The Elephant in the Operating Room: Are Brazilian Butt Lifts Safer Now?

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There is a running gag on social media showing users mimicking the actions of a post-Brazilian Butt Lift patient doing anything from eating their post-surgery salad to slowly walking into a room after undergoing the body-transforming surgery. The joke is in the way the person carries him or herself, eating and moving ever so delicately, as if one swift move could ruin their very expensive new body. 

The “BBL effect” taking over social is just a sign that the surgery that has been considered high risk hasn’t lost its place in our cultural zeitgeist. In 2019, the American Society of Plastic Surgeons Plastic Surgery statistics found that more than 28,000 BBLs had been performed that year, and in 2020 the number went down by 22 percent. A steep decline, yes, but there were still more than 20,000 BBLs performed despite the safety-risk warnings associated with the surgery. With new recommendations in play and doctors advertising a new “safer BBL” model, we had to find out if the procedure’s track record has improved.

Safety Protocols

“Yes, BBL procedures continue to be in demand throughout the United States,” says Newport Beach, CA plastic surgeon Sanjay Grover, MD. “There have been serious concerns about the fatality rate with BBLs. Estimates were recently incorrectly reported at 1 in 3,000 cases, but this was later refuted and found to be closer to 1 in 13,000 which was less or similar to abdominoplasty procedures.”

“The biggest danger with Brazilian Butt Lifts is fat entering the bloodstream and going to the lungs,” explains New York plastic surgeon Jeffrey S. Yager, MD. “This is known as a fat embolism and can be fatal.” 

Reducing the Risk

Dr. Grover notes that last year The Aesthetic Society formed a task force to evaluate this issue and came out with guidance for its members to improve safety. “These guidelines included ensuring placement of fat in the superficial subcutaneous space, or over the muscle, and not in the deeper muscles where large vessels exist and increase the risk for fat emboli. The size of cannulas used was also discussed as well as location of placement.”

Plastic surgeons who regularly perform BBLs say these recommendations have helped to vastly improve the safety rate of the procedures. “The keys to safety in a BBL are to keep the fat above the muscle, avoid the lower inner quadrant where the blood vessels are, and ensure the patient is in good health and understands the recovery process” adds Dr. Yager. 

“For safety, fat must be injected above the buttock muscle, not into the muscle,” adds Baton Rouge, LA plastic surgeon John V. Williams, MD. “When fat is injected into the muscle, the fat goes under the muscle and tears large veins of the buttock. This results in fat going to the lungs or heart, which is fatal.”

Proceeding with Caution

According to La Jolla, CA plastic surgeon Robert Singer, MD, even with the new guidelines, we’re not out of the woods yet. “First of all, there’s a risk in any procedure. Secondly, there have been cases where the doctor said that they absolutely injected above the muscle, and in fact the patient died and it was later found that the injection went not only above the muscle, but behind the muscle. We don’t have an eye at the end of the cannula, so you can’t be 100-percent sure.”

The Strip-Mall Factor

Santa Monica, CA plastic surgeon Steven Teitelbaum, MD says the most dangerous BBL cases come from environments where patient safety is often compromised. “The bottom line is that while it is theoretically safe to do a BBL if the fat is placed only in front of the muscle, deaths are still occurring. We know that many of the deaths in Florida have occurred at businessmen-owned discount clinics in strip malls. These clinics are a particular scourge in Florida. Doctors are said not to meet patients until the morning of surgery and supposedly they have schedules that are too busy.” 

Vetting Your Surgeon

“This procedure is best performed by a board-certified plastic surgeon, and you can always check this at plasticsurgery.org,” advises Dr. Yager. “Research your surgeon in advance, and meet with them beforehand. The surgeon should be performing BBLs often and should be certified in plastic surgery by the American Medical Board of Surgery.”

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