For years, the so-called ‘mommy makeover’ has been about surgically addressing pregnancy-related changes to the breasts and abdomen. Increasingly, women are looking to add a Brazilian butt lift (BBL) to the mix for additional contouring benefits. But is the inclusion of the BBL the future of the postpartum procedure? This newer iteration is known as a ‘hourglass mommy makeover,’ and we spoke to four plastic surgeons for the lowdown on why both patients and providers are now choosing to couple butt augmentation with the traditional breast, stomach, and fat-reduction surgeries.
Mommy Makeover 101
Pregnancy is beautiful, but the changes it brings to the body aren't always as embraced as the new bundle of joy that just joined the family. Not every woman who experiences pregnancy develops loose skin, a stretched-out belly button, or breasts that have lost their perkiness. But, for those that do, a mommy makeover can address these changes and offer a long-term solution.
A mommy makeover is an umbrella term for a collection of procedures that are usually performed in a single session. They include breast surgery (either a breast lift, breast augmentation, or both), liposuction to remove obstinate fat, and a tummy tuck to delete excess skin and repair the abdominal muscles. “The hourglass mommy makeover, as well as a traditional mommy makeover, usually involve the aesthetic improvement of breasts, abdomen, and other areas affected by the weight fluctuations of pregnancy,” explains John Layke, DO, a board certified plastic and reconstructive surgeon in Beverly Hills and co-founder of Beverly Hills MD. “It can also include the thighs, arms, and neck.”
Of course, depending on a patient’s needs and wants, plastic surgeons can perform any combination of procedures. The goal is a body that resembles more of what it looked like pre-baby, and, for some women, a mommy makeover gives them the body of their dreams – even beyond what they had before having children.
When it comes to timing, it’s best to wait at least six months after childbirth before electing to undergo any cosmetic surgery. Also, most surgeons recommend not moving forward until you are done breastfeeding, are close to your ideal weight, and have finished growing your family. These factors help to ensure the most optimal and lasting result.
What About the Fat?
Liposuction is a key component of the mommy makeover to remove stubborn pockets of fat from the abdomen, hips, waist, and even thighs. With all the fat that plastic surgeons remove, some started to put it to good use by purifying it and transplanting it to other parts of the face or body – including the butt. Adding fat to the buttocks via a BBL in conjunction with the standard mommy makeover is known as an ‘hourglass mommy makeover’ for the curves it creates. This variation can still feature all the aspects of a conventional mommy makeover, but it adds new emphasis to the buttocks.
The BBL has become increasingly popular due to current aesthetic ideals in popular culture and the fact that it's a relatively simple procedure to increase volume in the buttocks lost after pregnancy, Dr. Layke shares. It’s part of a larger shift in the goal of the procedure. “The hourglass mommy makeover is everything that a traditional mommy makeover is and includes 360-degree reshaping with fat grafting the buttocks,” says Jules Walters III, MD, a board certified plastic and reconstructive surgeon in Metairie, LA. “With advancements in fat-grafting technology, as well as safety, patients realize that they can achieve natural results with fat grafting to the buttocks, which enhances their mommy makeover results.”
After a traditional mommy makeover, some patients realize the surgery does not feel ‘complete’ as the backside of the body is not addressed at all, explains S. Alexander Earle, MD, a double board certified plastic and reconstructive surgeon in Miami. “Therefore, after the mommy makeover, patients may return for a BBL because they want to improve their buttocks, backs (especially along the bra line), and hips to achieve a harmonious hourglass shape and round out their new figure from all angles,” he says.
No rule says you must repurpose the removed fat. Those undergoing a mommy makeover who are perfectly happy with the size, curvature, and shape of their tush and prefer to leave it alone can – but that’s not to say they can’t use the fat for something else. Dr. Walters says patients may instead add fat to the breasts, face, and even labia majora. It should be noted that the fat removal and transfer must happen at the same time. Unfortunately, at the moment, there is no way to bank fat for future use.
The Perfect Proportion
Several changes happen to the body due to pregnancy and age, and it's not atypical for deflation of the butt to occur. It’s similar to what many women experience with the breasts. But only recently have women been more forthcoming about variations to their backside – especially the ‘hip dip’ area (where the hip and the thigh meet) – along with those affecting the breasts and abdomen. “By enhancing the buttocks with fat grafting, it allows for a smoother transition from the waist to the buttocks, creating an hourglass appearance,” Dr. Walters says. A tummy tuck alone does not create additional volume or contours to the posterior.
