1987 · L. S. Toledo
Fat grafting with intramuscular injection (classic BBL)
Layer. Subcutaneous fat and gluteus maximus muscle
Toledo began injecting large volumes of fat into the buttocks in 1985 and presented the Brazilian buttock technique in 1987. A 2001 series of 566 patients injected fat into muscle and fat at all levels, 300 to 400 mL per side on average.[1][2][3]
Suits. No longer recommended. Florida prohibits intramuscular and submuscular fat injection.
Trade-offs. Surgeons who injected into deep muscle had more fatal and nonfatal fat emboli. In 11 South Florida BBL autopsies, all had fat in the gluteal muscle at several levels.
2018 · D. Del Vecchio, S. Wall Jr
Subcutaneous-only fat grafting
Layer. Subcutaneous fat, above the gluteal fascia
Fat goes only into the subcutaneous fat. Cadaver studies showed that fat in the muscle migrates under it, while fat above an intact fascia stays above it. The authors proposed that all injections be subcutaneous. Florida made this the standard of care in 2019.[1][2][3]
Suits. Every fat BBL. It is the only plane allowed in Florida.
Trade-offs. In 50 patients, gluteal fat thickness rose 56.5% after surgery and fell 18.2% by 12 months, a retention similar to earlier intramuscular reports.
2018 · D. Del Vecchio, S. Wall Jr
Expansion vibration lipofilling (EVL)
Layer. Fat pushed by roller pump through a vibrating cannula
A power-assisted vibrating cannula expands the recipient tissue while a roller pump pushes fat through large cannulas, without syringes. In 2,419 cases, operations averaged 1 hour 40 minutes and 1,003 cc of fat.[1]
Suits. Large-volume fat transfer where the surgeon wants less hand effort and steady cannula control.
Trade-offs. No fat embolism or death in 2,419 cases; complications included seroma, infection and one pulmonary embolism. It needs a roller pump and power-assisted equipment.
2018 · A. L. Cansancao, A. Conde-Green
Real-time ultrasound-guided BBL
Layer. Subcutaneous fat, confirmed on ultrasound
An ultrasound probe on the buttock shows the cannula and the fascia while fat is injected. In 15 patients, with a mean 528 mL per side, every injection was confirmed subcutaneous. Florida has required ultrasound or equal guidance for office BBLs since July 1, 2023.[1][2][3]
Suits. Every fat BBL in a Florida office surgery setting, where it is required by law.
Trade-offs. Cost of the ultrasound device, longer operations, an assistant to follow the probe, and a learning curve. A 2025 meta-analysis of 6,235 patients found no deaths or fat emboli; a 2026 review found no randomized trials.
2023 · P. Pazmino, D. Del Vecchio
Static injection, migration and equalization (SIME)
Layer. Deep subcutaneous fat, static cannula under ultrasound
The cannula is held still in the deep subcutaneous space while ultrasound confirms its position, and fat spreads through that layer. A moving cannula then evens out the contour. The method was reported in 4,150 BBLs.[1][2]
Suits. Surgeons using ultrasound who want to fill specific deep subcutaneous compartments.
Trade-offs. It depends on ultrasound skill and equipment. The report gave no complication rates in its abstract.
1996 · R. Vergara, R. Gonzalez
Intramuscular buttock implants
Layer. Silicone implant inside the gluteus maximus
A silicone implant goes into a pocket within the muscle. Gonzalez's XYZ method uses three pelvic points and a line to guide the dissection, in 746 patients from 1986 to 2003. In a survey of 19 implant surgeons, 68.4% preferred the intramuscular plane.[1][2][3]
Suits. Patients with too little donor fat for grafting.
Trade-offs. A survey of 2,226 patients counted 848 complications (38.1%). A review of 2,375 patients found wound dehiscence in 9.6%, seroma 4.6%, infection 1.9% and transient sciatic symptoms 1.0%.
2004 · J. A. de la Pena
Subfascial buttock implants
Layer. Silicone implant under the gluteal fascia, above the muscle
The implant goes into a pocket under the deep fascia, sized with templates and sizers. ASPS lists implant placement either in the muscle or above it.[1][2][3]
Suits. Patients with too little donor fat who want projection from an implant.
Trade-offs. A 2017 review of 52 studies found an overall complication rate of 30.5% for implants and 10.5% for fat grafting.
2004 · FDA approval to Q-Med AB
Sculptra (poly-L-lactic acid), non-surgical
Layer. Injected under the skin, no surgery
Poly-L-lactic acid is injected in sessions a month apart. FDA approved Sculptra in 2004 for facial fat loss in HIV and in 2009 for facial wrinkles; buttock use is off-label. In a trial of 30 women with 3 monthly sessions, 84% were rated improved at 6 months.[1][2][3]
Suits. Mild contour loss in people who do not want surgery.
Trade-offs. About 3 vials per buttock per session were used. Pain during treatment was reported by 71% and bruising by 29%. Injectors must avoid deep injection near the gluteal vessels and sciatic nerve.