Buttock Augmentation (Implants and BBL) in Thessaloniki and Athens, Greece

Buttock augmentation is surgery that gives the buttocks more volume, projection and a better shape. It is done in one of two ways: with silicone implants designed specifically for the buttocks, placed within the gluteal muscle, or with fat taken from other areas of your body and transferred to the buttocks (BBL).

In the past, buttock implants had a higher complication rate, because of the materials and techniques of the time. With modern implants and intramuscular placement, complications have fallen. (Flores-Lima et al., 2013; Sinno et al., 2016)

The Brazilian butt lift (BBL) uses no silicone. I harvest fat by liposuction from the abdomen, the waist or the flanks (“love handles”), process it so that it is clean, and place it in the buttocks. This reshapes the waistline at the same time, because the fat is taken from where there is too much.

In some cases I combine the two methods: the implant provides size and shape, and the fat corrects irregularities around it. If your main concern is loose skin rather than lack of volume, see thigh and buttock lift.

Buttock augmentation suits healthy adults with a stable weight and realistic expectations. Implants also suit very slim people, while a BBL needs enough body fat to transfer. Which method is right for you, implants, BBL or a combination of both, is decided at the examination, based on your measurements and what you want to change.

Preparation starts with a consultation, where I examine you, take measurements and agree the method with you; you then receive a written plan and quote. Before surgery you need blood tests and an assessment for general anaesthesia, you stop smoking for at least 4 weeks, and you buy a buttock compression garment.

What happens at the consultation?

I examine your buttocks, pelvis, waist and thighs, the quality of your skin and how much fat is available for transfer. I take measurements of the pelvis and buttocks, which determine the diameter and projection of the implant. We discuss what you would like to change, whether implants, a BBL or a combination suits you, and the risks of each method. You receive a written plan and quote.

What tests and instructions apply before surgery?

You need pre-operative blood tests and an assessment for general anaesthesia. Smoking increases the risk of wound complications and reduces fat survival, so stop at least 4 weeks before and 4 weeks after surgery. If you take anticoagulants, antiplatelet drugs or hormonal medication, tell me; anticoagulants are only stopped in agreement with the doctor who prescribes them. Buy the special buttock compression garment in advance. The date of surgery is set once your tests are complete.

Buttock augmentation is done under general anaesthesia. With implants it takes 1 to 1.5 hours: the implant goes in through a 6 to 7 cm incision in the intergluteal fold (the crease between the buttocks) and sits within the gluteal muscle. In a BBL, fat taken by liposuction is injected only into the fat under the skin, never into the muscle.

I operate with you lying face down (prone position). The method, the implant size and the fat-transfer sites are agreed at the consultation and marked on the skin before surgery.

Where are buttock implants placed?

An implant can be placed above the muscle, under the muscle’s fascia (subfascial), within the muscle (intramuscular) or beneath the muscle. I prefer intramuscular placement, because it gives more natural results and fewer complications: the muscle covers the upper pole of the implant better, so its outline does not show, without the risks of placing it beneath the muscle, where the sciatic nerve and large blood vessels run. Subfascial placement is an alternative in some cases.

Once the pockets are created and bleeding is fully controlled, the implants are inserted with a fully aseptic technique and the muscles are secured at the intergluteal fold. I do not use drains unless there is an increased risk of bleeding or fluid collection.

Which buttock implants do I use?

Buttock implants resemble breast implants, but they have firmer silicone and a much more reinforced shell, to withstand the mechanical stress of sitting and movement. I prefer round implants, because their shape does not change if they rotate, with low or moderate projection, for a more natural result and greater safety. Anatomical (teardrop) and oval implants also exist, but with these any rotation shows.

Breast implants must not be used in the buttocks, however tempting the lower cost may be: the stresses are much greater and they are far more likely to rupture early.

How is a Brazilian butt lift (BBL) done safely?

A BBL starts with liposuction, usually of the abdomen, waist and flanks. The fat is harvested with power-assisted liposuction (MicroAire), so that it is not damaged, and cleaned of blood and fluid. It is then injected with special cannulas through 3 to 4 mm incisions, using the EVL technique (expansion vibration lipofilling), usually into the upper and outer pole of the buttocks.

The safety rule: fat is injected only into the subcutaneous layer, above the fascia of the gluteal muscle, and never into the muscle. Large veins run beneath the muscle; fat that entered there could pass into the circulation and cause a fat embolism in the lungs, the most serious complication of a BBL. This rule comes from the ASERF task force on gluteal fat grafting (Mofid et al., 2017) and the joint safety statement of the American plastic surgery societies (ASPS, The Aesthetic Society, ASERF, 2022). Anatomical studies have shown that fat injected into the muscle can migrate deeper, while fat placed under the skin stays above the fascia (Del Vecchio et al., 2018). For the same reason I use large-diameter cannulas, keep them parallel to the skin rather than angled downwards, and do not inject fat below the sitting bones. These rules reduce the risk considerably, but do not eliminate it.

Fat survival is not predictable: part of the fat is absorbed in the first months, and this is affected by smoking, technique and recovery. For how the fat is harvested, see also liposuction.

What is the hybrid technique (implants and fat)?

Once the implants are in place and the pockets are closed, I perform liposuction on the flanks and, if needed, the thighs, and place part of the fat with EVL into the outer and upper pole of the buttocks, again only in the layer under the skin. The implant provides the size and basic shape, and the fat refines the waistline and the transition to the buttocks. This gives the greatest correction in size and shape.

