Introduction Fat transfer procedures are very popular nowadays. Ever since we started removing fat with the help of liposuction, specialists have tried to find a method to use the fat collected to improve other areas of the body. The first results of fat transfer procedures were not impressive as the fat didn’t survive for long in the new environment. But due to the progress of technology and medical research in the last ten years, we can now use fat transfer to different areas of the body, including the buttocks, and achieve spectacular results that are long-lasting. Getting a big butt using a less invasive method compared to implants and with 100% natural results is a dream for many women. However, like any other surgical procedure, unsatisfactory results can occur. In this article, we will discuss the butt lipofilling procedure and how revision surgery is performed if necessary. Advantages of fat transfer to the buttocks The procedure is minimally invasive and entails a short hospitalization and recovery period. Fat grafting to the buttocks doesn’t leave behind significant scarring, and the incisions made on the donor areas for liposuction and the buttocks are no longer than 3-4 mm. The procedure can be successfully used to eliminate all the complications associated with using silicone implants. However, keep in mind that the augmentation achieved is not as significant compared to using silicone implants. The procedure is often requested by patients with an excess of adipose tissue in certain areas of the body, especially the abdomen and the flanks. Having an excess of fat tissue in other areas of the body is a mandatory condition to be eligible for fat transfer; however, areas with adipose pockets are also remodeled during butt lipofilling and the whole body shape improves in return. Unlike any other type of filler substance, the fat will behave like natural body tissue. The filling effect is permanent, as long as the patient keeps a constant weight with little fluctuations. When considering fat transfer to the buttocks, you should know that you can’t get the procedure done with fat from a donor or if you are smoking and can’t quit for at least three weeks before and after the procedure. Also, it is important to keep in mind that you might need multiple procedures to get the buttocks of your dreams as there is a limited amount of fat that can be removed and injected in one session. The autologous fat transfer can bring considerable improvement to the appearance of the buttocks, an improvement that can’t be achieved using any other method. The most important thing is that it leaves behind little scars and entails minimal risks. After fat transfer to the buttocks, there are a few complications that can occur. Most of them are common to any type of procedure and don’t pose any special risks. Excessive bleeding can occur in extraordinary circumstances and can be present on the buttocks or the fat donor areas. The risk of infection is minimal if the procedure is performed in an accredited medical facility with all the safety protocols in place and if the patient will be prescribed antibiotic treatment for five days after the procedure. How does lipofilling to the buttocks work? The main principle of the procedure is harvesting fat from areas where it is in excess, processing it to get pure fat cells and inject these cells into the buttocks. The fat that is harvested during liposuction is actually a mix of adipose cells, stem cells, and impurities (types of cells and tissue that can’t be used for the transfer). By processing the fat, we get a thick substance made of fat cells and stem cells. The aim of the purification process is to eliminate blood and other impurities. The fat cells are then injected with the help of special cannulas into the buttocks. The plastic surgeon will inject the fat in layers in different parts of the buttocks and at various depths to ensure that the vast majority of the fat grafted survives in the new environment. In the first few days after the procedure, the fat and stem cells need to form new vascular connections with the tissue they have been inserted into to be able to survive. The fat cells that won’t manage to get nutrition from a blood network will die and be reabsorbed by the body. However, it is important to know that the adipose cells that will survive after the transfer will stay there and start behaving like the other cells in the area, increasing or decreasing their volumes according to the patient’s weight fluctuations. An experienced plastic surgeon will know and tell you that a certain percentage (approximately 30%) of the fat injected will be reabsorbed by the body in the first few weeks after the procedure. Because of this fact, the plastic surgeon might decide to inject 30-40% more fat than necessary so the patient can achieve the desired results in the end. If the results are still not satisfactory, another session can be performed after six months from the initial procedure. For some patients, it might take two, three or even more procedures to achieve the results they desire. Can fat be removed from the buttocks after butt lipofilling is performed? In case the volume of fat injected is way beyond what the patient requested, a small liposuction can be performed to adjust the final results, but this happens in very rare cases. Keep in mind that it is natural for the buttocks to be swollen and bruised immediately after the procedure and for a few weeks or even months. Moreover, the volume of the buttocks can be much bigger immediately after the surgery than in two or three months’ time after the fat has settled and a certain amount has been reabsorbed by the body. This is why it is important for patients to understand that the initial results are not the final results. The patient should wait at least three months before evaluating and considering revision surgery. Fat can be easily removed from the buttocks with the help of liposuction if the patient finds the volume of the butt too big compared to what she expected to achieve with the surgery. Make sure to schedule the revision surgery no sooner than six months after butt lipofilling and wear the compression garments as per the doctor’s orders. The risk of getting unsatisfactory results can be significantly reduced if you choose an experienced, board-certified plastic surgeon that you can trust and talk openly with. The plastic surgeon should make sure you understand all stages of the procedure and the expected results. If you are unsure about what to expect in terms of initial results, ask the plastic surgeon to show you before and after pictures of patients with similar characteristics as yours. Moreover, keep in mind that most patients find it difficult to adjust to the new appearance of their butt for the first few months. You might need to get new clothes or change your clothing style altogether. But in time you will get used to your new appearance and start enjoying your big, round buttocks. Conclusion Fat transfer to the buttocks is very popular and sought after nowadays. Patients from all over the world benefit every day from the advantages of undergoing this procedure. The procedure sculpts the body on multiple levels and not just improving the buttock area. The donor areas are also slimmed down and the patient has a more alluring body shape after the procedure is performed. Many patients ask if fat can be removed from the buttocks if the results of the procedure are unsatisfactory. This is possible, but the recommendation is to wait at least three months after the initial procedure before making the decision to undergo revision surgery, and to schedule your liposuction after six months from butt lipofilling.