Before diving into the alternative treatments, here’s a quick primer on the popular BBL. During surgery, your plastic surgeon removes the fat (via liposuction) from an area like the stomach or elsewhere on the body where there’s enough fat to take before cleaning and transferring it into the butt. By moving the fat into the butt, your plastic surgeon can sculpt a more figure-flattering look and give your bum more height, roundness, prominence and fullness.
Unfortunately, back alley procedures, unsavory ethics, poor operating techniques, and a desire to make the butt as big as humanly possible initially gave the BBL a bad rap. But all of that has changed. Plastic surgery societies, including the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), are at the forefront of safety and have since set forth numerous recommendations to enhance the safety of the BBL. Practice advisories include only placing fat in the subcutaneous tissue to reduce the risk of fatal fat embolisms. Grand Rapids, MI, plastic surgeon David R. Alfonso, MD adds that national news stories regarding BBL safety highlight the importance of selecting a well-trained board-certified plastic surgeon, which is imperative for a good result. “Many states mandate the use of ultrasound during surgery to ensure the proper plane for fat placement,” he adds. And plastic surgeons are following the set forth protocols to ensure a safer operation for their patients. For example, in February, Fort Myers, FL, plastic surgeon Ralph Garramone, MD began integrating ultrasound guidance into the fat transfer portion of his BBLs. “This is the safest way to perform the procedure, and it gives better results,” he adds.
Even despite BBL amendments and the arrival of alternative noninvasive solutions, some doctors, like Pittsburgh plastic surgeon Jeffrey R. Antimarino, MD are seeing an uptick in demand for BBLs. “Many women are still interested in the BBL, enough to inquire about it. The main deterrent is whether they have enough donor-site fatty tissue to accomplish their goals,” he says.
But not every patient who wants a BBL is a candidate for one, and these alternate options make for a good solution for those who are too thin for surgery or can’t commit to its recovery period or the price tag. “Noninvasive procedures may not give the same improvement as a BBL, but they will give some betterment without the need for anesthesia or recovery time, which makes them quite safe,” Dr. Garramone says. These are the most effective treatments to consider, whether you want to try a nonsurgical option first or are looking to boost your booty without going under the knife.
1. Sculptra Injections
Most patients think of Sculptra injections for reducing facial wrinkles and reinstating lost volume, but they can also enhance the butt. Sculptra works by stimulating natural collagen creation, which Dr. Garramone says creates fullness via volume augmentation. “With the treatment, there is a period where there is essentially no improvement from the injections. So patients need to be aware of that and be patient to see the final result.” He adds that with Sculptra, the injections must be performed at intervals to achieve and maintain fullness.
Using Sculptra to augment the butt can get very expensive since doctors tend to inject a large amount of product over multiple sessions. Besides augmenting the bum, Sculptra injections also work well to even out hip dips (minor contour irregularities on and around the butt and hip) by establishing a smoother transition in the area. Some doctors choose to couple Sculptra with dissolvable polydioxanone (PDO) threads for added lift and a booty boost.
2. Emsculpt NEO
If a needle-free approach is more your speed, consider Emsculpt NEO, a noninvasive body-shaping procedure that improves muscle tone in the butt. “We may be seeing the beginning of a trend towards multi-modality treatments, like Emsculpt, as a less invasive means of achieving improved shape without the risks of a surgical procedure,” Dr. Alfonso says.
During the treatment, an applicator sits on top of the gluteal muscles and emits high-intensity focused electromagnetic technology (HIFEM+), the equivalent of doing about 20,000 squats in 30 minutes. “The energy causes the gluteus maximus muscle to contract many more times than it could naturally, causing the growth of the muscle, which enhances the shape and size of the buttocks,” Dr. Garramone explains. “It works best in patients who actively exercise rather than counting on Emsculpt to create all of the improvement.”
Typically, Emsculpt NEO utilizes radiofrequency (RF) energy to address fat reduction, but this feature is often turned off when treating the butt, so only the HIFEM+ technology targets the muscles. According to the brand, seven new clinical studies showed an average 25% increase in muscle mass after four Emsculpt NEO treatments. “It’s a good alternative to a BBL, and it’s natural because there is no implanted material,” Dr. Garramone adds. While Emsculpt NEO doesn’t physically add volume like fat, filler, or an implant, the visible changes are strictly due to muscle stimulation. Four to six downtime-free, painless sessions are recommended to see optimal results.
The second body-sculpting device in the CoolSculpting family, CoolTone, targets the muscles in the butt. But its technology differs from Emsculpt NEO, making the experience unique to the procedure.
CoolTone is FDA-cleared for the glutes (and abdomen and thighs) and relies on Active Magnetic Pulse (AMP). Sending out magnetic pulses triggers muscle contractions deep within the body to warm up, tone, strengthen, and firm the muscles while providing an active recovery, too. Like Emsculpt, CoolTone also creates intense muscle contractions to build definition in the butt.
Four 30-minute treatments are needed to see more muscle and firmer and better-toned buttocks, but each treatment plan is individualized to the patient’s goals and starting point.
Yes, liposuction is surgery, but how it enhances the butt (when performed solo) differs from a BBL. Liposuction—a vital component of a BBL—suctions out extra fat in areas that can cause the butt to look ununiform. “Doing liposuction to the hips, lateral thighs, and upper posterior can help shape the buttock and give the appearance of more projection without adding volume,” Dr. Antimarino says. The recovery is also shorter and less complicated than a BBL, with fewer limitations on activities and sitting positions. Still, most patients need to wear compression garments for one-month post-lipo.
If you don’t want to transfer the extracted fat into the butt, there are other homes for it. “The face and breasts are common areas to graft fat. Or, if a patient has contour issues, we can use the fat to improve those areas,” Dr. Antimarino explains.