A Brazilian Butt Lift (BBL) reshapes the buttocks using the patient’s own body fat, harvested via liposuction and strategically injected for volume enhancement. Fat necrosis is a potential complication where transferred fat cells fail to establish a blood supply and die. This cellular death leads to the formation of firm, non-cancerous lumps or fluid-filled pockets known as oil cysts beneath the skin. While concerning, this condition is a common and generally manageable occurrence after fat transfer.
Recognizing Fat Necrosis After BBL
Fat necrosis typically manifests weeks to a few months following the BBL, during the period when grafted fat cells integrate with existing tissue. Patients may notice a palpable, hardened lump or nodule under the skin that can range in size. These masses may feel tender, and the overlying skin can sometimes show discoloration or bruising. If dead fat cells liquefy instead of hardening, they form an oil cyst, which feels like a softer, oily lump.
Necrotic tissue can cause the skin surface to appear uneven or dimpled, affecting the smooth aesthetic result of the BBL. A plastic surgeon confirms the diagnosis primarily through a physical examination. To differentiate fat necrosis from other complications, such as a hematoma or infection, the surgeon uses medical imaging. Diagnostic tools like ultrasound or magnetic resonance imaging (MRI) provide a detailed view of the tissue, confirming the presence of dead fat cells or an oil cyst.
Non-Surgical and Minimally Invasive Management
Initial management often involves a conservative approach, as the body can resolve smaller areas naturally. The immune system naturally attempts to absorb the dead fat cells over time, especially in mild or asymptomatic cases, requiring only observation. This natural process can take several months. Intervention is reserved for lesions that are persistent, symptomatic, or cosmetically noticeable.
Conservative methods to accelerate the breakdown of lumps include deep tissue massage and physical therapy. Targeted massage increases blood circulation to the area, promoting the softening and gradual absorption of hardened masses. Improving local blood flow through these methods assists the body’s natural healing and removal of necrotic tissue.
When fat necrosis presents as a fluid-filled oil cyst, fine-needle aspiration (FNA) or needle drainage is often performed. Using a sterile needle and syringe, the liquefied fat is drawn out of the cyst, immediately reducing the size and tension of the lump. This technique effectively manages the fluid component but does not address hardened, calcified tissue.
For small, localized areas of firm necrosis, limited liposuction techniques are a minimally invasive alternative to open surgery. This method uses a small cannula to break up and suction out the dead fat tissue through tiny incisions. Ultrasound-assisted technology enhances precision, allowing for targeted removal of damaged fat while preserving surrounding healthy tissue. These outpatient procedures are successful for smaller lesions and offer a quicker recovery compared to formal surgical excision.
When Surgical Removal Becomes Necessary
Formal surgical removal, or excision, is typically reserved for cases where non-surgical and minimally invasive treatments have failed. Criteria for this invasive procedure include a large, persistent mass, chronic pain, or significant calcification of the necrotic tissue. Masses causing a noticeable aesthetic deformity or chronic discomfort require definitive surgical intervention.
Unlike living fat, dead fat that has hardened and calcified cannot be effectively suctioned. The procedure involves making a small incision and carefully dissecting the necrotic tissue out, similar to removing a benign tumor or cyst. The goal is to remove the entire mass while minimizing damage to surrounding viable fat cells.
The primary consequence of surgical excision is a loss of volume in the treated area, which may create a visible contour defect or “dent” in the buttock. If the removed mass is extensive, the surgeon may recommend a staged revision BBL. This second fat grafting procedure is performed later to fill the resulting depression and restore the desired contour, ensuring the issue is completely resolved before aesthetic reconstruction.