Introduction The appearance of the buttocks is very important for both men and women. Some like them round and big, while others complain about their buttocks being too flat or with sagging skin. The reality is that there are few people nowadays who are happy with the appearance of their buttocks and not willing to make any aesthetic changes to it. Plastic surgery comes to help patients who want to improve the appearance of their buttocks in a safe and efficient way. The results achieved when using plastic surgery to enhance the buttocks are different from patient to patient and dependent on the method used for butt augmentation. There are two methods available to augment the size of the buttocks, and one makes use of silicone prostheses to add volume while the other uses the patient’s own fat cells for the increase in size. When fat grafting to the buttocks is performed, liposuction needs to be done on the donor areas to collect the fat. In this article, we will discuss areas to be treated with liposuction to get fat for grafting and also the details of the fat transfer procedure. Liposuction before fat transfer to the buttocks No fat transfer procedure would be possible in the absence of liposuction. Actually, the reality is that even from the early days of liposuction, plastic surgeons have been looking for a method to preserve the fat collected and use it to add volume to other features of the body. The fat transfer procedures are a dream come true because they allow the patient to get rid of fat from areas where it is unwanted and reinject it in areas where more volume is needed. Moreover, when we use the patient’s own fat cells as a filling substance, the results are more sustainable in time and there are few complications associated with the procedure. When it comes to adding more volume to the buttocks, for example, there is no other filling substance that can provide the results achieved with fat transfer or deliver results that are just as sustainable in time. But where do we get the fat from? Before discussing the areas where liposuction can be performed to collect the fat, you should also know that it is not possible to perform the procedure with someone else’s fat, not even if he or she is your twin brother or sister. The body will reject fat that is coming from a donor and will only accept fat cells coming from other areas of the patient’s own body. So, to be eligible for a fat transfer to the buttocks, you need to have an excess of adipose tissue in other areas of the body. If during the pre-operative consultation the plastic surgeon discovers that you don’t have enough fat in your body to achieve the augmentation desired, chances are he will advise you to gain more weight before the procedure. Keep in mind that there is a maximum of six to seven liters of fat that can be extracted during one session of liposuction, so don’t overdo it with putting on weight as you might be left with an excess even after liposuction is performed. When liposuction is done for fat transfer purposes, the plastic surgeon will address areas that are wide and have the potential to provide enough quantity of fat. This means that areas with a small surface such as the chin, calves, and knees, for example, won’t be treated with lipo to get fat for the transfer, even if they have an excess of adipose tissue. Of course, the plastic surgeon can also treat the stubborn adipose tissues in those areas during fat transfer, but you will need to pay extra fees accordingly. Liposuction entails the use of small tubes called cannulas connected to a medical vacuum device. The cannulas are inserted into the areas to be treated through small incisions of no longer than 3-4 mm. The plastic surgeon will then move the cannula back and forth to dislodge the fat and liquify it so it can be suctioned out of the body. After the fat cells are collected, the incisions are sutured and compressive dressings are applied. Generally speaking, the areas to be treated with liposuction are: Abdominal area The abdominal area is a common choice when it comes to liposuction for fat transfer. Depending on the body type, patients can start accumulating fat in different areas of the body; however, fat accumulation on the tummy is pretty standard for all patients, both men and women, especially after a certain age. When liposuction is performed on the abdominal wall, the patient has the benefit of being left with a smaller circumference of the waist after the procedure and this can enhance the appearance of the body furthermore. Flanks Most women are confronted with unwanted adipose tissue on the flanks. When liposuction is performed on the flanks to collect the fat needed for grafting, the patient will benefit not only from a smaller circumference of the waist but more alluring curves and an improved body shape. Addressing the flanks with liposuction is commonly performed to create the hourglass shape that is desired by many women nowadays. Back Increasing the size of the buttocks with fat grafting on a patient that has an excess of adipose tissue on the lower part of the back can be difficult without addressing this excess of fat. Performing liposuction on the back is not as uncommon as you might think, especially when considering that the procedure is a part of buttock enhancement. Making the lower part of the back slimmer and makes the butt look larger. Moreover, some patients have enough fat on the back to provide the fat cells required for transfer to the buttocks. Thighs The thighs are another area of the body that can be successfully treated with liposuction to get fat for grafting to the butt but also to improve the overall appearance of the body. When liposuction is performed on the thighs, the patient will have a larger, rounder butt but also slimmer thighs which will improve the general appearance of the patient. Fat grafting to the buttocks: Procedure overview This technique is recent and can sometimes represent a feasible solution for patients who want an increase in the size of their buttocks without the complications associated with using butt implants. The procedure is associated with a moderate level of post-operative pain while the discomfort can be significant, but mostly because the patients are not allowed to sit or lie on their back. Three weeks after the procedure the patient can sit on the buttocks; however, the recommendation is to still use a special pillow under the hamstrings for as long as possible so as to not put unnecessary pressure on the fat cells that were transferred to the buttocks. Compression garments are mandatory to be worn for at least a few weeks post-op as they help with reducing the swelling and bruising that can naturally occur and also make the recovery period shorter. Work activities can be resumed within seven to fourteen days, but only with your plastic surgeon’s consent. Also, make sure to discuss with the plastic surgeon when you can start physical exercises again. Generally speaking, intense physical activities can be resumed gradually after the first two months after the procedure. The final results of fat grafting to the buttocks can be assessed after a minimum of three months, preferably six months. Conclusion Fat grafting to the butt is a procedure that can’t be performed without first undergoing liposuction to provide the required amount of fat cells for the transfer. When liposuction is performed for fat transfer, the plastic surgeon needs to address areas that are wide enough and have enough adipose tissue to provide the quantity of fat cells needed for the transfer. This means that in a vast majority of cases, the plastic surgeon will perform liposuction on areas such as the abdominal wall, flanks, thighs and back. Depending from patient to patient and the amount of excess fat present in one area, the plastic surgeon, might need to address one or multiple areas with liposuction. After the fat is collected, the plastic surgeon will need to process it and get only the purest fat cells to be used for fat transfer to the butt.