Introduction Like breast augmentation, prosthetic buttocks or gluteal implants have seen their demand explode in recent years. The development of social networks and the extreme media coverage of reality show celebrities such as Kim Kardashian have led to a real big booty trend that affects not only the United States but also Europe and other parts of the world. The big booty trend was already big in certain South American countries, and over the last ten years, it does look like it has taken over the globe. Although buttock augmentation surgery has been performed for more than 20 years now, it has benefited from the great advances that have been made in implant technology over the last few years. Over the last decade, another procedure has seen an incredible rise in demand as it also provides spectacular results. We are talking about the Brazilian butt lift, another procedure that aims to enhance the appearance of the buttocks by improving shape and adding more volume. In this article, we will discuss what are the surgical options to get round and firm buttocks. Buttock implant surgery Butt implant surgery is the procedure that can provide a bigger booty even for patients who have little butt tissue. The procedure can be performed on thin and petite women and also on men with good results and few complications. The butt implants used nowadays by board-certified plastic surgeons are the latest generation of implants and also safe and approved by the FDA. Gluteal prostheses are different from breast implants. Gluteal implants also consist of a silicone capsule prefilled with a high consistency silicone gel, but the thickness of their capsule and contents is different as butt implants need to take more pressure daily compared to breast implants. Moreover, the implants are created to best resemble the tissues where they will be implanted. This means that breast implants need to be soft and smooth like the tissue of the breasts while butt implants need to be harder to resemble the muscles of the buttocks. This is how the results of butt implant surgery will feel like – your buttocks will feel like well-toned muscles to the touch after the procedure. The gluteal implants are introduced into the buttocks through one or two incisions about 5cm long located in the gluteal fold. When the incision in the intragluteal fold is used, the scar left behind after the operation is completely concealed and won’t be visible, not even when the patient is wearing lingerie or a swimsuit. The advantage of having two incisions (one for each butt cheek) is not to have contact between the implant pockets and to avoid (in case of bleeding or infection) contaminating the second implant that was not initially affected. The implant is introduced into the gluteal muscle which will cover it in its entirety. This means that the gluteal implants should be chosen accordingly. An implant that is too big for the tissues of the butt to cover it properly will be visible through the skin and you will be able to feel it to the touch. This is not a satisfactory result to be achieved. The advantage of placing the implants inside the gluteal muscle is it gets good coverage because of the muscles that go around it. It also avoids an under muscular dissection in contact with the sciatic nerve. Because the incisions are so close to the anus, which is an area prone to bacterial proliferation, the plastic surgeon should maintain the area perfectly aseptic during the procedure. The patient will have the same responsibility after the procedure. Butt implant surgery can give you round and firm buttocks and it can be performed as a stand-alone procedure or even with other procedures such as fat transfer. Brazilian butt lift Another option to get round and firm buttocks is to get a world-known lift: The Brazilian butt lift. The Brazilian butt lift is one of the most popular plastic surgery procedures nowadays as it provides spectacular results without the complications associated with using an external prosthesis. When the Brazilian butt lift is performed, the plastic surgeon will use liposuction to sculpt areas of the body with an excess of adipose tissue. This is often the abdominal area and the flanks, but it can also be the thighs or the back. After the fat is collected with liposuction, the plastic surgeon puts it through a complex centrifugation process to get only the purest and healthiest fat cells that are needed for transfer to the buttocks. In the last stage of the procedure, the fat is reinjected into the buttocks to make it round and firm. The results achieved with the Brazilian butt lift are visible about three months after when the swelling and bruising are gone and the body has absorbed a certain percentage of the fat cells that didn’t survive the transfer. Many of the celebrities that have buttocks we admire have undergone this procedure. However, it is also important to mention that it often takes more sessions of fat transfer to get an impressive looking behind. The amount of fat that can be injected into the buttocks in one session is limited not only by the amount of fat that can be collected with liposuction but also due to the fact that injecting large quantities of fat in one area can cause the fat to die and get reabsorbed by the body. In other words, the augmentation achieved with the Brazilian butt lift is usually not as impressive as what can be achieved with butt implant surgery; however, repeated procedures can make your butt bigger, rounder and more impressive, but this means more money and several recovery periods after each procedure. For patients who want to get buttocks that are round and firm in just one session, I often recommend the combination of implants and fat transfer as this can certainly provide superior results that look completely natural. Traditional butt lift In some cases, it is not an augmentation procedure that will help you get round and firm buttocks, but a procedure that will sculpt the buttocks and help you get rid of saggy skin on the butt. The traditional butt lift is a procedure very different from the Brazilian butt lift, even if the name would suggest otherwise. If the Brazilian butt lift is minimally invasive and requires small incisions in the donor areas and the buttocks, the traditional butt lift involves incisions that are longer or shorter depending on the amount of skin to be removed. When the traditional butt lift is performed, the plastic surgeon will eliminate the excess of skin on the buttocks that makes the butt look saggy and unsightly. The traditional butt lift is a procedure recommended for patients who have gone through a massive weight loss and are now left with an excess of skin or for patients who have been affected by the passing of time and their buttocks have become saggy, despite their dedication to maintaining a balanced and active lifestyle. This procedure is often performed with the patient under general anesthesia and can last one to two hours, depending on the complexity of each case. The butt lift can be performed with liposuction on the thighs or the lower back and also together with implants if the patient has small buttocks and wants to have more volume in the area. Conclusion Round and firm buttocks are what both men and women want to have nowadays. Plastic surgery has developed different methods that can deliver this. Depending on the initial anatomy of the patient and the nature of the imperfection that has affected the buttocks, the plastic surgeon will recommend one procedure or the other or even a combination of procedures. Butt implant surgery is very well known nowadays and it can provide spectacular results when the implants are chosen wisely and the placement is done correctly. The Brazilian butt lift is another very popular procedure that is less invasive and only uses the patient’s own fat tissue to remodel the appearance of the buttocks. The Brazilian butt lift can only be performed on patients with an excess of adipose tissue in other areas of the body such as the abdomen, flanks, thighs, and back. The traditional butt lift is different than the Brazilian butt lift, and it entails a surgical removal of the excess skin that is saggy on the buttocks.