August 25, 2026 | Body Contouring, Plastic Surgery News
Patients ask me about making their buttocks bigger all the time. But there is another conversation happening in my office more and more often: patients who had buttock implants or large fat transfers years ago and now want to go smaller, leaner, and more natural. These are real questions from my consultations, answered in my own words.
Can You Remove Buttock Implants and the Fat From an Old BBL?
Yes. I recently consulted with a patient who had 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. Her goal was simple: 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 the Implant Comes Out?
When a surgeon places an intramuscular implant, the muscle is not really cut. It is just spread apart to make a space. So when I remove the implant, we remove the covering and the muscle simply comes back together. The only place I repair the muscle is where I make the cut to take the implant out. If you try to put a bunch of sutures in the middle of the muscle, it just rips open, because there is no fascia there to hold them.
Do You Remove the Capsule Too?
You take as much as you need to. If it is a thick capsule, we take it out. If the implant has ruptured, we take out the entire capsule. Sometimes the capsule is so thin that removing it just damages muscle, and sometimes there is no capsule at all. With older implants, rupture or leaking at the ten year mark would not change the plan. I clean everything out either way.
Will I Be Flat Afterward?
You will still have projection, just less than before. Sometimes the implant is creating the shape in one spot, and removing it would leave a divot. When that happens, I save some of the fat and skin from the lift and flip it in to restore that volume. The goal is a smooth, round, natural shape at a smaller size.
Why Do I Need a Buttock Lift With It?
Because we are removing a lot of volume, the skin needs somewhere to go. A buttock and lateral thigh lift removes the extra skin, tightens everything, and smooths the transition into the thigh. I tighten both the superficial layer and the deep layer so the lift holds. The incision is long, but it can be hidden in clothing lines.
What About Seromas and Hematomas?
Prevention comes first. I leave drains in and do not remove them until they are ready, usually about a week. Drains prevent seromas. Hematomas behave differently, and in the buttock they are extremely rare. In more than a thousand buttock cases, I have never had a hematoma there. The muscle has so much blood supply that it essentially repairs itself within days.
How Long Is the Surgery and the Recovery?
For a combination like this, 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. You can sit and sleep on your back right away unless I add fat injections for small irregularities. Out of town patients should stay at least a week, two if they can.
Is It Safe if I Had My Original Surgery Abroad?
Many of my patients had their original implants or fat transfers overseas. What matters now is doing the removal in an accredited facility. My surgery center is Quad A accredited, which is the same standard as a hospital. We handle almost every issue in house, and we run pre op labs and an EKG on everyone. If you start with a normal hemoglobin, transfusion is not a realistic concern with this surgery.
Why Choose Dr. Agullo?
I am a double board certified plastic surgeon, a Mayo Clinic fellowship alum, and I teach plastic surgery as 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 my practice at Southwest Plastic Surgery in El Paso.
Ready to Talk?
Call my office at (915) 590-7900, text the consult line at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com.
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
