MIAMI — In hindsight, Nikki Ruston said, she should have recognized the red flags.
The Miami office where she programmed what is known as the Brazilian pool lift had closed and she was moving her files to a different facility, she said. The price she was quoted – and they paid it upfront – increased the day of the operation, and she said she didn’t meet her surgeon until she was put under general anesthesia.
“I was ready to get out,” said Rushton, 44, of Lake Alfred in central Florida. “But I had paid for everything.”
Days after the July procedure, Ruston was hospitalized for infection, blood loss and nausea, her medical records show.
“I went cheap. That’s what I did,” Ruston recalled recently. “I looked for the lowest price and found him on Instagram.”
People like Ruston are often lured to surgery centers in South Florida by social media marketing that makes Brazilian butt lifts and other cosmetic procedures seem deceptively painless, safe and affordable, researchers, patient advocates and surgeon groups say.
Unlike ambulatory surgery centers and hospitals, where a patient may stay overnight for follow-up after treatment, office-based surgery centers offer procedures that typically do not require an inpatient stay and are set up as an extension of the doctor’s private practice.
But such surgeries are often owned by companies that can offer discount rates by contracting with surgeons who are motivated to work on as many patients a day as possible in as little time as possible, according to state regulators and medical critics. installations. .
Ruston said she now lives with constant pain, but for other patients a Brazilian butt lift cost them their lives. After a rash of deaths and a lack of national standards, Florida regulators were the first in the nation to enact rules in 2019 in order to make the procedures safer. More than three years later, the evidence shows that deaths still occur.
Patient advocates and some surgeons — including those who perform the procedure themselves — expect the problem to worsen. Emergency restrictions mandated by the state medical board in June expired in September, and the corporate business model that took off in Miami is spreading to other cities.
“We’re seeing entities that have a strong footprint in low-cost, high-volume cosmetic surgery based in South Florida manifesting in other parts of the country,” he said. Bob Basuvice president of the American Society of Plastic Surgeons and a practicing physician in Houston.
During a Brazilian butt lift, fat is taken by liposuction from other areas of the body – such as the trunk, back or thighs – and injected into the buttocks. More than 61,000 buttock augmentation procedures, both buttock lifts and implants, were performed nationwide in 2021, a 37% increase from the previous year. according to evidence by the Aesthetic Society, a trade group of plastic surgeons.
As with all surgical procedures, complications can occur. The Miami-Dade County coroner has documented nearly three dozen cosmetic surgery patient deaths since 2009, 26 of which resulted from buttock lifts in Brazil. In each case, the person died of pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood from flowing to the lungs.
No national reporting system nor insurance code tracks outcomes and patient demographics for buttock lifts in Brazil. About 3% of surgeons worldwide have had a patient die as a result of the operation, according to a Exhibition 2017 by a Task Force of the Foundation for Cosmetic Surgery Education and Research.
Medical experts said the problem is, in part, because healthcare professionals, such as physician assistants and nurse practitioners, perform key parts of the butt lift instead of doctors. It is also driven by a business model that is motivated by profit rather than safety and the motivation of the five surgeons to exceed the number of surgeries outlined in their contracts.
In May, after a fifth patient in as many months died of complications in Miami-Dade County, Kevin Kearns proposed the state’s emergency rule to limit the number of butt lifts a surgeon could perform each day.
“I was sick of reading about women dying and seeing cases come before the board,” said Kearns, a physician and former member of the Florida Board of Medicine..
Some doctors performed as many as seven, according to disciplinary cases against surgeons being prosecuted by the Florida Department of Health. The emergency rule limited them to no more than three and required the use of ultrasound to help surgeons reduce the risk of a pulmonary fat clot.
But a group of doctors who perform Brazilian butt lifts in South Florida clapped back and formed Surgeons for Safety. They argued that the new requirements would make the situation worse. Qualified doctors should perform fewer procedures, they said, thereby driving patients to dangerous, unscrupulous health professionals.
The group has since donated more than $350,000 to the state Republican Party, Republican candidates and Republican political action committees, according to campaign contribution records from the Florida Department of State.
Surgeons for Safety declined repeated interview requests from Kaiser Health News. Although the team president, Constantino Mendietahe wrote inside an August article While he agreed that not all surgeons have followed the standard of care, he called the limits placed on surgeons “arbitrary.” The rule sets “a historic precedent of vetting surgeons,” he said during a meeting with the Florida medical board.
In January, Florida state Sen. Ileana Garcia, a Republican, filed a bill with the state legislature which suggests no limit to the number of Brazilian butt lifts a surgeon can perform in a day. Instead, it requires office-based surgery centers where procedures are performed to staff one doctor per patient and prohibits surgeons from working on more than one person at a time.
The bill would also allow surgeons to outsource certain parts of the procedure to other clinicians under their direct supervision, and the surgeon must use ultrasound.
Consumers considering cosmetic procedures are advised to be cautious. Like Ruston, many people base their expectations on before-and-after photos and marketing videos posted on social media platforms like Facebook, Snapchat and Instagram.
“This is very dangerous,” said Basu, of the American Society of Plastic Surgeons. “They get excited about a low price and forget to do their homework.”
The average price of a buttock augmentation in 2021 was $4,000, according to data from the Aesthetic Society. But this only applies to the doctor’s fee and does not cover anesthesia, surgery costs, prescriptions or other expenses. A “safe” Brazilian butt lift, performed at an accredited facility and with proper aftercare, costs $12,000 to $18,000, according to recent article on the American Society of Plastic Surgeons website.
Although Florida requires a physician’s license to perform liposuction on patients under general anesthesia, it is common in the medical field for mid-level physicians, such as physician assistants and nurse practitioners, to perform the procedure in the office, according to Mark Mofidwho co-authored the 2017 Foundation for Cosmetic Surgery Education and Research task force study.
By relying on staff who do not have the same specialty training and are paid less, office-based surgeons can perform more buttock lifts per day and charge a lower price.
“They do it all at once in three or four different rooms and it’s staffed by one surgeon,” said Mofid, a plastic surgeon in San Diego, who added that he doesn’t perform more than one Brazilian butt lift a day. “The surgeon does not do the real case. They are helpers.”
Basu said patients should ask if their doctor has privileges to do the same procedure at a hospital or ambulatory surgery center, which have stricter rules than office surgery centers about who can do a butt lift and how it must be done.
Bargain-seekers are reminded that cosmetic surgery can have more serious risks beyond fatal fat clots, such as infection and organ puncture, as well as kidney, heart and lung problems.
Ruston’s surgery was performed by a board-certified plastic surgeon she said she found on Instagram. She was initially quoted $4,995, which she said she paid in full before the surgery. But when he got to Miami, he said, the clinic charged for liposuction and for post-op clothes and appliances.
“I ended up paying, $8,000,” Ruston said. A few days after Ruston returned to her Lake Alfred home, she said, she started feeling dizzy and weak and called 911.
Paramedics took her to an emergency room, where doctors diagnosed her with anemia due to blood loss, blood and abdominal infections, her medical records show.
“If I could go back in time,” he said, “I wouldn’t have done it.”
Kaiser Health News covers health topics.
