What came first, Jennifer Lopez's big booty or women's desire for big booties? According to plastic surgeons, the "American Idol" judge wins that philosophical debate.
"Ever since Jennifer Lopez made it on the scene," says Dr. Jeffrey Roth, a local plastic surgeon, "women really want that heart-shaped look with fullness in the upper pole of the butt."
In other words, just like Sir Mix-A-Lot all those years ago, they want big butts and they cannot lie.
According to figures from the American Society for Aesthetic Plastic Surgery, Americans spent more than $31 million on buttock augmentation surgeries in 2010, a 40 percent jump from the year before. Judging from the sex symbolism of other celebrities, such as Beyonce and Kim Kardashian, the trend likely won't go away anytime soon.
In some cases, the celebrity's butt is as famous as the celebrity.
On her reality show "Keeping Up With the Kardashians," Kardashian's abundant rearview is a regularly addressed topic. To dispel rumors that she underwent buttock augmentation surgery, she had an ultrasound performed at a doctor's office. And, just before her Playboy photo shoot the reality star asserted, "I'm doing it with class 'cause I got a big ass."
Young female viewers took note.
According to Roth, that's a double-edged sword for plastic surgeons. Five years ago, the ideal look was that of Paris Hilton and Nicole Richie, the polar opposite of Kardashian's curves. But, Hilton and Richie's ultra-thin frames made for loads of lipo requests.
"Even size ones wanted to be size zeroes," says Roth, who refused those extreme cases. "As crazy or as unwatchable as ('Keeping Up With the Kardashians') is, these 17-year-old girls discovered they can have curves."
The result? Less and less lipo demand. Yes, the requests for buttock augmentations went up, but not enough to compensate for the lipo losses.
As it turns out, ideal candidates for buttock augmentations aren't as easy to come by as the liposuction ones. First, the patient has to be in good health. No smoking, no steroids, no other health problems. Second, and this is usually the part that brings consultations to an abrupt end, big booties need not apply.
"Some of them have a big enough butt already," Roth says. "They just want a really big butt."
With this particular procedure, maximum results only come from the most minimum of rears. Simply put, it's not the kind of surgery that allows for supersizing.
Luckily, there are a few famous behinds that don't qualify as XXL, but still enjoy public accolades. Pippa Middleton, the younger sister of Kate Middleton, experienced huge fanfare after donning a white clingy, sheath dress in the royal wedding. Some say her backside stole the spotlight from the bride. It even spurred its own Facebook fan page. The Pippa Middleton Ass Appreciation Society has more than 243,000 "likes." Just as quickly as the fan page launched, so did the accusations that Pippa used padding.
Either way, butts such as Pippa's may receive a glowing spotlight, but they aren't the kind of butts that women willing to go under the knife covet.
"With breast surgery, they used Dolly (Parton) as a reference point or Pamela Anderson," says Dr. Marcel Daniels. But with butts, "it's either the Salma Hayek or the Kim Kardashian."
Hayek is for those who want roundness, but with limitations. Kardashian is for those who don't always know when to say when.
Daniels practices out of Southern California and runs plasticsurgerybeyondthehype.com, a website meant to educate the public and give them the real deal about plastic surgery.
"Be careful what you wish for," he says. "People need to be educated and understand these are not perfect procedures."
Butt augmentation can be performed two ways. One option is to use an implant, like with breast enhancement surgery. The second method is a fat transfer in which doctors take fat deposits from other parts of the body and use it to plump up the patient's backside.
The problem with the implants, Daniels says, is malposition, risk of infection and it "can feel like sitting on your wallet." The problem with fat transplants is that the outcomes can be unpredictable.
Revision rates for buttock augmentations run about 30 percent. The downside related to both options are discouraging enough for Daniels not to offer the procedure at all. It hasn't stopped many of his peers, though.
"A lot of (plastic surgeons) treat patients like frat guys treat girls at last call," he says. "They say whatever it takes to close the deal."
There seems to be a sense of desperation surrounding this particular procedure, though. Women are willing to endure drastic measures to get a bigger behind. In November, police in South Florida arrested a woman, who was not a doctor, for injecting a mixture containing Fix-A-Flat in a woman's buttocks for $700. The patient suffered an infection and other medical problems. Buttock augmentation surgery typically runs $6,000 to $8,000.
Locally, Elena Caro died while trying to enhance her buttocks in the back of a tile shop last year. The married couple from Colombia who performed the "surgery" are now serving prison sentences.
When performed properly, Daniels says the surgery itself doesn't pose a higher risk than other surgeries. It's only when patients seek augmentation from makeshift operations that things can go terribly wrong.
But, as long as celebrities such as Beyonce, Jennifer Lopez and Kim Kardashian continue to represent the ideal body type, women will continue coveting ample assets. And Roth, whose patients love to say "less like CoCo (as in CoCo Austin who is married to Ice-T), more like J-Lo" will continue reining them back.
"My favorite word," he says, "is proportion."
Contact fashion reporter Xazmin Garza at email@example.com or 702-383-0477. Follow her on Twitter at @startswithanx.