Introduction The appearance of the buttocks has been a concern for both men and women in the last decade as it is a symbol of sex appeal and one of the features of the body that makes our body image more or less attractive. When the buttocks are too small, too saggy or has other imperfections such as asymmetries, we often have one solution to improve their appearance, and this is via plastic surgery. Plastic surgery nowadays offers different methods for butt enhancement, and among the procedures frequently performed nowadays are the butt lift, but reduction, and butt augmentation via implants or fat grafting. The procedures are safe and have a high success rate; however, to achieve the best results possible, you need a talented, experienced plastic surgeon to guide you through the process. In this article, we will discuss about butt implants and fat transfer and which procedure is more suitable to be used when trying to correct buttock asymmetries. Butt implant surgery: How it’s done A procedure that is very popular nowadays and performed all around the world is butt implant surgery. The procedure entails the use of gluteal implants which are external prostheses made of thick silicone. These implants are inserted in pockets created inside the gluteal muscles. When butt implant surgery is performed, the patient will be asked to start preparing for the procedure about a month in advance. Birth control pills, if the patient is taking any, need to be stopped a month before the surgery to avoid the risk of developing a blood clot. At the same time, two weeks before the procedure, the patient needs to avoid taking any anti-inflammatory medication and natural supplements without the plastic surgeon’s consent. Anti-inflammatory medication can act as blood thinners, increasing the risk of excessive bleeding after the procedure. Six to eight hours before the procedure, the recommendation is not to drink or eat anything as this will increase the risk of developing a complication associated with the general anesthesia often used for this procedure. The day of the surgery, a general anesthetic is administered to the patient who will fall asleep. Then, the plastic surgeon will start making incisions on the buttocks, usually on the intragluteal fold in between the buttocks, to get access to the gluteal muscle where the pocket that will accommodate the implants will be created. The plastic surgeon needs to be very careful when creating the pocket as it needs to be the perfect fit for the implants without being able to move or shift. This procedure should only be performed by a board-certified, experienced plastic surgeon who plays out procedures like this on a regular basis. After the implants are inserted, the incisions are sutured and the patient is moved to the recovery room. The hospitalization period is short, and after a few hours the patient is free to go home with the condition of following the recommendations of the plastic surgeon to the letter and returning the next day or two for the first follow-up consultation. Butt implant surgery is recommended for correcting asymmetries especially after a significant trauma to the buttocks. If the patient is left with one buttock bigger than the other, different size implants can be used to make the appearance of the butt more symmetrical. At the same time, it is important to know that implants can only correct asymmetries present on the upper part of the buttocks as they are inserted inside the gluteal muscles which are positioned on the upper part of the butt. This means that if the imperfection is on the side of the buttocks or the lower part, fat transfer should be performed to achieve the best possible aesthetic result. Fat transfer to the butt: How it’s done Fat transfer to the buttocks has developed tremendously over the last decade. Fat grafting is the so-called “natural” method to get a butt augmentation without the risks and potential complications associated with the use of gluteal implants. This means that patients who are eligible can choose to have this procedure instead of butt implant surgery to get more volume on their buttocks and an improved shape. However, it is important to understand straight from the beginning that the results achieved with the two procedures are very different and the procedures can’t be a substitute for each other. To be able to undergo fat transfer to the butt, the patient needs to fulfill certain conditions. The most important criteria for becoming eligible for fat grafting is the presence of donor areas. Donor areas are areas of the body with an excess of adipose tissue that can be extracted with the help of liposuction and used for transfer. Generally speaking, the donor areas are the abdomen, flanks, and thighs, but in some cases it can also the back, depending on the physical characteristics of the patient. If the patient doesn’t have areas with an excess of fat, it means that he is not eligible for the procedure. The procedure can’t be performed with fat collected from other people, even if they were twins. In a vast majority of cases, general anesthesia is also administered to the patient undergoing fat grafting to the buttocks, so the same requirements are valid for the pre-operative period. The procedure will start with the plastic surgeon performing liposuction on the donor areas. This means that small incisions are made on the donor areas so the plastic surgeon can insert the cannula. Back and forth movements are performed with the cannula, so the fat is liquefied and suctioned out of the body. The plastic surgeon needs to be very careful when doing the fat extraction as he needs the fat cells undamaged. An inexperienced plastic surgeon might damage the fat cells so there will be not much left for transfer to the buttocks. Keep in mind that not all the fat extracted can be used for the transfer. The fat goes through a centrifugation process to be purified. The blood, impurities and damaged fat cells are eliminated during this process, so the plastic surgeon is left with only healthy fat cells to be used for transfer. The transfer is performed with a special syringe, and again, it entails very small incisions on the buttocks. The injections are performed at different depths inside the buttocks and on different areas of the butt. An experienced plastic surgeon will be able to create a symmetric result and even correct butt asymmetries that were present before the procedure was performed. However, it is important to understand that when using fat transfer, we can only correct slight asymmetries of the buttocks as the plastic surgeon can’t inject too much fat in one area of the butt as it might die. Fat transfer can also be used to correct minor sagginess of the buttocks as the fat will give the buttocks a lifting effect. This is the reason why fat grafting is also known as the Brazilian butt lift. When dealing with more significant asymmetries of the buttocks, the plastic surgeon might decide to use a combination of procedures such as implant surgery, liposuction, and fat transfer to ensure satisfactory results are achieved. Conclusion The appearance of the buttocks can be improved by using different plastic surgery procedures via implants or fat grafting. Each procedure has a different medical indication and each patient will benefit more from one or the other and even from undergoing combined procedures. To correct the asymmetries of the buttocks, we can use implants or fat transfer, depending on the type of asymmetry. After a proper assessment of the patient’s anatomy and of the condition of the tissues in the buttocks, the plastic surgeon will make the recommendation for the optimal surgical plan to correct the imperfection.