4D VASER High-Definition Liposuction

Dr. De La Cruz is a Houston plastic surgeon who performs the 4D VASER High Definition liposuction Houston.  Check out our Before and After Liposuction Page.

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Factors That Can Affect Fat Grafting Success in Brazilian Butt Lift

Fat grafting is the latest trend in body sculpting. A fat grafting procedure transfer autologous fat (from your own body) from areas in which patients have excess fat, such as arms, abs, flanks and back, and injects it into areas that may need volume-enhancement, such as face, hands, breasts or buttocks. In particular, many of my patients who desire a fuller, more curvaceous derriere opt for a buttocks augmentation with fat grafting (BBL). Since the fat grafted is not a foreign material such as an implant, there is no risk of rejection and very little risk of complications associated with implants such as often reported ruptures or leaks.


After the autologous fat is re-injected, 65% to 85% of the transferred fat will usually take and stay in the area for years to come, providing a permanent solution for the patient’s cosmetic needs. The rest of the transplanted fat will be harmlessly and naturally metabolized by the body.Due to this variable amount of fat graft take patients frequently require more than one session of grafting to attain their desired result. The percentage of the fat that survive will vary depending on many factors, some of which doctors can affect (the method of harvesting, processing and placement) and some others which are under patients’ control.

 The method of harvesting is among the factors that enhance survival of the transferred autologous fats, and surgeons can definitely influence it. Clinical studies have shown that fat transfer procedures success is dependent on factors during the removal of the fat, such as the aspiration pressure used, and the cannula’s size used. The area where the fat comes from per se is not a determinant factor in fat grafting attainment. In this respect, I favor VASER liposuction system for viable fat harvesting. Fat cells treated and removed during VASERlipo procedures are typically of high quality and are viable to re-introduce the body (1). The VASER lipo system was designed to maintain the integrity of fat cells, by using ultrasound energy to selectively target and dislodge fat cells from the fatty tissue matrix. Atraumatic VentX cannulas give you the ability to fine tune suction pressure to remove the treated fat. Typically, 2.9mm to 4.0mm precision cannulas are used, depending on the donor site, and the pressure utilized to extract the fat with VASERlipo system is minimal (around 15 inch Hg) as opposed to the standard 25 inch Hg, which can affect the viability of the fat cells harvested. Two recent, independents studies have confirmed the viability of fat removed with VASERlipo: Cytori Therapeutics conducted a multi-site study that confirmed the viability of VASER-treated fat at 85% and regenerative cells at 87%, and the University of Pittsburgh Medical Center found the viability of VASER-treated fat to be over 80%, six weeks post re-injection (2). Research concluded that breaking apart adipose tissue prior to aspiration allows the use of atraumatic cannula and lower vacuum levels, which prevent the fat from tearing or shearing during aspiration.  

Moreover, the method of processing is the second key factor that surgeons can use to maximize fat survival. The preparation process clears the donor fat of blood, pain killers and other unwanted elements that could cause infections or other undesirable complications. Separation from excess fluid (purification of the fat) ensures that the surgeon is injecting a higher proportion of fat. After the fat selection process is completed, only 500cc to 1500cc of the fat will be injected into each butt cheek. Three primary methods (sedimentation by gravity, filtering technique, and centrifugation) have been used clinically to process fat grafts. In this respect, centrifugation is the more effective method of choice for processing facts, based on numerous clinical studies that concluded: “although may be more aggressive on adipocytes, centrifugation clears the fat from most blood remnants and is able to possibly maintain the highest concentration of stem cells within the processed lipoaspirates” (3). For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, sedimentation by gravity or filtering technique. Research determined that fat grafts processed with centrifugation at 1200 g for 3 minutes have better viability and should be recommend for processing fat grafts.

Third, high success rates of fat survival can be achieved by choosing a proper method of placement. After the harvested fat is purified, the surgeon carefully transfers fat cells into each buttock. To do so successfully, he or she will make small incisions (less than 1cm in diameter) in the butt cheeks and use a hollow tube to insert small quantities of fat cells into each side of the buttocks (micro-fat injections). This process is repeated until the desired correction has been achieved, creating a grid of grafted fat. At the end, the surgeon proceeds to massage the grafted areas to create a satisfactory contour. By all means, fat placement requires slow injection techniques and is time consuming. Clinical studies in patients found that “a slow injection speed of 0.5 to 1.0ml/second resulted in larger fat grafts compared with a fast injection speed of 3.0 to 5.0 ml/second” (4). Increasing injection speeds can result in cellular damage. The studies also reinforce the principle that fat grafts, once placed, should have a maximal amount of contact with the vascularized tissue in the recipient site for better survival.

Lastly, proper BBL post-operative care and healthy lifestyle habits are factors that significantly affect fat survival. Patients can actively contribute a great deal on the success of the procedure and longevity of the results by following their surgeon’s recovery recommendations. In my experience, patients who successfully avoid sitting or putting pressure on their buttocks or stretching for the first eight weeks after their surgery are much more likely to have long-lasting results than patients who fail to follow this advice. The longevity of transplanted fat cells can also be affected by lifestyle factors. In particular, smoking can lead to the degradation of new cells because reduces circulation throughout the body. By eating right and avoiding cigarettes, patients can considerably increase the longevity of their Brazilian Butt Lift.



