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Fat or implants? The derriere debate

Article-Fat or implants? The derriere debate

Rump, booty, bottom, tushie. There are a lot of terms for rear ends — almost as many as there are approaches used by plastic surgeons to augment them.

Most seem to use fat to expand volume and mold new contours, but some still turn to silicone implants and injectable fillers, according to a poll of audience members at April’s annual meeting of the American Society for Aesthetic Plastic Surgery and Aesthetic Surgery Education and Research Foundation in Las Vegas.

Still more poll results revealed varying opinions:

  • How long until your patient can sit again?
    More than 40% don’t let them sit for a week, but almost as many prefer two to three weeks.
  • How long should patients should wear compression garments?
    Slightly more than half (61%) said four weeks.
  • How long should patients should wait before exercising?
    Almost 70% said four to five weeks.

But among the speakers, there was general agreement on one thing: Fat is where it’s at — but implants haven’t vanished into the history books just yet.

When it comes to fat grafting and implants, says Brazil plastic surgeon Raul Gonzalez, M.D., “the surgeon who wants to work with buttocks has to master them both.”

Dan Del Vecchio, M.D., a plastic surgeon based in Boston, prefers to rely on fat. “I can get much better results with fat than implants. There’s no question,” he says. In contrast, he says butt implants are often problematic, especially when there’s inadequate soft tissue: “I tell patients that one-third will need to have them removed due to pain, infection, malposition.” 

However, he says, implants can be appropriate “when you want to augment an existing good butt.”

For his part, Dr. Gonzalez recommends that his colleagues rely on fat grafting even when they turn to implants. When he uses implants, he says, he also performs fat grafting in about 70% to 75% of cases.

NEXT: Why Use Implants at All?


Why Use Implants at All?

Dr. Gonzalez says they’re appropriate in thin patients, patients with high expectations and those who had disappointing results with previous fat-grafting procedures.

M. Mark Mofid, M.D., FACS, associate clinical professor (voluntary) of plastic surgery at the University of California at San Diego, has similar views. “Fat grafting is always preferable to implants, assuming that donor fat graft material is available and the amount of volume restoration reasonably expected by the patient is attainable,” he says.

However, fat will not meet every need in this age of body standards set by the Kardashians. That’s where implants come in, he says, but large ones — those over 350 cc — “place patients at logarythmically higher risks of complications.” And most surgeons will agree: No badonkadonk is worth a trip to the hospital. 

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