August 12, 2026 | Uncategorized
The BBL reversal consultation almost always starts the same way: a patient explains that her body changed, or her taste did, and the buttock she chose a decade ago no longer belongs to the life she has now.
There is a physiologic reason this happens, and understanding it is the key to understanding the whole operation.
Why a BBL Behaves Differently Over Time
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. That fat is transferred to the buttock.
Once liposuction is done in those areas, they do not increase in volume as much when the patient gains weight. The buttock becomes the one area that increases the most. So when a patient gains weight years later, the proportions shift: the buttock is no longer proportionate, or has developed cellulite or droopiness. Some patients develop a double butt crease deformity, which patients themselves have nicknamed elephant butt or frog butt.
Not everyone in my reversal practice has gained weight. Some simply want a more natural, less aggressive contour. And some were never happy with the original result: exaggerated hips, too much projection, an over-scooped lower back, or a buttock that doesn’t transition well into the thighs.
The Surgical Plan
Reversal surgery can involve a combination of a lot of procedures.
Liposuction reduces the volume of the buttock and gives some contouring. The trade-off is that when we perform liposuction, the skin often becomes looser, and the buttock can droop more. To fight that, we can use Renuvion J-Plasma, which is radiofrequency with helium plasma, and even Morpheus8 stacked on top of it, which is microneedling with radiofrequency. These tools create skin contraction, but the amount of contraction is hard to predict; each patient reacts differently to these technologies.
If we’re removing a significant amount of fat, then oftentimes a buttock lift, and even a lateral thigh lift, is necessary. For patients with the double butt crease deformity, we perform a Miami thong lift. And for patients whose original surgery included implants, implant removal is part of the plan.
I usually do the surgery all at once, which gives the best results. The exception is the patient trying to avoid lift scars, who wants to see whether Renuvion and Morpheus8 create enough contracture on their own. Those patients understand that if buttock ptosis or loose skin develops at three or six months, the buttock lift and lateral thigh lift may still be needed.
What Result Is Realistic
We can get patients to their pre-BBL body, although most don’t really want to go that far back. They’re looking for a result in between: tighter contours, tighter skin, sometimes a more athletic look. Whether that is achievable, and what it requires, gets determined at the consultation, based on the patient’s expectations and which procedures they are willing to undergo.
Photographs matter more here than almost anywhere else in plastic surgery. The buttock is a hard anatomical place to describe in words, so I ask patients to bring pictures of the shape they want, to the consultation and again on the day of surgery.
A Recent Case
A patient consulted virtually from the East Coast. Years ago I had performed her supercharged BBL, implants plus fat transfer. After babies, weight changes, and a move to a more conservative community, she wanted a more discreet, athletic contour.
Her operation combined buttock implant removal, liposuction of the lateral thighs, saddlebags, and buttock, a buttock lift with lateral thigh lift, and a Miami thong lift to correct her double crease and create a sweeping curve where the lower buttock meets the thigh. Four and a half hours under general anesthesia, back to her hotel the same day. My nurse visited the next morning with IV fluids and helped her into her garments. Lymphatic massages every other day, drains out day seven, and she flew home without complications. At four months she is mostly healed and very pleased.
Most reversal patients follow this pattern: they come from out of town, had their original surgery elsewhere or in another country, and are more than five years out. The full travel protocol is the same one my body contouring patients use.
Risks and Recovery
The risks specific to reversal are asymmetries, development of cellulite, and buttock ptosis if a lift is not performed at the same time. Recovery typically runs about a week to return to normal activity and driving, and about four weeks to return to exercise, running, and jumping.
Why Choose Dr. Agullo
I am a double board-certified plastic surgeon, Mayo Clinic fellowship trained, and served as founding vice president of the World Association of Gluteal Surgeons. I still perform BBLs of every size, from skinny BBLs to exaggerated ones, which is exactly why patients trust me to reverse them: reversal is a judgment operation, and judgment comes from doing the original well.
Ready to Talk?
Most BBL reversals start with a virtual consultation and photos. Call (915) 590-7900, text 1-866-814-0038, or book a consultation online. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Companion reads: the editorial on the reversal wave at drworldwide.com, and the destination-patient overview at swplasticsurgery.com.