(1) Schafer, M.E., et al. “Acute Adipocyte Viability After Third-Generation Ultrasound-Assisted Liposuction”. Aesthetic Surgery Journal. 2013 Jul; 33(5):698-704.

(2) Fisher, C., et al. Comparison of Harvest and Processing Techniques for Fat Grafting and Adipose Stem Cell Isolation. Plastic Reconstructive Surgery. 2013 Aug; 132(2):351-61

(3) Lee L.Q. Pu. “Towards more rationalized approach to autologous fat grafting”. Journal of Plastic, Reconstructive & Aesthetic Surgery.pdfs.semanticscholar.org



(4) Strong, Amy L. “The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques”. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov


Recientemente se han reportado numerosos casos del uso de productos de grado industrial inyectados en distintas partes del cuerpo, como en los glúteos y muslos, realizados por profesionales no calificados o que no poseen las licencias reglamentarias. Algunos de estos productos van desde silicona inyectable o ácido hialurónico, hasta el hidrogel de alto volumen. Aunque algunos de estos productos, como la silicona, pueden ser biológicamente inertes, dichos materiales han sido implicados en una variedad de reacciones adversas que incluyen granulomas, nódulos deformantes y linfedema, a veces con períodos latentes de décadas. A menudo, pueden causar infecciones crónicas deformantes que pueden requerir antibióticos por vía intravenosa o extensas intervenciones quirúrgicas. Incluso, han habido algunos casos en que las infecciones crónicas resultantes de productos de grado industrial ilegalmente inyectados en las extremidades inferiores, resultaron en amputaciones como un recurso para salvar vidas.


Figura 1: Infección crónica generada por inyecciones de Biopolímeros en glúteos y muslos, aplicadas por un profesional sin licencia y no calificado.

Síntomas y Manifestaciones Clínicas

• Infección crónica, como la celulitis, que es recurrente a pesar de los antibióticos.

• Rigidez o endurecimiento del área donde las inyecciones fueron aplicadas.

• Dolor crónico, como dolor en los glúteos.

• Sensación de entumecimiento del área tratada.

• Decoloración de la piel en el área de las inyecciones.

Gestión Clínica

• Recomendamos obtener un estudio con imágenes por resonancia magnética (IRM) del área de inyección para determinar el alcance de la inyección y la zona donde el material pudiera haber migrado, potencialmente. La resonancia magnética actuaría como un mapa para estipular dónde su cirujano debería remover los biopolímeros. 


• El tratamiento varía de paciente a paciente. Este puede ir desde la extirpación quirúrgica, a la inyección de hialuronidasa, seguida de la liposucción VASER y la transferencia de grasa en el área tratada, para corregir la deformidad resultante. Desafortunadamente, no es posible eliminar por completo los biopolímeros sin provocar una deformidad significativa del área afectada. La remoción completa, como la extirpación quirúrgica, pudiera provocar una deformación que le cambiaría la vida.


remover los biopolímeros.png

Figura 2: Eliminación de hidrogel/biopolímeros de los glúteos utilizando la liposucción VASER con transferencia de grasa a glúteos, para corregir la deformidad resultante de la eliminación de los biopolímeros. El paciente tuvo la resolución de dolor crónico en glúteos después de la cirugía.


Resulta altamente recomendable visitar a su cirujano plástico para la evaluación y posible eliminación de los biopolímeros inyectados en su cuerpo. Un estudio de imágenes por resonancia magnética puede ser necesaria para medir la ubicación del material inyectado. Es importante recalcar que cada caso médico es diferente, y de igual manera, cada tratamiento puede ser distinto y ajustado a las necesidades particulares de cada paciente.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon


Many people who desire a fuller, beautiful, curvy backside will opt for a buttocks augmentation with fat grafting (generally known as “Brazilian Butt Lift”). This is a popular cosmetic procedure which uses fat transfer to provide a more curvaceous buttock without the use of an implant. Liposuction is generally used to both sculpt the surrounding area and collect the autologous fat (from your own body) to be injected.

According to the statistics issued by the American Society of Plastic Surgeons, more than 18,000 buttock augmentations with fat grafting were performed in the United States in 2016(1). This figure surpasses in 26% the statistics corresponding to the previous year. Experts say butt augmentation surgery with fat grafting is by far the most popular butt enhancing procedure they perform and many significant advantages are accountable for patients’ preference of this procedure over buttocks implants and dermal fillers, and its steady increasing demand.

Before and After Brazilian Butt Lift performed by Dr. De La Cruz

Before and After Brazilian Butt Lift performed by Dr. De La Cruz

Patients’ welfare is among the main reason why Brazilian Butt Lift’s requests are on the rising. This is proven to be a safer procedure in comparison with butt implants. In fact, patients who have implants can experience pain and infection, and have trouble sitting on their butts for a longer period of time. Moreover, implant patients are more likely to develop seromas (lumps caused by an accumulation of serum within the tissue) and experience dehiscence and capsular contracture(2). Also, since BBL utilizes autologous fat, the chance of allergic reactions to foreign substances, such as dermal fillers and silicone prosthesis (implants) are reduced, and the results are longer lasting. Recovery is also better with butt augmentation with fat grafting. BBL’s patients can typically return to work a week after surgery, as opposed to those who receive butt implants and would need at least two weeks to resume their regular activities.     



