• John R Squires MD, FACS: Double Board Certified Plastic Surgeon

Brazilian butt lift risk sparks warning — and safety guidelines

brazilian butt liftBrazilian butt lift (BBL) is one of the most popular procedures for enhancing your backside. It also has the highest mortality rate of any cosmetic surgery, an estimated 1 in every 3,000 procedures.

But there is some good news on the horizon: a new task force set to tackle this complex issue just issued a major warning to plastic surgeons.


What is a Brazilian butt lift?

A BBL is a surgical procedure where fat is liposuctioned from one area of your body and transferred to your butt for a rounder shape (a procedure also known as fat grafting).

There are two main BBL techniques. The safest involves injecting fat into the subcutaneous tissue, the area closest to the surface of your skin. The riskier technique injects fat into the deeper muscular plane, producing more dramatic results — at a much greater risk, especially in unskilled hands.


What’s the risk?

Autopsies from Brazilian Butt Lift patients have shown the number one cause of death as fat embolism.

A fat embolism happens when a vein is injured during fat transfer, causing fat to enter the blood vessel. The veins in question are located in the deeper muscular plane, which is why injecting into the muscle is a riskier technique even though results might look better.


What’s being done?

This week, all plastic surgeons received an urgent warning that fat should no longer be injected into the muscle, only the subcutaneous tissue. This is an unprecedented announcement.

“Never before has a plastic surgery society come out with such a strong warning about a procedure,” says Denver-based plastic surgeon, Dr Squires. “But never before has there been a procedure associated with such a high death rate.”

The newly formed multi-organization* task force that issued this statement will continue to conduct studies to help develop technical safety guidelines for BBLs.


How to be safe

While the death rate is alarming, many board-certified plastic surgeons have a lot of success with Brazilian butt lifts. So why all the complications? “The majority of this year’s deaths to date have been from ‘unaffiliated,’ renegade doctors, practicing outside of their training,” says Dr. Squires.

He recommends finding a “board-certified plastic surgeon who expresses familiarity with this risk, brings it up in a forthright way with the patient, and demonstrates that they understand what they need to do — most notably to never inject into the muscle.” It’s also important that you and your doctor go over any questions you have during your consultation. RealSelf put together a list of the best questions to ask before a BBL to help you prepare.

Setting the right expectations is also key. Your aesthetic goal may not happen in one surgery. It’s best to listen to your surgeon and not push for more volume than they recommend as safe.

“We are very confident that these complications only occur if very large veins deep in the buttock are injured,” says Dr. Squires. “If surgeons avoid them, the risk of death should approach zero.”


*The following organizations make up the task force: The American Society for Aesthetic Plastic Surgery (ASAPS), American Society of Plastic Surgeons (ASPS), The International Society of Aesthetic Plastic Surgery (ISAPS), International Federation for Adipose Therapeutics and Science (IFATS) and International Society of Plastic Regenerative Surgery (ISPRES).