The addition of fat to the butt and the surrounding areas gives a more feminine curve to the lower part of the body. While it may seem counterintuitive that adding fat can create a more desirable shape, it most certainly can. Plus, the additional fat makes a lower hip-to-waist ratio that ‘cores out’ the lower back for a more sculpted appearance. In some cases, patients may need to add fat to the buttocks to make their legs look more proportionate to the rest of their bodies, and it may be the opposite for others, says Constantino Mendieta, MD, a board certified plastic and reconstructive surgeon in Miami.
The amount of fat necessary to create these desired proportions varies from patient to patient. On average, a BBL requires anywhere from 250 to 750 ccs (or more) of fat. However, the amount of fat your plastic surgeon can remove via liposuction has to fall under a state's legal limit. For example, Dr. Mendieta says that in Florida (where he practices) the legal limit for fat extraction is four liters. “If there is any sort of cutting involved – like with a tummy tuck or breast augmentation done that same day – the legal limit is one liter,” he adds. Patients need to keep this in mind when considering how much volume they want in their butt. “If a patient does not have a lot of fat, their result may not be as dramatic,” he cautions.
Of course, how much fat exists naturally and the aesthetic someone is trying to achieve influence how much fat to use. For example, Dr. Walters says he sometimes focuses just on the lateral buttocks (i.e. the hip dip) if the patient has a limited amount of donor fat. However, if more significant volumes of fat are available, plastic surgeons can transplant more of it to the butt. Dr. Layke advises that larger volumes of fat can lead to an exaggerated waist-to-hip ratio, so it’s important to discuss your desired results with your surgeon to determine what will be safe and effective.
One Surgery vs. Two: Which Route to Go
A traditional mommy makeover is usually performed all at once (though a patient may choose to break it up). With the hourglass mommy makeover, not every plastic surgeon who performs the surgery chooses to do it all at once. Some, including Dr. Earle, prefer splitting it into two separate surgeries. “It is safer for the patient this way,” he says. In addition, staging the surgery reduces complication rates, makes recovery easier, and results in less discomfort for the patient, he adds. When operating on the buttocks, the breasts, and the stomach, it can be challenging to sleep comfortably, which is crucial for a healthy recovery.
Another critical reason why an hourglass mommy makeover may be broken up is to increase the rate of fat survival. For the fat to successfully establish itself after transfer, patients should not sit or apply pressure to their buttocks or hips for up to six weeks post-op. “This becomes very difficult if another surgical procedure is done to the front of the body simultaneously,” Dr. Earle says. For this reason alone, he recommends doing the BBL first and then, three months later, performing the breast procedure and tummy tuck portions.
Some surgeons may agree to perform the BBL in conjunction with the other two. And since some patients don’t want to undergo surgery twice, they opt to have all three areas of the body addressed in a single surgery. It's important to have that discussion during the consultation process.
The Ideal Candidate for an Hourglass Mommy Makeover
Not every woman undergoing a mommy makeover has deflation in the buttocks, nor does every patient want the additional surgery. However, Dr. Layke says he recommends the hourglass mommy makeover to women who have square body frames, a flatter buttocks, and/or fat accumulation in the back and flank region. It's also suitable for those who have lost a significant amount of weight – whether from weight loss or after pregnancy – and see noticeable changes in their bodies.
Of course, patients need to be in excellent health, at their ideal weight, and have the right amount and kind of fat. “Those with too high a BMI (greater than 30) or who have a high degree of visceral fat are not candidates,” Dr. Earle says. As long as there is enough fat to remove and harvest, most women undergoing a mommy makeover can opt for the BBL portion of the surgery, and Dr. Walters says 99 percent of the mommy makeovers in his practice “include fat grafting to the buttocks to optimize the overall shape.”
For patients who lack enough fat to harvest for transfer, there are alternatives to achieving more of an hourglass figure. Injections of biostimulants like Sculptra® or Renuva® can enhance the shape and size of the buttocks. The former stimulates collagen production, while the latter helps you grow more fat (hence why it's often marketed as an off-the-shelf alternative to autologous fat transfer).
The goal of the hourglass mommy makeover is to create a more shapely lower body by enhancing the butt and hips, in addition to addressing changes to the breasts and abdomen. From what procedures to combine to how much help with childcare you will need, there is a lot to consider pre-op. Check out our guides to the best questions to ask before a mommy makeover and what to expect from the recovery process to help narrow down your research. It’s also imperative to find a board certified plastic surgeon who specializes in mommy makeovers and understands your aesthetic goals. Ultimately, there’s no right or wrong way to go with the procedure, as long as it ends up safely and effectively addressing your concerns.
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