A growing share of the out-of-town patients arriving at Southwest Plastic Surgery are coming to undo, or at least quiet down, a decision made a decade ago.
BBL reversal has become a signature of the practice’s destination surgery program, and Dr. Frank Agullo, founding vice president of the World Association of Gluteal Surgeons, has a front-row view of why.
Why Now
“Most of the patients are asking to reduce their BBLs,” Dr. Agullo says. The physiology explains it. “A BBL is a procedure where liposuction is done in the trunk, including the upper back, lower back, lateral chest, abdomen, and sometimes the thighs and arms. Once liposuction is done in these areas, they do not increase in volume as much when the patient gains weight. This fat is transferred to the buttock, and when the patient does gain weight, the buttock is the one area that increases in volume the most.”
The result, years later: a buttock that is “no longer proportionate, or has developed cellulite or even droopiness.” Some patients develop what he calls a double butt crease deformity, “which some patients call elephant butt or frog butt.”
Others never gained a pound. They “just want a more natural, less aggressive body contour.” And some were never happy with their original surgeon’s work: too much hip, too much projection, an over-scooped lower back.
The Combined Operation
Reversal at Southwest Plastic Surgery usually happens in a single session. “The surgery is usually done all at once, which gives us the best results,” Dr. Agullo explains.
The toolkit is broad. Liposuction reduces buttock volume. Renuvion J-Plasma (“radiofrequency with helium plasma”) and Morpheus8 stacked on top (“microneedling with radiofrequency”) drive skin contraction, though “the amount of contraction we’re going to get is hard to predict, as each patient reacts differently to these technologies.” When a significant amount of fat comes out, a buttock lift and even a lateral thigh lift are often necessary. The double butt crease gets its own operation: the Miami thong lift. Implant removal joins the plan for patients whose original BBL was supercharged with implants.
Skin quality maintenance afterward, from microneedling to other med spa treatments, is available in the same building.
A Typical Destination Case
One recent patient consulted virtually from the East Coast. She had her supercharged BBL years earlier, then had babies, moved to a more conservative community, and wanted a discreet, athletic contour.
Her single-session plan: implant removal, liposuction of the lateral thighs, saddlebags, and buttock, a buttock lift with lateral thigh lift, and a Miami thong lift. Four and a half hours under general anesthesia, and back at her hotel the same evening.
Then the practice’s travel protocol took over: a nurse visit the next morning with IV fluids, help with the first shower, and garment fitting; post-surgical massage (lymphatic) every other day; drains out on day seven; and a flight home. No complications, and at four months she is mostly healed and very pleased.
That profile is the norm. Most reversal patients had their original surgery out of town or in another country, more than five years ago, and travel to El Paso the way the practice’s other body contouring patients do.
Expectations and Recovery
Can a reversal restore the pre-BBL body? “We can get patients to their pre-BBL body, although most patients don’t really want to go that far back. They’re looking for a result in between… tighter contours, tighter skin, and sometimes a more athletic look.”
Recovery runs about a week to normal activity and driving, and about four weeks to the gym. Risks specific to reversal include asymmetries, cellulite, and buttock ptosis when a lift is declined; scar-avoidant patients who skip the lift know it may still be needed at three to six months.
Dr. Agullo’s favorite planning tool is low-tech: photographs. “The buttock is a hard anatomical place to describe and get your wishes across with words,” he says, so patients bring inspiration photos to the consultation and to the operating room.
Is the BBL Over?
“The BBL era is far from over,” he says. The practice still performs skinny BBLs and occasionally exaggerated ones. The trend line simply favors “more of an upside-down heart shape than a shelf.”
About Dr. Agullo
Dr. Frank Agullo is a double board-certified plastic surgeon, Mayo Clinic fellowship trained, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, Castle Connolly Top Doctor for thirteen consecutive years, and founding vice president of the World Association of Gluteal Surgeons.
Schedule a Consultation
BBL reversals at Southwest Plastic Surgery usually begin with a virtual consultation and photos. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Dr. Agullo wrote two companion pieces: the reversal-wave editorial on drworldwide.com, and the clinical guide on agulloplasticsurgery.com.
