When it comes to cosmetic procedures, arguably none have gotten more attention—both good and bad—as of late than the Brazilian butt lift, aka the BBL. Attribute it to social media or a general culture shift, but the booty continues to have a major moment. According to The Aesthetic Society, buttock augmentation increased by 37% between 2020 and 2021 alone.
And while no butt augmentation procedure is without risk (and illegal-market butt injections, in particular, can be quite problematic), the BBL is more notorious than the rest, with lots of buzz about its associated dangers. So, is this bad reputation warranted or just over-blown hype? And what, exactly, can make a BBL potentially dangerous? Ahead, top plastic surgeons answer those questions and explain how to avoid the major risks of Brazilian butt lift surgery.
What is a BBL, exactly?
A Brazilian butt lift is a cosmetic procedure that changes the size and shape of a person’s butt using their own fat. “Fat is removed via liposuction from the abdomen, hips, thighs, or lower back,” George Bitar, MD, a board-certified plastic surgeon in Washington, DC, tells SELF. “The extracted fat is then purified and strategically injected into specific parts of the derriere to help patients achieve their desired size and shape.”
“Contouring the body in this way makes a BBL a very impactful procedure that can transform someone’s shape in ways that simply aren’t possible with butt exercises alone,” Alex Earle, MD, a board-certified plastic surgeon in Miami and president of the World Association of Gluteal Surgeons, tells SELF.
Why is a BBL potentially dangerous?
To be clear, no cosmetic procedure—even something considered minimally invasive, like injectable eye fillers—is risk-free. But there seems to be a never-ending stream of news stories and reports detailing Brazilian butt lift–related complications and even deaths. (Google “BBL gone wrong” and you’ll see what we mean.) A 2017 paper in the Aesthetic Surgery Journal found the death rate associated with BBL surgery to be as high as 1 in 2,351—higher than any other cosmetic surgery, including tummy tucks, which were previously the riskiest, Steven Williams, MD, a board-certified plastic surgeon in Oakland, California, and founder of Tri Valley Plastic Surgery, tells SELF.1 (But note that the death rate has declined significantly since that study was published—more on that point in a minute.)
So what’s behind such an alarming number? The 2017 research shows that the cause of death in the majority of these cases was a pulmonary fat embolism. During a BBL, fat is placed into the butt with a long cannula (a thin, straw-like tube) that’s inserted under the skin, Dr. Earle says. “If the surgeon is inexperienced or doesn’t have a good sense of anatomy and goes too deep into the muscle, the fat can end up injuring the superior and inferior gluteal arteries,” he explains. “These blood vessels have a direct route to the heart, so if they’re injured and fat gets into them, that fat can go into the heart and lungs and the patient can die immediately.”
It’s scary stuff for sure, which is why several plastic surgery societies, including the American Society of Plastic Surgeons (ASPS), formed the Task Force for Safety in Gluteal Fat Grafting in 2018. Their goal: Create new guidelines to make Brazilian butt lifts safer. These included recommendations such as injecting the fat only in the subcutaneous space above the muscle (directly under the skin) and using larger cannulas that don’t bend, which make it easier to see where the tip is, says Dr. Bitar.
Implementing this protocol appears to have had the intended effect so far. By 2020, deaths associated with Brazilian butt lifts had dropped to approximately 1 in 15,000, according to a study published in the Aesthetic Surgery Journal.2 “This rate is on par with that of very commonly accepted procedures, such as tummy tucks,” says Dr. Earle. (In fact, another 2020 study in Plastic and Reconstructive Surgery puts the BBL death rate at 1 in 20,000, compared to 1 in 13,000 for a tummy tuck.)3
And experts continue to put additional BBL guidelines in place. This past June, The Aesthetic Society released new recommendations, stating that all surgeons should use ultrasound technology before and during the fat injection portion of BBL surgery.4 “This transforms the procedure from one that you are essentially doing blindly to one in which you can see exactly where the cannula is, ensuring you stay in the safe space between the muscle and the skin, greatly minimizing the chance of a fat embolism,” explains Dr. Earle. These most recent guidelines also recommend that surgeons perform no more than three BBLs per day, citing surgeon fatigue as another potential reason for complications and problems.
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