faucet, which has been touched by the dirty hands of god knows who? What about the paper dispenser? Now, how do you get out of the bathroom? Do you dare pull the handle, which those who did not wash their hands may have touched as they left? Let’s face it—taking a pee in a public bathroom is a stressful experience.

I have previously written on this subject as it relates to a hospital environment and preventing infections:

We live in a pretty dirty world, but a little prevention can help keep you healthy. For example, a recent study showed that the handles of two thirds of grocery carts are contaminated with fecal material. Also, 70% of the lemon wedges in your drink at a restaurant were found to be contaminated with bacteria—E. coli or fecal bacteria! As a cosmetic patient or plastic surgeon, minimizing the risk of infection is important for recovery.

How bacteria cause infection

Our bodies are teaming with bacteria. There are billions of them in different parts of our bodies—even our left and right hands have different types of bacteria on them. Even though we think of the anus as the dirtiest part of the body, there are actually more types of bacteria in our mouth than in any other body part (our mouths are, in that sense, dirtier than a dogs’ mouths, which have less bacterial load and variety!).

Infection as a disease occurs when either:

  1. Pathogens (bacteria or viruses) break through our natural defenses against infection, such as through a break in the skin, or
  2. There is an imbalance in the normal bacterial flora where the different types keep each other in check 

Some particularly virulent bacteria, like some strains of E. coli, streptococcus and salmonella, don’t need much of a break in our natural body defenses to enter and cause infection. A small scratch in the skin, some inflammation of the gut. Others, like Clostridium difficile, lurk in the intestines, and if you are on antibiotics and kill off your normal gut flora, the C. diff. goes wild, takes over and makes you sick.


Natural defenses against infection

Once the bacteria is inside our bodies, we have a number of defenses:

  1. Antibodies – small proteins circulating in our blood that attach themselves to and destroy pathogens
  2. White blood cells – a number of different types of white blood cell are present in the blood and will accumulate and kill invading organisms.


What antibiotics do

If you go to the doctor, he or she will give you antibiotics, which are medicines that either:

  • directly kill bacteria, or
  • prevent their replication

If you have a viral illness, there is usually not much to do but keep yourself comfortable, hydrated and rested until the disease hopefully runs its course. Only a few viral illnesses, such as herpes and HIV, have medicines available that can slow the rate of replication and keep you somewhat healthy. Some viral illnesses can now be immunized against, such as:

  • HPV (human papiloma virus, which has been linked to cervical cancer)
  •  Herpes zoster (which gives you shingles)
  •  Hepatitis C


Cleanliness as a way of fighting the risk of infection

All of this is important because to remain healthy, we need to limit our exposure to bacteria and viruses. One of the best ways to do this is to clean our hands and bodies regularly to decrease the amount of bacteria on our bodies. We don’t want to take a bath in alcohol every day—that would kill almost all the bacteria and leave us open to attack by the one strain or another that was not killed, like the C. diff. example above. We just need to limit our exposure to pathogens.


Where are pathogens located?

Pathogens are located everywhere. Most commonly, though, bacteria and other pathogens are associated with dirtiness—dirt on our bodies or dirt on the food we eat and water we drink. Purifying water and properly cooking and washing food takes care of many pathogens. Dirt on our bodies should be washed away with soap and water. Alcohol sanitizers will also kill many pathogens on our hands—use them!

In a recent issue of the Wall Street Journal, there was a small article about some studies that have been done on the subject of public bathrooms and the public’s preferences and habits regarding them. I became re-interested  in the question of handwashing a few weeks ago myself.  I was watching the movie Contagion, in which a worldwide killer disease is passed from one person to another through the air (by sneezing and coughing) or from fomites (transmission from one person directly to another by touch or via rough physical objects like door handles and glasses). You soon realize that we are essentially constantly touching each other. Another interesting fact I learned from the movie: we touch our faces between 2000 and 3000 times a day!  And our noses are where most of the pathogens hide. Also, average adults touch up to 30 objects a minute!

In the next post, I’ll amaze you with some facts about using public restrooms.

Morad Tavallali, M.D., FACS

How to Decrease Bruising after Plastic Surgery

How to reduce bruising after plastic surgery 


This post is about how to reduce bruising, but it’s important to read a previous post about how to decrease swelling after plastic surgery before reading on:

Causes of bruising after cosmetic plastic surgery

Let’s see how bruises form. When blood vessels are injured in surgery through cutting, they will bleed into the tissues around them. This bleeding shows up as bruising (in a red, blue and black color) under the skin. Any action or medication that interferes with or delays the normal healing process and stops blood clotting will cause bruising. With time, leaked red blood cells start to break down into bilirubin and iron components, creating a yellow color as the bruises heal. White blood cells then come into the injured skin area and start to remove the remnants of red blood cells.

Some areas of the body are not covered with skin, such as the eyes. When bruising occurs around the eyes, such as after a cosmetic eyelid surgery, blood actually shows red in the white part of the eye!

