Aesthetic tastes have shifted since the 80s and 90s, and healthy curves have taken the spotlight over ultra-lean silhouettes. Enter gluteal fat transfer, more commonly known as a Brazilian butt lift or “BBL”. It has become quite the hit at La Jolla Cosmetic in San Diego and across the country.
When performed by a highly experienced, qualified plastic surgeon, a Brazilian butt lift can achieve beautiful results that look and feel natural and potentially last a lifetime. Tens of thousands of people undergo the procedure each year with board-certified plastic surgeons, and the vast majority of them love their results.
However, if you’ve been considering BBL surgery, recent headlines may have given you pause about the procedure’s safety. Several reports of serious complications after the procedure have surfaced in recent years, and studies show that gluteal fat injections once carried a higher mortality rate than any other cosmetic surgery procedure, about 1 in 3,000. (That number is much lower now—more on that below.)
All very sobering information, and as a board-certified plastic surgeon who is committed to my patients’ safety, I think it is very important to understand the risks associated with any procedure before moving forward. In light of the recent news, I would like to offer my perspective on the safety of fat transfer procedures, particularly Brazilian butt lifts.
What Is a Brazilian Butt Lift & How Is It Performed?
A Brazilian butt lift enhances the size and shape of the buttocks using a person’s own fat as a filler. The fat is removed from surrounding areas (such as the abdomen, thighs, or hips) with liposuction, and some of this fat is injected back into the buttocks to add volume.
BBLs have quickly become more popular than butt implant surgery, which our surgeons don’t perform or recommend. Silicone buttock implants are foreign materials, and because they have so much pressure put on them so often, they’re prone to stretching, migrating, and getting infected. It’s no surprise that this procedure has a much higher complication rate, and that the BBL is such a welcome alternative.
What Are the Biggest Risks of Brazilian Butt Lift Surgery?
The most serious risk associated with Brazilian butt lift surgery is fat embolism in the heart or lungs, which can occur when fat is injected too deeply into the space below the muscles. This can push fat into the muscle tissue beneath the subcutaneous fat layer and cause fat particles to enter the bloodstream and travel to the heart or lungs, potentially resulting in fatal fat embolism.
“In other countries, the surgeon takes the fat that they liposuctioned out and injects it into the muscle instead of the fat that rests above the muscle. The benefit they see in this is that they can get a much bigger enhancement because you can inject more fat into the entire buttock area,” he explained. “But the risk is that the muscle in the buttock has very, very large veins. And those veins communicate directly with the vena cava, which then goes right into the heart.”
Qualified surgeons reduce this risk by adjusting how deeply they inject the fat.
“The solution from the American Board of Plastic Surgery is that we simply do not inject the fat into the muscle area,” Dr. Swistun said. “We keep our injection above the muscle, which is essentially under the skin and into the fat. We do not violate the muscle. That basically eliminates the entire dangerous aspect of this surgery.”
Why Do Brazilian Butt Lifts Have Such High Complication Rates?
Most reported complications have much more to do with the surgeon’s qualifications than the procedure itself. As indicated above, a plastic surgeon’s level of training, experience, and skill can literally mean the difference between life and death.
In almost all reported cases of death after Brazilian butt lift surgery, the surgeon was not properly trained or qualified to be performing fat injections.
What’s more, large-volume fat grafting is not a standard part of many plastic surgeons’ residency programs. It’s certainly not part of the training of doctors who are not board-certified plastic surgeons. Plastic surgeons must undergo additional rigorous training in the specific principles and techniques of fat grafting during a fellowship or other specialty program. They must also complete numerous procedures alongside knowledgeable surgeons to become sufficiently experienced to perform fat grafting safely on their own.
So, when it comes to your safety, it’s critical that you choose a plastic surgeon who is board certified in plastic surgery and who has specific training with years of experience in gluteal fat grafting. In the hands of a qualified, board-certified plastic surgeon, the risk of serious complications is very low.
How Have Regulations Made Brazilian Butt Lifts Safer?
When troubling headlines arose detailing buttock-enhancement deaths, we in the plastic surgery community knew under-qualified surgeons were taking advantage of the popularity of Brazilian butt lift surgery and putting people’s lives at risk.
The community knew we needed to assess the situation and provide support and safe surgical options. To that end, a multi-society task force was created to analyze the mortality causes and rates of BBL.
The Multi-Society Gluteal Fat Grafting Task Force
Composed of representatives from the American Society of Plastic Surgeons, The Aesthetic Society, the International Society of Aesthetic Plastic Surgeons, the International Society of Plastic & Regenerative Surgeons, and the International Federation for Adipose Therapeutics and Science, this task force reviewed BBL-related deaths to find common factors and then created surgical recommendations for avoiding complications.
In August 2018, the task force issued a statement warning of the dangers associated with gluteal fat transfer when performed incorrectly. It urged all plastic surgeons who perform Brazilian butt lifts to immediately re-evaluate their technique to minimize the risk of fat embolism, nerve damage, and other serious complications.
