When it comes to cosmetic procedures, arguably none has garnered more attention—both good and bad—than the Brazilian Butt Lift, also known as BBL. Credit it to social media or a general culture shift, but booty continues to have a major moment. According The Aesthetic Societybuttock growth increased by 37% between 2020 and 2021 alone.
And while no butt augmentation procedure is risk-free (and illegal butt injections, in particular, can be quite problematic), BBL is more notorious than the rest, with a lot of buzz about its associated risks. So is this bad reputation justified or just too much hype? And what exactly can make a BBL potentially dangerous? Ahead, leading plastic surgeons answer these questions and explain how to avoid the major risks of buttock lift surgery in Brazil.
What is a BBL? | What can make a BBL dangerous? | Side effects of BBL surgery | BBL versus other buttock enhancement procedures | How to minimize the risks of a BBL
What exactly is a BBL?
A Brazilian butt lift is a cosmetic surgery procedure that changes the size and shape of a person’s buttocks using their own fat from other areas of the body. “Fat cells are removed through liposuction from the abdomen, hips, thighs or lower back.” George Bitar, MD, a board-certified plastic surgeon in Washington, D.C., tells SELF. “The extracted fat is then cleaned and strategically injected into specific areas of the derriere to help patients achieve their desired size and shape.”
“Contouring the body in this way makes a BBL a very effective procedure that can transform one’s shape in ways that simply aren’t possible with glute exercises alone.” Alex Earle, MDboard certified plastic surgeon in Miami and its president World Association of Gluteal Surgeonshe says to HIMSELF.
Why is a BBL potentially dangerous?
To be clear, no cosmetic procedure—even something considered minimally invasive, such as injectable eye fillers—is without risk. But there seems to be an endless stream of news and reports detailing the complications associated with butt lifts in Brazil and even deaths. (Google “BBL gone wrong” and you’ll see what we mean.) A 2017 paper in Journal of Cosmetic Surgery found the death rate associated with BBL surgery to be as high as 1 in 2,351 – higher than any other cosmetic procedure, including tummy tucks, which were previously the riskiest, Steven Williams, MDa board-certified plastic surgeon in Oakland, California, and founder of Tri Valley Plastic Surgery, tells SELF.1 (But note that the death rate has dropped significantly since that study was published—more on that in a minute.)
So what is behind such an alarming number? Research from 2017 shows that the cause of death in the majority of these cases was a pulmonary fat embolism. During a BBL, fat is placed in the buttock with a long cannula (a thin straw-like tube) inserted under the skin, Dr. Earle says. “If the surgeon is inexperienced or doesn’t have a good sense of anatomy and goes too deep into the muscle, the fat can end up injuring the superior and inferior gluteal arteries,” he explains. “These blood vessels have a direct route to the heart, so if they are injured and fat gets into them, that fat can go to the heart and lungs and the patient can die immediately.”
It’s definitely scary stuff, which is why many plastic surgery companies, including him American Society of Plastic Surgeons (ASPS), formed it Task Force for Safety in Gluteal Fat Grafting in 2018. Their goal: Create new guidelines to make the Brazilian butt lift safer. These included recommendations such as injecting the fat only into the subcutaneous space above the muscle (directly under the skin) and using larger cannulas that don’t bend, which makes it easier to see where the tip is, Dr. Bitar says.
Implementing this protocol seems to have had the intended effect so far. According to a study published in Journal of Cosmetic Surgery.2 “This rate is on par with that of very commonly accepted procedures, such as abdominal thrusts,” says Dr. Earle. (In fact, another 2020 study in Plastic and Reconstructive Surgery puts the death rate from BBL at 1 in 20,000, compared to 1 in 13,000 for a tummy tuck.)3
And experts continue to implement additional BBL guidelines. Last June, The Aesthetic Society published new recommendations, stating that all surgeons should use ultrasound technology before and during the fat injection portion of BBL surgery.4 “This turns the procedure from one you essentially do blindly to one where you can see exactly where the cannula is, ensuring you stay in the safe space between the muscle and the skin, greatly minimizing the chance of fat embolism.” Dr. Earle explains. These latest guidelines also recommend that surgeons perform no more than three BBLs per day, citing surgeon fatigue as another possible reason for complications and problems.
