Florida Sets Limit For Plastic Surgeons Who Perform BBLs to Three Surgeries a Day

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Despite recent recommendations and increased patient education on risks, Brazilian Butt Lift–related fatalities in South Florida continue to occur. In the last five years, 19 women have died due to complications with the popular surgery. It’s such a reoccurring concern that the Florida Board of Medicine made a swift move last week to limit the number of BBLs performed a day by plastic surgeons to three.

The Three BBL Surgery a Day Limit

According to NBC6 in South Florida, the board ruled to limit the number of BBLs a surgeon can perform each day to avoid fatigue, which some surgeons have advocated for in an effort to reduce risk. BBL risks include fat embolism which can occur when the fat used to reshape the butt enters the bloodstream. Louisville, KY plastic surgeon M. Bradley Calobrace, MD says the ruling is a good step forward in addressing this concern. “I think this action is very appropriate as our role as plastic surgeons is to provide treatments, but err on the side of safety. We can’t put our head in the sand. It is right to look at those things surgeons can do to minimize risks while still being able to provide the benefit. Deaths have occurred from BBLs and something must change if we want to continue to provide these treatments.”

Ultrasound Guidance Requirement To Reinject the Fat

In the last four years, a specialized multi-society plastic surgery task force was created to research BBL risks and provide surgeons with recommendations to mitigate these risks. In addition to urging surgeons to inject the fat above the muscle, they also recommend using ultrasound technology during the procedure to avoid puncturing an artery while reinjecting. Florida’s emergency ruling, which is in effect for 90 days, also includes a requirement for BBL surgeons to use ultrasound technology to guide them as they inject fat into a patient’s butt. “Real-time ultrasound imaging has been shown to be useful in determining the depth of the gluteal muscles during the BBL in order to avoid injecting fat in the wrong location that could result in fat embolism,” says Eugene, OR plastic surgeon Mark Jewell, MD. “I believe that the limitation of three BBL procedures per day per surgeon is also reasonable because surgeon fatigue can produce technical errors and mistakes during the BBL.”

While the use of ultrasound technology may be deemed beneficial, Tucson, AZ plastic surgeon Raman Mahabir, MD says more information and education is needed before it becomes a requirement for surgeons across the board. “Safety is always important and I would support any attempt to increase the safety profile of this operation that has a high morbidity and mortality rate. That said, there is little evidence to support the use of ultrasound as a way to limit risk. At best, it may be helpful; at worst it may create a false sense of safety. What ultrasound training is required of the surgeon? What is the specific equipment and timing requirement? It may raise more questions than answers.”  

Florida Plastic Surgeon Reactions

Fort Myers, FL plastic surgeon Ralph R. Garramone, MD says he hopes this decision is carried out throughout the country. “Florida may be progressive with regard to this ruling, but it should be a national standard established by the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery,” he shared.

Miami plastic surgeon Sean Simon, MD, who has performed thousands of BBL surgeries, agrees that the ruling raises more questions than provides answers. He believes the Florida Board of Medicine should target the specific “surgical mills” where these deaths are occurring and that setting limits and the amount of surgeries that can be performed is a Band-aid solution. “If there is one takeaway about this for me, it’s that the board should look into the specific cosmetic surgery centers where this is happening. The one thing that will save lives and be incredibly simple and cost savings for the state of Florida would be to remove the Florida Department of Health as the organization that accredits these surgical centers and require that the accreditation come from the American Association for Accreditation of Ambulatory Surgery Facilities.”

The ‘Surgical Mill’ Problem

For his part, La Jolla, CA plastic surgeon Robert Singer, MD says the recommendations have made strides in improving the safety of the procedure in recent years, and the Florida ruling is a reasonable progression to improve safety. “The other aspects are that for some reason the highest rate of fatalities has been in Florida. We do have to look at where the procedure is done and many of these centers are in strip malls without good oversight of the facilities,” he notes. “Certainly, patients need to avoid surgical mills where multiple procedures are done on these patients day and night. The issues come down to physician training, ethics, ability and the most important thing for any operation, patient safety.”

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