- The Brazilian butt lift — or gluteal fat grafting — is one of the fastest growing aesthetic procedures in the United States and worldwide.
- An alarming number of fatalities has prompted the American Society of Plastic Surgeons (ASPS) to issue an urgent advisory.
- Knowing what to ask can help you choose a qualified surgeon committed to meeting the safety guidelines.
Promising dramatic, often unrealistic results with minimal downtime and expense, an increasing number of self-styled Brazilian butt lift specialists are putting the lives of unsuspecting patients in danger.
Despite attempts by a special international task force to standardize the way Brazilian butt lifts (BBL) are performed, an alarming number of fatalities continue to be reported. The American Society of Plastic Surgeons (ASPS) recently issued an urgent warning to surgeons who perform the operation, prompted by a mortality rate estimated at one in every 3,000 patients — far higher than any other cosmetic surgery.
Is the Brazilian butt lift truly dangerous? We asked several plastic surgeons who regularly perform the procedure.
BBL deaths linked to improper injection techniques
According to the ASPS report, the main cause of death following Brazilian butt lift surgery is vessel blockage by fat globs travelling through the patient’s bloodstream.
The procedure involves extracting the patient’s fat through liposuction from an area such as the abdomen, flanks or thighs, filtering it so that only healthy fat cells remain, and then injecting back into a desired area — in this case, the buttocks.
Danger occurs when fat is incorrectly injected back into the body. Fat should be inserted under the skin into the subcutaneous area, and not directly into muscle tissue.
Dr. Kimberly Henry, a board-certified plastic surgeon who performs BBLs in the San Francisco area, explains:
“You do not want to want to inject fat into the gluteus maximus muscle layer, near blood vessels. If it goes into the vessels, the veins in that area will be returning the blood back to the lungs. And if there’s any fat in those veins, it could go into the lungs and cause a pulmonary fat embolism.”
In every death resulting from a BBL, fat was later found in the gluteal muscle, indicating a likely link between a fat embolism and intramuscular injection. The ASPS therefore strongly advises surgeons against deliberately placing fat in muscle tissue and cautions them to be extra vigilant during the procedure so as to avoid doing so unintentionally.
How is accidental penetration of muscle avoided? Though proper technique and adherence to the ASPS guidelines — they’re vital for safety and should be understood by patients evaluating a prospective surgeon.
Proper technique reduces risk with Brazilian butt lifts
In order to ensure fat is deposited only where it belongs in the subcutaneous area, surgeons are meant to make small, sideways, superficial injections — not deep, penetrative injections into the muscle below.
Dr. Frederic Corbin, a board-certified plastic surgeon who performs BBLs in the Beverly Hills area, explains that the cannula — the thin tube used to inject the fat — is always inserted medially into the area between the skin and muscle: “As you withdraw the cannula, you inject the fat, the idea being to avoid blood vessels.”
Dr. Ricardo Rodriguez is a Baltimore area, board-certified plastic surgeon and member of the international task force behind the report on BBL safety. On his blog, he explains why keeping track of the cannula tip is essential while performing a BBL.
“Unless your plastic surgeon is using an ultrasound probe while he injects, he cannot see veins while he is injecting,” Rodriguez says. As such, feeling the tip is the only way to ensure that it’s in the subcutaneous space right under the skin, and away from the danger area of the gluteal veins.
Unrealistic expectations may lead to a riskier approach
The desire for faster, more dramatic results may tempt doctors toward taking greater risks. In its advisory, the ASPS stresses the importance of managing expectations with BBLs.
Rodriguez finds this trend worrying and cautions that to be performed safely, fat transfers should be done gradually.
“Injecting small volumes of fat (1–3 cc’s) at many different injection locations largely eliminates the risk of large chunks of fat blocking a vein,” he says, noting that some surgeons now “power inject” 60 or even hundreds of cc’s per pass.
“In my opinion, this cannot be good,” Rodriguez warns. “It stands to reason that dumping a lot of fat at one time into an unknown space is a recipe for disaster.”
The ASPS therefore recommends staging, which means working slowly through more than one procedure. As this involves time and expense, while perhaps offering more modest gains, some doctors may be reluctant to disappoint their patients by taking this route.
“[Staging means] multiple, small amounts of fat rather than large amounts at once,” says Corbin, “Most patients don’t want to do that — it’s more downtime.”
How to protect yourself: ask questions, go board-certified
Before any procedure, a doctor should review its risks and benefits, explore alternatives, and be able to answer a patient’s questions and concerns in detail.
“Do not be afraid to ask your plastic surgeon about how he performs the fat injection process,” stresses Rodriguez. “Ask if injections will be made into the muscle or the subcutaneous plane.”
Patients should also bring up the aforementioned ASPS advisory during consultation to ensure their doctor is aware of the guidelines.
High demand means many medical professionals now offer BBLs. For safety, it’s crucial to choose a board-certified plastic surgeon.
“There are some people out there who say they’re cosmetic surgeons, but they’re dermatologists or surgeons, and they don’t do this procedure frequently,” says Henry.
Even an experienced surgeon may not be sufficiently trained to perform a BBL correctly. Rodriguez elaborates that it’s important to distinguish between doctors who are board-certified in “cosmetic surgery” and “plastic surgery.” Only the latter have had residency training in liposuction and fat transfer — training that is required to perform this procedure properly and safely.
“Do not pick your surgeon solely based on their Snapchat and Instagram videos,” he adds. “The most important criteria is proper training.”
The bottom line: put your safety at a premium
As previously mentioned, the risk of mortality from a BBL was recently estimated to be 1 in 3,000, which is higher than any other cosmetic surgery procedure. Safety studies are ongoing.
While there is cause for concern and a need for education, the doctors consulted for this article continue to believe that when performed correctly, the BBL is a safe procedure.
The importance of choosing an informed, board-certified plastic surgeon cannot be overstated. Alternative procedures, such as Sculptra injections, buttocks implants, or autologous flap augmentation can also be explored to make an informed decision.
» Want to know more about buttocks enhancement surgery? Meet our Medical Review Team.