The Florida Board of Medicine’s Emergency BBL Ruling
As a result of the task force’s findings, the Florida Board of Medicine issued an emergency ruling that mandated specific procedure techniques for gluteal fat transfer. Specifically, this ruling states that fat may only be injected into subcutaneous tissue and never cross to the gluteal fascia. Injection of fat intra- or sub-muscularly is strictly prohibited. It’s unclear at this time if other states will follow suit.
“Mortality risk associated with gluteal fat grafting can be minimized if the entire procedure is confined to the subcutaneous space, with NO violation of the fascia of the gluteus maximus muscles.”
Multi-Society Gluteal Fat Grafting Task Force
Studies Show Measurable Improvements
An April 2020 study published in the Aesthetic Surgery Journal showed notable improvements in BBL safety compared to just a few years earlier. Some of the major points include:
- The incidence of pulmonary fat embolism was 1 in 2,492, down from the 1 in 1,030 reported in 2017.
- The mortality rate decreased from 1 in 3,448 in 2017 to 1 in 14,952 in 2019.
- Of reporting surgeons, 94% were aware of the new safety recommendations.
- Only 0.8% of surgeons reported that they still injected fat deeply, compared with 13.1% in 2017.
- Only 4% of surgeons reported using the higher-risk technique of angling the cannula down, compared with 27.2% in 2017.
Despite these promising improvements, it’s still critical that you do your research before putting your BBL consultation on the calendar.
How Can I Choose a Safe Plastic Surgeon for My Brazilian Butt Lift?
Asking a surgeon directly about their training, experience, and credentials is essential to assess whether they’re qualified to perform BBLs safely and successfully.
Make sure your surgeon is board certified in plastic surgery.
Only plastic surgeons certified by the American Board of Plastic Surgery are guaranteed to have completed at least 3 years of plastic surgery residency training after medical school and have passed rigorous testing proving their skill and knowledge in all aspects of plastic surgery. You can check whether your surgeon is board certified on certificationmatters.org.
Check that your surgeon operates in an accredited facility.
Fat grafting is a complex surgical procedure that requires a fully qualified anesthesiologist and support team, specialized equipment, and a fully functional AAAASF-accredited operating room to perform safely. Doctors who perform fat injections in a standard medical office, hotel room, or other space as a way to offer cheap plastic surgery are putting your life at risk and should be avoided at all costs.
Look for a full gallery of real BBL before-and-after pictures.
You always want your plastic surgeon to have plenty of experience in your procedure, but as we pointed out, this is critical with fat grafting. Narrow your prospective surgeon pool only to those with proof they have performed the procedure dozens, if not hundreds, of times, with mostly superb results—even if this means traveling out of town for your procedure (as long as it’s within the U.S.).
Note that most surgeons don’t post all photos online due to permission requirements. You can expect to see a selection on the practice’s website and numerous additional options during your in-person consultation.
You can see a few of La Jolla Cosmetic’s real BBL results in our before-and-after photo gallery.
How Can I Afford a Brazilian Butt Lift Without Sacrificing My Safety?
It’s no surprise doctors without proper credentials offer BBLs for too-good-to-be-true prices. It’s the only way they can entice people into choosing them over reputable surgeons who prioritize safety. But you don’t have to fall for these traps to safely get a result you love.
Brazilian butt lifts cost between $10,000 to $13,000 at our San Diego practice, but you don’t have to pay that all at once. Financing options through PatientFi®, CareCredit®, and other companies can break that price up into monthly payments that fit into more budgets than you may think. And at the end of the day, your safety is always worth the investment.
Our Promise to You: Your Safety Is Our #1 Priority
For over 30 years, the board-certified plastic surgeons, nurses, and staff at La Jolla Cosmetic Surgery Centre & Medical Spa have been dedicated to providing our patients with safe, exceptional aesthetic medical care. Every procedure and treatment we offer has been vetted as a safe, effective option, and our team routinely attends national conferences and participates in ongoing education.
When it comes to buttock enhancement surgery, we promise to only move forward with your procedure if we feel it is safe and in your best interest to do so. By combining advanced technology, an intimate understanding of human anatomy, and experience with the safest BBL techniques, we strive to give you the beautiful results you want with as little risk as possible.
Have Questions About Plastic Surgery Safety? Talk to a Board-Certified Plastic Surgeon
In qualified hands, plastic surgery, including fat transfer, is a safe, effective way to update your shape. The key is doing your homework and not compromising when it comes to surgeon experience and facility accreditation. If you have questions about your options and want an honest, thorough discussion on the safety of any procedure, we will be happy to help.
Please call or text our office at (858) 452-1981 or request a consultation online to plan a time for your free BBL consultation. Our plastic surgery center and medical spa welcomes people from Oceanside, Escondido, and throughout Southern California.