CosmeticSurg blog: Expert insights from Dr. Ricardo L. Rodriguez

Why does the butt look lifted in a BBL?

It’s all about how the eye perceives shapes. When you look at the back of a typical woman what you think is the butt is really a combination of two separate fat pockets:

1. the buttock itself
2. the flank, or “back muffin top” above the buttocks

The combination of the two fat volumes creates a visual unit. It is longer than it is wide so the butt appears to be droopy or sagging. From the side it appears there is no shelf but a long slope that makes the buttock look like it is hanging. If you eliminate the back muffin top above the buttock there are a lot of perception changes that result.

Plastic surgeons have been performing Fat grafting surgeries for over a hundred years. Patients interested in having a procedure involving fat grafting should be familiar enough with the process to ask questions during their consultation.

The success of fat grafting is highly dependent on the skill and technique of the surgeon as well as the patient’s attention to detail and instructions during post-op.

Here are 10 questions to arm yourself with prior to a consultation for any plastic surgery involving a fat transfer:

If you’re considering Liposuction to the your love handles, saddlebags, or abdomen, familiarize yourself with the procedure and the options available to your surgeon. Know exactly how your liposuction procedure will be handled before you schedule it. Dr. Rodriguez explains what you need to know.

There are four main factors that can affect your liposuction result. Two of them have to do with the instrument used by your plastic surgeon, and the other two are related to the post op recovery period.

Recently, a patient came to me for a second opinion. She was an attractive, dark skin Hispanic female who had had Liposuction to the saddlebag area along with a tummy tuck and a breast lift. The result was great, but the patient was unhappy. She had a small waist, and a nicely defined hourglass figure. Her hips were curvy. Now why would a patient be unhappy with a ‘good’ result?

The use of IV Sedation with cosmetic surgery offers several advantages over General Anesthesia:

1. IV Sedation has less nausea than General Anesthesia
2. quicker recovery immediately following the surgery
3. dramatically reduces the risk of pulmonary embolism which is a major concern with General Anesthesia

In many plastic surgery forums I always see the question – ‘Can a tummy tuck can be performed with something other than General Anesthesia’? The good news is YES – you can have a tummy tuck with IV Sedation. Instead of general anesthesia, I use local tumescent anesthesia with IV sedation. This type of anesthesia is highly preferable compared to general anesthesia and I want to explain why. With General anesthesia , a machine is breathing for you and you have a tube down your throat or nose. With IV anesthesia you are breathing on your own and there is no tube in your throat or nose. Recovery from IV sedation is also much easier with IV sedation compared to General anesthesia. Most people experience much less nausea with IV sedation.

In my previous blog post about postoperative Tummy tuck swelling I talked about how the blood supply is disrupted to different degrees using the two different types of Tummy tuck techniques (standard vs. Lockwood). In summary, the more skin that is elevated and separated from the muscle layer, the more blood supply disruption you have. On this post we will address swelling of the tissues after Tummy tuck and why compression garments following surgery are important to reduce swelling. The body is made mostly of water, and there is a constant fluid leakage from the tissues balanced by reuptake of fluid into the lymphatic drainage system. When the lymphatic system is impaired, we get fluid accumulations. The fluid can accumulate between the tissues as interstitial fluid (like a soaked sponge), or outside of the tissues as a seroma (like a sac of fluid). It can also accumulate at some distance from the operative site, usually the upper thighs or legs. The drawing illustrates the various types of fluid accumulation following surgery. As you move from left to right on the illustration you have increasing swelling to result in these conditions:

As a senior (a little over 60 years old) I had given continued thought and prayer to having Breast reduction surgery for a number of years (at least 30 or more). In the past few years the thought and prayers became more and more on my mind and approximately 2 years ago I went as far as having a consultation with a plastic surgeon. I don’t know if it was my frame of mind or exactly what all the reasons were, but I was not comfortable with the surgeon, his staff, or even the thought of continuing on with this surgery. I didn’t go back for a 2nd visit…

Dr. Rodriguez explains how Abdominoplasty surgical techniques influence blood supply disruption and post-operative swelling, so let’s take a look at how that plays into reducing swelling and eliminating fluid collections.

There have been several comments recently on one of my previous blog posts about Tummy tuck swelling. While swelling is a definite concern, it’s only one of the possible complications following Abdominoplasty. Other complications can include infection, wound separation, and fluid collections. Be sure to discuss these things with your plastic surgeon prior to your surgery.

The most common question we get about Tummy Tuck recovery in my Baltimore practice is ‘How much time off work do I need?’ The answer is 2-3 weeks. If you have an office job, you can resume WFH computer type work in week 3. You can go into work in week 3, but no driving until the end of week 3. 

Exparel is a long acting local anesthetic which is injected into the operative area at the end of the procedure. Like the pain pump, it focuses just on the operative area, and does not disseminate to the entire body like a narcotic does. The function of the Exparel is to numb the area of surgery so you do not feel pain. With cosmetic surgery, patients only need the one injection, and the pain control lasts for about 3 days. Similar to the pain pump, patients take fewer narcotics post operatively, because the pain is more controlled.

I’m sitting here waiting for my next case, a Mini Tummy Tuck. It is a natural tendency to want maximum results for minimal effort. That is why the words “mini facelift”, mini this and that, are so popular today. The main thing to remember about these procedures is that they are limited versions of the original procedure designed for patients with a minimal defect. Be aware that mini procedures can also mean mini results. Not everybody is a candidate, but some are.

I asked the patient if he be interested in a procedure to tighten the muscles that was not described anywhere in the literature (this was early 90’s!) but that I could perform a surgery using techniques I was comfortable with? He agreed, signed the informed consent, and I did the procedure by making an incision around the belly button for access to the deeper tissues. The procedure went so well I immediately felt bad for all those patients on whom I had done a traditional incision to treat this problem. So if I could do this going above the belly button, why not do it for muscle separations below the belly button?

The Mommy makeover is a combination of cosmetic surgery procedures done at the same time to address the changes in the body after pregnancy. Each Mommy makeover is customized to your concerns. However, the Mommy makeover should address 3 main issues: the breast , stomach, and upper body changes.