June 18, 2026 | Body Contouring, Brazilian Butt Lift
A patient sat down across from me last month for her two-week post-op visit after a Brazilian Butt Lift and asked me, more or less in a whisper, whether it was normal that she could smell herself.
The answer is that it is normal, it is preventable, and almost no one talks about it. So when an Australian GP-trade outlet, Medical Republic, ran an article titled “Jingle bells, your butt smells” last month and reprinted my four-bullet post-op hygiene protocol out of an earlier post I wrote on the same subject, I was happy to see the conversation moved out from behind the consult-room door. The piece credited me as a board-certified plastic surgeon and a founding vice-president of the World Association of Gluteal Surgeons. Both of those titles came with the expectation that the protocol would travel further than the original blog post, and it has.
So let me write the longer clinical version here, with the reasoning a plastic surgeon would give a patient sitting across from her, not a 200-word reprint of the bullets alone.
Why a Fresh BBL Is a Hygiene Project, Not Just a Surgical One
A Brazilian Butt Lift, done well, involves harvesting fat by liposuction from the donor areas, processing it, and reinjecting it into the gluteal subcutaneous compartment with anatomic placement. The liposuction creates a meaningful surface area of disturbed tissue under the skin of the donor sites. The gluteal injection creates additional fluid shifts, micro-trauma, and a degree of inflammation around the grafted parcels of fat.
For the first six weeks, the body is moving fluid out of the operated tissue while simultaneously laying down the new microvasculature that keeps the transferred fat alive. The compression garment is on most of the day. The patient is sleeping in a face-down or side-lying position. Sitting is restricted. Sweating is increased because the garment is occlusive. The combination is a recipe for a humid, occluded, slow-clearing environment around the perineum, the intergluteal cleft, and the incision sites.
That environment, in the absence of disciplined hygiene, produces three predictable problems. A surface odor. A surface skin breakdown. And, in the worst case, a bacterial colonization of an incision that should have closed cleanly.
The protocol I write into every BBL recovery handout is designed to remove all three problems before they start.
The Four Parts of the Protocol
Part One: Hibiclens as a Body Wash During the First Weeks
Hibiclens is a chlorhexidine gluconate antibacterial wash that is widely used in pre-operative skin preparation and in burn-unit care. It is available over the counter. For my BBL patients, I recommend using it as a body wash from the day after the operation through the first two to three weeks of recovery, with normal soap on the face and the hair.
The reasoning is straightforward. Chlorhexidine has a meaningful residual antibacterial effect on the skin after rinsing, which means that the protective effect carries on past the shower into the hours when the patient is back in the compression garment. The skin around the perineum and the intergluteal cleft is the highest-risk zone in the first two weeks, and a chlorhexidine wash applied gently to that zone every day measurably reduces the bacterial load.
A few clinical points the bullet does not include. Avoid Hibiclens above the neck. Keep it out of the eyes and ears. Do not use it on irritated, broken, or rashy skin in the early phase, where soap and water are kinder. And in the small subset of patients who have a real chlorhexidine sensitivity, a different antibacterial wash is substituted.
Part Two: A Bidet for the Perineum and the Intergluteal Cleft
The intergluteal cleft and the perineum, after a BBL, are a hard zone to clean with toilet paper alone. Toilet paper is abrasive, leaves residue, and tends to drag through tissue that has been freshly operated on. The compression garment then traps the residue against the skin for the rest of the day.
A bidet, or a handheld bidet attachment, solves all of those problems at once. Water rinses without abrading. The patient can dry gently with a soft towel after the rinse. The compression garment goes back on over genuinely clean tissue.
The hardware can be a full bathroom bidet, a sprayer attachment that costs under fifty dollars on Amazon, or even a peri-bottle of the kind used after childbirth. The point is the same. Rinse, do not abrade.
Part Three: Two Compression Garments in Rotation, Washed Daily
The compression garment is on most of the day for the first six weeks. It absorbs sweat, lymphatic fluid that weeps through the small liposuction incisions, and any drainage from the donor sites. By the end of one day of wear in a hot El Paso summer, the inside of the garment is a humid, bacterial-friendly environment that the patient is then about to sleep in.
