 Hi everyone, how's everyone doing today in Beverly Hills, Dr. Saul? We're gonna talk about one of the topics you guys asked for. Is it possible to do a BBL under local? Yes, it is, but it's dependent on your surgeon and I have I would have to see you to see if you would qualify. Let's talk about BBL. Fat reduction versus diet versus exercise. Remember when we start doing Fat removal. There's different fat cells around, not different, but different layers. When we lose weight, the fat cells shrink. It's not that they die off. They just shrink. When we gain fat, these fats get bigger, so they swell up. So how are fat cells destroyed? A lot of people come and tell me, oh, I'm going to go get cool sculpt. Great. But remember, when you're doing cool sculpt, if you have 12 fat cells, it takes care of only 15 to 20 percent. That means you're losing three fat cells. But when we do laser lipocontouring, we're removing as much fat as possible and leaving one layer of fat. Everyone needs a little bit of fat between the skin and the muscle. It's a lubricant. In order for the skin to be able to slide over the muscle, you need lubrication. It's just like a car. This is your lubrication, is your fat cells. First, we start what type of frame you have. Some people are A shaped, some people are V shaped, some people are square, some people are round. If you guys follow along with us, you see before I mark every patient, I always tell them we want their waistline smaller than their hips. So we want to get that hourglass look. We want to shave down on the sides. So what we're looking for is mostly giving someone this nice A shaped. So what comes into account? What type of frame we start with? If someone has a square body, the plan is different if they have an A shape. If someone has a round, it's different than if they have a V shape. So always the type of frame we start with is individualized to the patient. It's the canvas we start with. I can't change your bony shape. Then if you have any asymmetries, that means asymmetry means if your left and right side look different and 99% of people have asymmetries. Very seldom is someone a replicate of their other side. Your right and left are not replicatable to the other side. Then a lot of people have this midlateral buttock C dip. The C dip is the point right here where there's a dip and we could always fill that in with some fat and then the transition from the frame to torso. So the frame to the torso, this transition, we got to see where you start to where we end. So these are the four things that I look at when you come in for a consult. So the frame is the skeletal system that can't be changed. There's muscle that can't be changed and then there's the relationship between the frame and the muscle together and then we come to the aesthetic unit. Believe it or not, the buttock, and you can see it's broken up into 11 different aesthetic units which we tried to put it together to give you a round buttock. This right here, number eight is the C dip. This is what I always say that's where the buttock curve is and this is what we tried to remove to give you that shape and this is where the ribs end there where we try to contour you. So here's a patient of ours, so it's interesting she had some stretch marks but she wanted to get a nice little BBL. She qualified for doing it under local. You could see she had minimal amount of fat but still I made it work for her. Remember even if I could get 500 or a liter of fat, it's much better than any kind of injectable radius or sculptural because it's your own fat. It will last longer and it has the potential to get bigger as we saw. Sometimes fat cells increase as we gain weight. So what did we do for her? We did her abdomen and we did her flanks. So you could see how there's more curvature here. The buttock is lifted up and the abdomen is flatter. You don't have the excess skin here. From the lateral aspect, you could see this lordosis created here. Look at it. It's not as curved in the pre in the before picture. Number two, look at the buttock very naturally elevated and a nice circular look. Here there's nothing up here pushing it up. Here we pushed it up with the fat. Here's the three quarters. This is I think the best view to see how we have fullness up here. That's not here. It looks like almost someone is lifting her buttock up. It gives her beautiful, beautiful look. And the other thing is remember we also did some framing. By framing, I mean is we addressed the other aesthetic units. We took out fat from here. We took out fat from here to give the aesthetic look to after look. Here she is again. One thing I like to point out two things I like to point out in this is look at the C dip. This is the C dip right here. It's gone. It's round and full. Number two, the curvature here. She's more curved and it goes very smoothly. Number three, the lower back. It's nice and it goes in and goes into the buttock. Number four is look at how the underwear sits on her. It sits on a straight line. But in this one it's hugging her because we shaped and made her buttock round. And then the other thing is again look at the C dips on both sides. They're fuller. They look nicer and they look lifted. Again from the lateral, same points of view. Remember also the framing. It wasn't just adding fat here. This area was addressed to look at the before, look at the after. And even with the resultant fat, I believe in this case we did about 500 cc's to each buttock. That was way plenty for her to have such a great result. And here she is from the lateral view. Here's another patient you could see again. Same things addressed. Remember it's not just I want fat in my buttock. You have to frame the buttock. Always start with framing the buttock. Look at the shape. Look at now how cinched in she is. Look at the buttock. It's more square. Now it's round. And then look at the up here. All this is gone. Look at how nice it is up here. Here she is from the lateral. Look at the arch that's created. Look at her arch here. But look at this one. Goes deep and comes out. The buttock looks almost lifted like someone put air but it's of course it's not air. It's fat. It looks elevated and it's maximal projection is exactly where we like it right at the midpoint. You could see here when I look at it it looks heavy. It looks heavy down low but now it looks like lifted. Look at the point. It's almost like the nipple. You want the nipple right there not down here. Here she is from the other side. And if you guys want to know this is the small little dot that's how I get in and out. Okay here's another patient. Again what did we do? We adjusted her frame first. Here she is in, out, in, out, in, out. That's the c-dip right here. Look at her c-dip. What did we do here? We went in and it comes out and the c-dip is full. You could see in and then out. This is smaller than this. This is her maximal point. The hits. The mid-hits should be the maximal point. Here you could see it's almost like 0.9. Here is 0.6. The relationship of the waistline to the hip. This one is like more 0.65 to 0.7 which looks more natural. Here she is from three quarters. Here she is turned from the side. You could see again better arch and better fullness up here. Here she is again from the lateral. You could see again this has been cleared. Framing the buttock is very important. All this has been cleared. And then look at the roundness. Look at the fullness up here. She doesn't have the fullness up here. No fullness, no fullness. That's where we put it in. Look at the lateral buttock. Look at how nice and rounded it is. Here she is from the back. From the back first thing I see is the c-dips are gone. It's much smoother right here. She didn't want a huge buttock. She just wanted it rounder. The buttocks are rounder. They're not as square. And number four is this. Look at this. Look at the angulation. Look at how smooth she looks up there. And there she is from the lateral. And there's more pictures of her. Here's another picture of our patient. Again on this one I want to show you the relationship. Look at her waistline and look at her hips. There this is actually it's bigger here to here. So it's like a over it's about 1.1 to 1 relationship because she's way bigger at the waistline. Here look at her waistline and look at her hips. We totally transverse that relationship and make this more like 0.7 to 0.75. And that's what looks nice because that's how dresses are made. Remember dresses are made cinched in and they come out. They come out cinched in and they come out. They don't come out and then tuck in. That's not how a dress is made. The dresses are made to come in and then go out. And there she is. Look at this is another one. The framing of it. Look in this one it looks like her buttock starts here and goes down here and she has a very short torso. Okay. Look at here now she has a nice curvature and her buttock is projecting. There's the maximal projection. You don't see that in the preoperative picture. And there she is. Another view of how important it is for our relationship. The waistline, the hips. The waistline, the hips. And then look at the look at the again the very coming in like that V-shaped we talked about. Here round shape. That's what this patient wanted. She wanted the round shape. So we gave her the round shape. Thank you very much for listening to us. Stay tuned for another lesson coming to you soon.