(1) “Plastic Surgery Statistics Report 2016”. American Society of Plastic Surgeons. www.plasticsurgery.org

(2) Chugay, Paul. “Buttock Augmentation with Implants and Fat Grafting: A Comparative Study”. The American Journal of Cosmetic Surgery. www.journals.sagepub.com


Treatment of Biopolymer/Hydrogel Buttock Injections

Recently, there had been numerous cases of the use of industrial grade products injected into the body, such as the buttocks and thighs, performed by unlicensed or unskilled practitioners.  Some of these products range from injectable silicone or high-volume hyaluronic acid or hydrogel. Even though some of these products, such as silicone, may be biologically inert, these materials have been implicated in a variety of adverse reactions including granulomas, disfiguring nodules, and lymphedema, sometimes with latent periods of decades.  Often, they may cause disfiguring chronic infections that may require intravenous antibiotics or extensive surgical debridement.  

There had been a few cases that the chronic infections  resulting from illegally injected industrial grade products into the lower extremities, such as the legs, resulted in amputations as a life-saving procedure.  

Figure 1:  Chronic infection from an Biopolymer injections into the buttocks and thighs performed by an unlicensed and unskilled practitioner. 

Figure 1:  Chronic infection from an Biopolymer injections into the buttocks and thighs performed by an unlicensed and unskilled practitioner. 

Clinical Manifestations & Symptoms

  • Chronic infection, such as cellulitis, that are recurrent despite antibiotics
  • Firmess or hardening of the area of injections
  • Chronic pain, such as buttock pain
  • Numbness sensation of the area of injection
  • Discoloration of the skin of the area of injection

Clinical Management

  • We recommend obtaining an MRI of the area of injection to determine the extent of injection as well as the area where the material has potentially migrated.  The MRI would act as a map to determine where your surgeon would remove the biopolymer.


  • The treatment varies from patient to patient.  This may range from surgical excision, to hyaluronidase injection followed by VASER liposuction and fat transfer into the area to correct the resultant deformity.  Unfortunately, it is not possible to completely remove the biopolymer and not result in a significant deformity of the area involved.  Complete removal, such as surgical excision, may result in a life-changing deformity.  
Figure 2:  Hydrogel/Biopolymer removal from the buttocks using the  VASER Liposuction  with fat transfer to the buttocks to correct the resulting deformity from removal of the biopolymer.  Patient had resolution of a chronic buttock pain after surgery.

Figure 2:  Hydrogel/Biopolymer removal from the buttocks using the VASER Liposuction with fat transfer to the buttocks to correct the resulting deformity from removal of the biopolymer.  Patient had resolution of a chronic buttock pain after surgery.

I recommend seeing a plastic surgeon for evaluation and possible removal of the biopolymer injected into one's body.  An MRI may be necessary to evaluate the location of the injected material.  Every person is different, and each treatment may be different.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon Houston, Texas

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

  • The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
  • Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
  • The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%
  • Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%
  • Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
  • Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."
4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas


Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

Schafer, et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Brazilian Butt Lift | Fat Transfer to Buttock in Houston, Texas

From an evolutionary standpoint, an hourglass figure with a narrow waist and full buttocks is associated with female reproductive potential and has been considered an aesthetic ideal across cultures.  A round, well-projected buttock indicates fertility and youth in a woman and is considered aesthetically pleasing.  With the popularity of several celebrities' derriere such as those of Kim Kardashian, Jennifer Lopez, Beyonce and Sofia Vergara, the plastic surgery procedure called Brazilian Butt Lift has become more popular among women.

What is the Brazilian Butt Lift?

  • This plastic surgery procedure involves liposuction and the transfer of fat into the buttock.
  • The 4 D VASER Hi-Definition liposcuplture incorporates the transfer of fat into the buttock as part of the procedure.  Not only one will have an athletic figure, the buttock is also enhanced to produce a more aesthetically pleasing body.
  • The fat is harvested using the Coleman technique, and the fat is then transferred into the buttock to produce a more rounded and more voluptuous buttock.
Figure1:  Before & After Photos of  4 D VASER Hi-Definition Liposuction  with  Brazilian Butt Lift  (6 DAYS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure1:  Before & After Photos of 4 D VASER Hi-Definition Liposuction with Brazilian Butt Lift (6 DAYS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure 2:  Before & After photos of  Brazilian Butt Lift   (24 HOURS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure 2:  Before & After photos of Brazilian Butt Lift  (24 HOURS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, TX | The Woodlands, TX

The Galleria Clinic

1700 Post Oak Boulevard

2 BLVD Place Suite 600Houston TX, 77056(Next to Whole Foods, above North Italia Restaurant)

The Woodlands Clinic

2219 Sawdust Road  #1203  The Woodlands, TX 77380

Call us at 832-520-1844