Here are some other posts about swelling and bruising and the use of ice and heat after plastic surgery:


How to stop bruising after plastic surgery

Stopping bruising involves not only the removal of blood that has seeped into tissues, but also mechanisms to heal vessels and encourage clotting along injured vessel walls so that no more blood seeps out.

  • Elevation of injured area

Decreasing blood flow will decrease swelling and the amount of blood that seeps into the skin through injured vessels.

  • Ice

Cold contracts blood vessels, resulting in fewer cells going out into the tissues. Likewise, avoiding heat (heating pads or warm towels) will be beneficial in the initial 72 hours after surgery because it increases flow and bleeding before the blood vessels have had time to heal.

  • Avoidance of NSAIDs

NSAIDs (see above) decrease blood clotting. Specifically, they decrease the production of prostaglandins, which are essential for forming a clot. No clot and you keep on bleeding. Swelling might be decreased, but you keep on bleeding!


  • Foods to increase vitamin K

Food high in vitamin K levels, such as green leafy veggies (or even vitamin K pills), can also help clotting.


  • Pressure on injured area

Applying pressure to bleeding areas will help clotting, decrease swelling and decrease the amount of blood that escapes. Once bleeding has stopped, pressure does not do any more good other than to decrease swelling.


  • Application of heat after 48 hours

The initial application of ice to an injury site will decrease bruising. After 48 to 72 hours, though, once the blood vessel has clotted, applying gentle heat with something like a moist warm towel will encourage blood flow through normal vessels, which aids in the removal of remnants of dead red blood cells in tissues. Some of my Far Eastern patients roll freshly hard boiled eggs (shell on) over the areas of bruising for heat and massage at the same time!

Of course, you should call your plastic surgeon immediately if you have an area of bruising under the skin that is getting large. This may be a hematoma, a large collection of blood under the skin that may need to be surgically removed.


Morad Tavallali, M.D., FACS

Cosmetic Surgery Procedures Done at Home

DIY cosmetic surgery


I’m the type of person who likes to work with my hands.  That may well be one of the main reasons I became a plastic surgeon who performs cosmetic surgery. I like to think I use my brain also, but I get enjoyment from using my hands. When at home, I am forever tinkering with things in the house or garden, plastering, painting and fixing, and I am an avid do-it-yourself type of fellow. However, as the post below, supplied to me by the American  Society for Aesthetic Plastic Surgery, shows, DIY may not be the best thing for cosmetic surgery unless you really are a board-certified plastic surgeon.  I certainly no longer do  complicated electrical or plumbing work! Mind you, I’ve tried in the past, but I always failed.

Here is a recent article about what you DO NOT WANT TO DO in terms of do-it-yourself plastic surgery:

While the high cost of some plastic surgery procedures has caused some people to seek dangerous alternatives, such as using unlicensed individuals and potentially dangerous ingredients, others have chosen to perform them on their own at home, which also poses serious risks, say reports from ABC news and CBS Pittsburgh.

The low cost and ease of buying a do-it-yourself kit for a non-surgical cosmetic procedure such as microdermabrasion, laser hair removal or chemical peel is causing many to try these treatments out on their own. However, doctors warn that they may end up doing more harm than good.

Plastic surgeons and cosmetic dermatologists are seeing an increase in the number of individuals who have had to endure pain and long-term skin damage due to Cosmetic Surgery Procedures Done at Home.

“We’ve had patients come in the day before their daughter’s wedding and done an at-home chemical peel and come in with second-degree burns,” a  cosmetic dermatologist told the news.

Experts say that although prescription-strength acids used for chemical peels can be found online and obtained without a prescription, consumers should avoid them.

“If you stumble upon a website selling prescription-strength retinoid, that should be a red flag and [you should] seek professional help first… because there are certain reactions that can happen and certain products you don’t want to mix together with those.”

Caution also needs to be used when attempting do-it-yourself laser hair removal, as misuse can cause burning, redness and scarring. In-office treatments are also likely to be much more successful.

“The companies say after five treatments you have a 50 to 70 percent reduction in hair growth,” an industry expert told ABC News about at-home laser hair removal. “I expect 70 to 100 percent from office devices.”

Permanent damage can also result from microdermabrasion kits and scrubs that promise to exfoliate the skin and produce a more glowing complexion. Over-scrubbing can result in pain and bleeding. “They start to think if a little bit is good, more is better, so, they start to do more for their skin and that can really damage the barrier function of the skin.”

Whether you want to restore a more youthful glow to your skin or get rid of unwanted hair, consulting with a licensed, board-certified cosmetic plastic surgeon is recommended in order to achieve the desired result and maintain safety.

Cosmetic surgery doesn’t mix with alcohol

Alcohol and surgery

Last night a patient called me at 11.30 (after my bedtime) to ask me if she could have a beer. She was recovering from a breast enlargement surgery, brazilian buttock lift and mini tummy tuck. The cosmetic plastic surgery procedure was ten days ago.
I was initially a bit pisssed off. After all she had called the emergency line after hours; a line reserved for true medical emergencies. I initially thought of telling her NO! NO beer! but then realised that it might have been an emergency beer she needed and so told her to go ahead and swig one back!

