A new kind of consultation is becoming common at Southwest Plastic Surgery. Not patients asking to go bigger, but patients who had buttock implants or large fat transfers years ago and now want the opposite: smaller, leaner, and natural. These are the questions Dr. Agullo answers in those visits, in his own words.
Can Implants and Old BBL Fat Really Come Out?
Yes. A recent consultation involved 300 cc silicone implants placed inside the muscle a decade ago, followed by two Brazilian butt lifts with about 1,100 cc of fat per side. The goal was much smaller, leaner, more natural looking. The plan combines implant removal, liposuction to reduce the transferred fat, and a lift to handle the loose skin left behind.
What Happens to the Muscle?
When an intramuscular implant goes in, the muscle is not really cut, only spread apart to make a space. Once the implant comes out, the muscle simply comes back together. The only repair happens where the incision was made to remove it. Stitches placed in the middle of the muscle just rip open, because there is no fascia there to hold them.
Does the Capsule Come Out Too?
As much as needed. A thick capsule comes out. A ruptured implant means the entire capsule comes out. Sometimes the capsule is so thin that removing it only damages muscle. At the ten year mark, rupture or leaking would not change the plan; everything gets cleaned out either way.
Will the Result Look Flat?
No. Projection remains, just less of it. If an implant was creating the shape in one spot and removing it would leave a divot, some of the fat and skin from the lift gets saved and flipped in to restore that volume. The goal is a smooth, round, natural shape at a smaller size.
Why Add a Buttock Lift?
Removing that much volume leaves skin with nowhere to go. A buttock and lateral thigh lift removes the extra skin, tightens both the superficial and deep layers so the result holds, and smooths the transition into the thigh. The incision is long but hides in clothing lines.
Seromas, Hematomas, and Drains
Drains stay in until they are ready, usually about a week, and they are what prevent seromas. Hematomas in the buttock are extremely rare; in more than a thousand buttock cases, Dr. Agullo has never had one there. The muscle’s blood supply is so rich it essentially repairs itself within days.
Surgery Time and Recovery
Plan on about four to four and a half hours under general anesthesia: roughly two hours of liposuction, up to two hours for the implant removal, and the rest for the lift. Antibiotics run until the drains come out. Sitting and back-sleeping are allowed right away unless fat injections are added for small irregularities. Out of town patients should stay at least a week, two if possible.
What if the Original Surgery Was Done Abroad?
Many patients had their implants or fat transfers overseas. What matters now is doing the removal in an accredited facility. The surgery center at Southwest Plastic Surgery is Quad A accredited, the same standard as a hospital, with pre op labs and an EKG on every patient.
Why Southwest Plastic Surgery?
Dr. Agullo is a double board certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor at Texas Tech University Health Sciences Center. Body contouring revisions, including implant removals and BBL reductions, are a core part of the practice.
Ready to Talk?
Call (915) 590-7900, text the consult line at 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
