The Brazilian butt lift (BBL) is a procedure that enhances the buttocks through fat transfer. Excess fat is harvested from other areas of the body including the abdomen, hips, lower back and thighs through liposuction. BBL is a popular procedure for those seeking to enhance their bodies. However, with the recent reports of patient deaths from undergoing BBL, many have now labeled it as the most dangerous cosmetic procedure.

Dangers of a Brazilian butt lift

The postmortem findings from the deceased patients showed two common causes of death following a BBL: 1) fat within and beneath the gluteal muscles, and 2) massive fat emboli. The findings were consistent with the typical risks associated with the intramuscular fat grafting technique.

Intramuscular fat injection is one method that plastic surgeons employ along with the superficial administration of fat during BBL. While it is mostly done to ensure that there is a higher chance of fat survival, it requires a precise and careful application. Anatomically, important nerves and blood vessels pass through the gluteal region. Thus, injecting the cannula deep into the muscles can hit these major structures and cause injury and complication. It can even lead to a heart or pulmonary fat embolism (PFE) that can become deadly if not treated immediately. Fat embolism results when the grafted fat is injected into the bloodstream, obstructing the major blood vessels of the heart or the lungs.

Causes of risks and complications following a BBL

What gives rise to these dangers after a Brazilian butt lift? We have listed a few of the more common dangers below:

1. When it is performed by an unlicensed practitioner. Training and experience are important when handling and performing cosmetic procedures like BBL. This is what unlicensed practitioners lack. While they may be familiar with the anatomy of the body, they may not have received proper training in actually doing the procedure. This makes BBL, and other cosmetic procedures, unsafe as one miscalculated move could lead to irreparable mistakes that may become fatal.

2. Using injectables like silicone and fillers instead of fat. Silicone and fillers are both FDA-approved for their use to enhance breasts and improve signs of aging. They are not approved for use for a Brazilian butt lift. Because BBL is not a low-cost procedure itself, patients are turning to these fat alternatives to enhance their buttocks. This is not advisable because these alternatives are not made to be used for a BBL procedure. The final results may be unsatisfactory and may require revision surgery or may become a deadly complication if not treated right away.

3. Unsterile operating area and surgical instruments. Failure to sterilize the operating area and the surgical tools to be used can put the patient in danger. It exposes them to agents of infection that can cause complications to arise. Likewise, it may lead to a poor outcome that may need a second surgery to correct.

4. Intramuscular injection of the grafted fat. Intramuscular fat grafting is a common technique for BBL. However, it imposes danger to patients, especially when the cannula is injected deep into the muscle where nerves and blood vessels lie. Hitting a blood vessel can cause massive fat emboli, which can be fatal.

Preventing dangers of BBL from arising

Because of the increasing malpractices and rising deaths due to BBL, plastic surgeons from across the world through an Inter-Society Gluteal Fat Grafting Task (BBL Task Force) have taken the initiative to advise fellow doctors to assess their techniques in conducting the Brazilian butt lift. Likewise, they encourage patients worldwide to know more about BBL before deciding to undergo surgery.

The BBL Task Force also proposes the following measures to plastic surgeons to prevent the increasing occurrence of problems and deaths during surgery:

1. Be familiar with the patient’s body. While we are familiar with the human anatomy, the body is different from one patient to another. Thus, it is important also to be well-acquainted with the patient’s body. It will enable us to develop a technique that is best for our patient and avoid incurring any injury to internal structures in the gluteal region.

2. Avoid using the intramuscular-fat-injection technique. Injecting fat into the muscles and beyond increases the chances of injuring the underlying nerves and blood vessels in the buttocks. Keep fat injections within the superficial planes of the buttocks, with the subcutaneous space being the safest location to place the grafted fat. Doing so lowers the possibility of causing complications from the procedure significantly.

3. Use a blunt and pressure-controlled cannula. Controlling the movement of the cannula as well as limiting the area where fat will be injected prevents unintended deep passes into the muscles where vital structures lie. Likewise, blunt cannulas lessen the chance of puncturing blood vessels and injecting fat into the bloodstream.

4. Have access incisions to ensure that the cannula is kept at a superficial trajectory. This technique allows us to keep the angulation of the cannula at the subcutaneous level. External palpation can also help ensure that the cannula is not angled too deeply while injecting the fat into the buttocks.

5. Injecting fat must be done while moving the cannula. This technique prevents high-pressure bolus injections, which can be deadly when it causes a blockage in the major veins of the heart and lungs.

6. Thoroughly explain the risks and complications that undergoing a BBL procedure entails to patients. It is recommended to not only inform but to educate our patients about the BBL procedure. It helps them re-evaluate and make the right decisions about undertaking the cosmetic procedure.

Safety while achieving aesthetic goals

Achieving aesthetic goals is essential for any patient considering BBL. As a plastic surgeon myself, I would want nothing more than to help my patients attain these goals. But above this, their safety is paramount, especially since the Brazilian butt lift can be a complicated procedure that requires accurate and careful execution.

As a plastic surgeon experienced in performing the Brazilian butt lift, here are two pieces of advice I can offer patients who are considering the procedure:

1. Consult with a board-certified plastic surgeon. Board-certified plastic surgeons went through years of study and training in performing intricate surgeries like the BBL. Our experience and training have enabled us to properly educate patients about such cosmetic procedures, guide them through the whole process, and expertly care for them before, during and after the surgery.

2. Do not trade your health, or life for low-rate BBL alternatives. Above your aesthetic goals, your safety comes first when undertaking any cosmetic surgery. The Brazilian butt lift is not a low-cost procedure, but plastic surgery facilities are offering financing options that patients can consider to have a safe and well-guided BBL surgery.

When it comes to procedures like the BBL, do not short-change yourself just to achieve your aesthetic goals. Seek advice and take the initiative to educate yourself about the surgery. Doing so will enable you to make a sound decision about undertaking the Brazilian butt lift or any other cosmetic procedure in the future.

Patrick Hsu is a plastic surgeon.

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