See here for links to some articles on postoperative care

Complications of plastic surgery occur at known rates for infection, bleeding etc. It is important though not to increase your chances of having a complication by limiting factors that delay your healing or give post operative recovery problems. Alcohol causes problems in this period!


Alcohol after cosmetic surgery

The timing of when a patient can start to drink alcohol after cosmetic plastic surgery will depend on a number of factors. The basic factor is that alcohol has a number of effects that can alter postoperative results of a cosmetic patient.


Alcohol as vasodilator of skin

Vasodilation means opening of blood vessels. You may know those ruddy cheeks you get when you have had a few too many drinks. You know, red cheeks along with a warm feeling, slurred speech and bad jokes?  Skin vessels will open to allow more blood into them and rob blood volume from vital organs. You are already dehydrated from surgery and with more loss of fluid from areas that need it- brain and heart- you will only feel light headed, get nausea and worse!


Alcohol as a nervous system depressant

Alcohol effects our brains by depressing our central nervous system.

Initially this means decreasing our psychological inhibitions and mellow us out. It also mellows out our breathing rate and brings it down . If you are taking narcotics for pain control, they also decrease your breathing rate. The additive effect can mean you stop breathing! Not good for a cosmetic surgery recovery.

Alcohol increases vomiting

Another effect of alcohol is to increase our brain’s sensitivity to noxious stimuli and make it easier for us to vomit. Not good if you have had any type of cosmetic surgery. The anesthesia will already have lowered your vomiting threshold. With a tummy tuck vomiting will be very painful as stomach muscles contract. With a face lift,  increase in blood pressure occurring with vomiting can lead to bleeding.


Alcohol as a diuretic

Alcohol also has the effect of increasing the rate of urine formation (increases your peeing) and as such can lead to dehydration. That is why when you have a hangover you have a headache. Dehydration causes fluid to leave the area around your brain (cerebrospinal fluid)  which leads to headache. If you are already dehydrated from surgery, the increase in dehydration will only make you feel worse.
You may think that alcohol will allow you to relax after your cosmetic plastic surgery and maybe it will if taken in moderation. However you will be better off taking a Valium to decrease your anxiety and avoid all the other alcohol side effects.Also drink lots of…water!

Brazilian Buttock Enlargement with Liposuction Fat Transfer

Big fat bums


For information about Brazilian buttock enlargement, look here:

 The world is the sort of place where those who have one thing are clamoring for another thing they don’t have. If you have curly hair, you want it straightened; and your hair is straight, you curl it. If your buttocks are small, you want buttock enlargement; if they are big you want them… bigger? Well, yes, in some cases.

Size of buttocks

The size of bums is determined more by their shape than their actual volume. Buttocks look big if they are long and wide, long in terms of length from the upper hip to the lower end of  buttocks and wide in terms of distance from the central bum crease to the outermost parts of the hips or saddle bags. In one of my cosmetic plastic surgery patient’s before photos below, notice how much distance there is between the back crease and the lower part of the buttocks. In the after photo, this distance appears shorter. By the way, that is her result a week after a natural buttocks enlargement via a belly fat transfer!


What patients want for their buttocks

Most patients want to have buttocks that are shapely, round or full. Sometimes that is confused with size/volume. Buttocks enlargement means different things.

Round, full bottoms offset by a small narrow waist will look bigger; sometimes even liposuction of the waist will give the impression that bottoms have been made larger. For men who want larger or fuller buttocks, waists cannot be narrowed as much as for women.

Some patients have a paucity of fat in the lateral (outside) part of  their bum.  These patients need fat to be filled in those areas in order to get a rounder bum.

How to do buttocks enlargement

In previous posts, I have discussed larger buttocks with silicone implants or with a Brazilian buttocks enlargement technique.

My preference is for a Brazilian buttock enlargement or natural buttock enlargement, in which fat is suctioned from other areas of the body such as the belly/abdomen. Next, a fat transfer and injection into the buttocks is performed. This procedure is gaining in popularity. I have taught several of my cosmetic plastic surgeon colleagues how to perform this surgery. There are a number of companies that sell cosmetic plastic surgeons different materials to allow for easier or quicker harvesting of  fat, but I find that these don’t really help. Liposuction with fat transfer under the buttocks’ skin and muscle in multiple lines gives the best results.

How long does fat injection into the buttocks last?

When I first started performing this cosmetic procedure years ago, I would tell my patients what I had been told to say by the plastic surgery authorities at the time: “We don’t know, but it should last at least two years.”  I now know that I still don’t know, but results can sometimes last for almost a lifetime; they might disappear when you are getting on a bit.

Risks of Brazilian buttock enlargement

  • Infection – can be devastating and eat away all the injected fat.
  • Bleeding – very rare.
  • Loss of volume – sometimes occurs unpredictably.

With more and more cosmetic plastic surgeons performing surgery to enlarge buttocks, results are becoming better and more predictable. So, whether you are a man or a woman, a nice round big bum is hopefully within your reach…