What scars will I have?

With implants there is a single 6 to 7 cm incision in the intergluteal fold, between the buttocks; the scar stays hidden and becomes barely noticeable over time. In a BBL the incisions are few and small, 3 to 4 mm each, and leave small scars that fade with time. The skin stitches are removed at 5 to 7 days.

Can it be combined with other procedures?

Buttock augmentation is often combined with liposuction of the waist, abdomen or thighs. When there is loose skin, especially after major weight loss, augmentation alone is not enough and we discuss a thigh and buttock lift.

Do I need to stay in hospital?

No. You do not need to stay overnight in hospital after buttock augmentation. You go home with a companion, wearing the special compression garment, and you must not drive after general anaesthesia.

With implants you wear a buttock compression garment and avoid pressure on the buttocks for 3 weeks: you sleep face down and sit with care. After a BBL you return to daily activities in about 2 weeks, and I decide individually when you can sit and sleep on your buttocks. Exercise waits 6 weeks. Pain is usually mild.

When	How you feel	What you can do
Days 1–3	Mild pain, controlled with ordinary painkillers; after a BBL, soreness and bruising in the liposuction areas	Compression garment day and night; short walks around the house; sleep face down if you have implants
Weeks 1–2	Swelling settles, mild discomfort	After a BBL, sitting and sleeping on the buttocks when I tell you, depending on which pole (upper or lower) mainly received the fat; back to daily activities in about 2 weeks
Week 3	Some tightness in the buttocks	Compression garment stops; with implants, the restriction on pressure on the buttocks ends; office work
Week 6	Feels almost normal	Gradual return to exercise
Months 3–6	The implants settle into their final position and there is no foreign-body sensation; after a BBL, the fat volume stabilises	Normal activity and sport without restrictions

Buttock augmentation does not need an overnight hospital stay, and the skin stitches are removed at 5 to 7 days, before you leave. Plan to stay in Greece for 10 to 15 days, with implants or a BBL; I confirm it for your own case at the consultation.

The main practical question is sitting. With implants you avoid pressure on the buttocks for 3 weeks, and after a BBL I decide individually when you can sit, so the journey home needs planning: book an aisle seat, stand up and walk every 30 to 60 minutes and, after a BBL, sit on a cushion placed under your thighs so that your buttocks carry no weight. You travel wearing your compression garment, and you take home the written instructions I give you after surgery.

Follow-up: in person until your final check the day before your flight, then by video call at 10 days, 1 month, 6 months and 1 year.

At home, arrange help for the first days; nursing care at home can be arranged if you would like it. Plan for about 2 weeks off work after a BBL and 3 to 4 weeks after implants, and no exercise for 6 weeks.

With implants, the final result shows at 3 to 6 months, once the implants have settled into their final position; it is stable and does not change with weight fluctuations. After a BBL, the fat that survives stays permanently, but its volume follows changes in your weight.

Once the implants have settled in there is no foreign-body sensation, and they do not get in the way of sport. The change in size and projection is usually greater with implants than with fat alone. After a BBL, part of the fat is absorbed in the first months and survival is not predictable, so a second session may be needed. The buttocks continue to change with age, pregnancy and major changes in weight.

Buttock augmentation carries risks, like any operation. With implants, the most common complications are the wound opening (dehiscence) and fluid collection. After a BBL, the most serious is fat embolism, which is rare but dangerous; this is why fat is placed only in the layer under the skin. I explain your own risks at the consultation.

Complication	How common	Prevention and management
Wound opening (implants)	Not rare; the most common complication with implants	Avoiding pressure and keeping the intergluteal fold clean; usually heals with wound care
Fluid collection (seroma)	Not rare	Compression garment and limited movement; drained with a needle if it occurs
Infection	Rare	Aseptic technique and antibiotics; the implant rarely needs removing
Implant displacement or rotation	Rare	Intramuscular placement and round implants; corrected with revision surgery
Asymmetry or a palpable implant	Uncommon	Correct size and low or moderate projection; improved with fat transfer
Sciatic nerve irritation or change in sensation	Rare, usually temporary	Avoiding placement beneath the muscle; monitored at follow-up
Fat embolism (BBL)	Rare, but serious	Injection only into the subcutaneous layer, never into the muscle; large-diameter cannulas, parallel to the skin
Contour irregularities or asymmetry (BBL)	Not rare	Injection in thin layers; correction in a second session
Fat absorption or fat necrosis (BBL)	Absorption of part of the fat is expected; fat necrosis is rare	Careful fat processing, no smoking; repeat session if needed
Bruising and swelling	Common, temporary	Compression garment; settle within a few weeks
Deep vein thrombosis	Rare	Early mobilisation, preventive treatment where needed

Smoking. Stop at least 4 weeks before and 4 weeks after surgery; smoking increases healing complications and reduces the survival of the transferred fat.

Blood thinners. Tell me if you take anticoagulants or antiplatelet drugs. They are always stopped in agreement with the doctor who prescribes them.

I do not publish prices, because the cost of buttock augmentation depends on the method, the implants, the amount of fat harvested and the length of the hospital stay. You receive a quote after the consultation, once you have been examined and we have agreed together on the plan that suits you. The quote depends on:

• The method: implants, BBL or the hybrid technique.
• The type and size of the implants.
• The liposuction areas and the amount of fat.
• The length of the operation and of the hospital stay.
• Combination with another procedure, such as a thigh and buttock lift.

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