The Brazilian Butt Lift (BBL) is a cosmetic procedure that reshapes the body by transferring fat from areas like the abdomen or flanks to the buttocks, enhancing their size and contour. While this fat grafting technique aims for smooth, harmonious results, post-operative contour irregularities are a common concern. These irregularities manifest as visible unevenness, depressions, or indentations—often called “dents”—which can occur in both the fat harvesting (liposuction) and fat receiving (buttocks) sites. Understanding the causes and timing of these changes is the first step toward finding professional solutions to restore a smooth contour.
Why Contour Irregularities Occur
The formation of dents and uneven texture after a BBL stems from a combination of biological responses and technical factors. One primary biological cause is fat necrosis, which occurs when transferred fat cells fail to establish a new blood supply and die off. This cell death can lead to localized volume loss, resulting in depressions, or it can form firm, hard lumps beneath the skin surface.
Fibrosis, the development of dense scar tissue, is another major contributor to contour problems. This scar tissue can contract and harden beneath the skin, physically pulling the surface downward to create a noticeable indentation or divot. Fibrosis is part of the body’s natural healing process but can be exacerbated by trauma or uneven post-operative compression.
Technical issues related to surgical execution also play a significant role. Uneven fat harvesting during the liposuction phase can leave depressions or grooves in the donor areas, such as the back or flanks. Similarly, if the fat is injected unevenly or too aggressively into the buttocks, it can lead to lumpy contours or areas of over- or under-correction.
Aggressive liposuction techniques can damage underlying tissue layers, resulting in a rippling or dimpled appearance in the skin of the donor site. Placing too much fat in a single area of the buttocks can also compromise the blood supply, increasing the likelihood of fat necrosis and subsequent irregularities.
Recognizing Early vs. Permanent Changes
Patients experience temporary effects that can mimic permanent dents in the immediate weeks following the procedure. During the first six to twelve weeks, swelling, bruising, and fluid accumulation (seromas) are common, creating temporary lumps and unevenness. These early changes are part of the normal recovery process and typically resolve as the body heals and fluid is absorbed.
True, persistent contour defects usually cannot be accurately assessed until the initial swelling has fully subsided. The final assessment of the BBL result, including any dents caused by fibrosis or fat necrosis, is generally recommended around six months to a full year post-operation. By this time, the majority of transferred fat that will survive has integrated, and the body’s inflammatory response has calmed down.
Signs that an indentation may be permanent include a persistent hardness or immobility of the tissue at the site of the depression. These firm areas often indicate established scar tissue or a significant pocket of necrotic fat that will not be absorbed easily. True contour defects, unlike temporary swelling, remain static and do not fluctuate significantly over several months.
Professional Treatment Options for Revision
Correcting established dents and irregularities after a BBL involves professional interventions, depending on the cause and severity. For minor indentations or areas of early, soft fibrosis, non-surgical approaches are often the first line of treatment. Targeted steroid injections can be used to soften and flatten thick, hardened scar tissue that is pulling the skin inward.
Minimally invasive treatments like radiofrequency (RF) and ultrasound-assisted techniques can also be applied to the area. These devices use energy to gently heat the underlying tissue, which helps to break up and remodel fibrous scar tissue, gradually smoothing the skin contour. Medically indicated deep tissue or lymphatic drainage massage, performed by a trained therapist, can sometimes help to manually soften and redistribute fluid or early scar tissue.
For more significant or persistent depressions, surgical revision is often the most effective solution.
Revision Fat Grafting and Subcision
Revision fat grafting involves harvesting fat from a new donor area and strategically injecting small amounts into the dents and surrounding areas to fill the defect and blend the contour. This process is often combined with subcision, where a specialized needle is used to release the fibrous bands of scar tissue tethering the skin down before the fat is injected.
Adjunct Procedures
Targeted liposuction may be used as an adjunct procedure to smooth out surrounding areas that appear too full relative to the dented area. This focuses on creating a smoother transition and improving the overall contour blend. If hard, established nodules of necrotic fat cannot be softened or filled, they may require excisional treatment to surgically remove the dead tissue.
Dermal fillers, such as hyaluronic acid-based products, can also be utilized for very small, localized depressions that do not warrant a full surgical revision. While these offer an immediate smoothing effect, they are temporary and are generally reserved for minor touch-ups, as fat grafting remains the preferred and more permanent method for addressing larger contour defects. All revision procedures require careful planning by a qualified surgeon to ensure the underlying cause is addressed effectively.