Recent reports suggest that the Brazilian Butt Lift surgery that has been known to be the most dangerous of all cosmetic surgery procedures has shown no signs of slowing down. According to experts who spoke to NBC 6 in Miami last month, BBL deaths rose in 2021 after lockdowns the year before caused elective surgeries to be put on the back burner, leading to an increase in overbooking procedures in certain cases the following year. Some surgeons believe that this spike in south Florida fatalities signals a need to put limits on how many procedures a plastic surgeon can perform on the same day.
We reached out to many plastic surgeons familiar with BBL cases and their history as a controversial procedure. Along with the multi-societal task forces being put into place to evaluate the dangers of BBL surgery, there has also been guidance and recommendations provided to plastic surgery society members to improve patient safety. “The procedure has become safer after the global survey, which stimulated research anatomically, but the unfortunate thing is even though somebody knows they shouldn’t reinject the fat into the gluteal muscle, the end of the cannula doesn’t have eyes on it, so there is still room for errors to occur even with the best surgeons,” notes La Jolla, CA plastic surgeon Robert Singer, MD.
In February, at a cosmetic surgery symposium, Dr. Daniel Del Vecchio proposed limiting doctors to three surgeries a day, but others say proper training is the best solution. “If the surgeon is trained in Brazilian Butt Lift surgery and competent with regards to where the fat is placed, above the muscle fascia, this should not be an issue,” says Eugene, OR plastic surgeon Mark Jewell, MD. “I don’t think that anyone would want to be doing more than three cases a day anyway.”
Houston, TX plastic surgeon Courtney El-Zokm, MD says we have to be careful with what we label “high volume” surgery. What is high volume for some may not be for others. “The definition of high volume needs to be defined based on the particular surgeon’s practice,” he explains. “For example, doing multiple blepharoplasties in a day is completely different than doing multiple Mommy Makeovers that are more labor intensive.”
Tucson, AZ plastic surgeon Raman Mahabir, MD says he doesn’t perform BBLs as he doesn’t want to take the risks that come with the surgery. He also doesn’t believe that coming up with a number of surgeries a doctor should perform will be the solution. “Everyone’s trying to come up with a way to pass the buck and say it’s still safe and you should still do it, but the data is not there that you can see. So a lot of people, myself included, have just said I don’t need to do that operation. There are many reasons, but it’s not worth the risk for some fashion trend which I think will go away. Also, it’s not a surgery that is fixable either. So, this conversation is a distraction from the underlying truths.”
One practice that can help doctors navigate the risks is ultrasound technology says Dr. Jewell. “Ultrasound has great promise in avoiding fat injections into the muscle where fat emboli can occur,” he says. Dr. Courtney agrees and adds that the future is rife with possibilities on how to best mitigate risks, but it’s going to take time for everyone to get on board. “The reality of using ultrasound for fat grafting is it will require training, physicians adopting it, and then some way of showing that number needed to treat actually having a positive effect on outcomes,” he shares. “Using large cannulas in the subcutaneous tissues with good techniques will keep you out of trouble most of the time, but just like with any surgery, having the best technical skills and following best practices doesn’t always keep surgeons from having a poor outcome.”
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