The protocol is to own two garments and rotate them. One is worn, one is washed, and the patient swaps every twenty-four hours. The washing is straightforward: a gentle detergent, a cold to warm wash, no fabric softener, and a flat air dry. Dryer heat tends to break down the medical-grade fabric of a quality compression garment over time and is best avoided.
This single change in the recovery routine has a larger effect on odor and on incision-site comfort than any other piece of the protocol.
Part Four: Post-Operative Manual Lymphatic Drainage Massage
Manual lymphatic drainage, performed by an experienced therapist trained in post-surgical massage, mobilizes the fluid that the BBL has produced in the donor sites and around the grafted fat. The technique uses gentle, directed strokes that move fluid along the body’s natural lymphatic pathways toward the central drainage nodes.
The clinical benefits are well-described. Less swelling. Faster bruise resolution. Less fibrosis in the donor sites. Better contour at six weeks. The benefit that the hygiene-focused literature does not always include is that moving fluid out of the operated tissue removes one of the substrates that bacteria would otherwise have to colonize. A well-drained donor site is a less hospitable environment for a low-grade skin infection than a poorly drained one.
The treatment cadence I prescribe is typically two to three sessions a week for the first two weeks, then a weekly session through week six, then a tapering schedule through week twelve. The protocol is individualized to the patient.
The Four Parts at a Glance
| Part | What | When | Why |
|---|---|---|---|
| Hibiclens body wash | Chlorhexidine wash, body, not face | Days 1 through 21 | Residual antibacterial effect on the highest-risk skin |
| Bidet | Rinse the perineum and intergluteal cleft | Every bathroom use | Cleans without abrading; no residue under the garment |
| Two-garment rotation | Wear one, wash one, rotate daily | Six weeks | Removes the humid bacterial environment from the inside of the garment |
| Lymphatic drainage massage | Trained therapist, structured cadence | Weeks 1 through 12 | Less swelling, less fibrosis, less substrate for skin colonization |
What the Protocol Does Not Replace
The protocol is layered on top of the rest of the recovery plan. It does not replace the antibiotic course if one is prescribed. It does not replace the surgical follow-up cadence. It does not replace the position restrictions, the sitting protocol, or the activity restrictions in the early weeks. And it does not replace a phone call to the office if any of the warning signs of a real complication appear: a fever above 100.4 F, a focal area of redness, swelling, increasing pain, or a frank wound discharge.
Layered on top of everything else, the four-part protocol does the quiet work that takes a fresh BBL through the first six weeks without the smell, without the surface breakdown, and without the bacterial colonization that nobody talks about until it has happened to them.
Why I Wrote This Protocol Down in the First Place
I founded a practice that performs a high volume of Brazilian Butt Lift procedures, and I have been a founding vice-president of the World Association of Gluteal Surgeons since the organization was founded. The intersection of those two roles is that I see, on a busy week, every variation of BBL recovery, including the ones nobody wants to discuss in public. Writing the hygiene protocol down was the cleanest way to give patients a tool they could use at home without having to call the office about a topic they were embarrassed to bring up.
Australia’s GP-trade journal picked the piece up because the topic crosses a cultural boundary that most clinical writing does not. Patients in Sydney and patients in El Paso both have the same skin biology, the same recovery physiology, and the same need for a clean, simple home protocol that works.
Why Choose Dr. Agullo
Double board-certified, American Board of Plastic Surgery and American Board of Surgery. American College of Surgeons Fellow. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. Founding Vice President of the World Association of Gluteal Surgeons. A BBL consultation in my office includes the operation, the recovery plan, and the hygiene protocol in writing.
Ready to Talk?
If a BBL is on your mind, the first step is a consultation. We will discuss the operation, the recovery, and the four-part hygiene protocol in detail. If you are already recovering from a BBL done elsewhere and you have questions about your recovery hygiene, call the office.
For the surgeon’s editorial version of this conversation, see What Nobody Tells You About BBL Recovery: A Surgeon’s Protocol on drworldwide.com. For the practice-program version that lays out the in-house recovery support, see The BBL Recovery Program at Southwest Plastic Surgery.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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