The Brazilian butt lift, also known as BBL surgery, is a popular cosmetic procedure that can enhance natural lower body curves and balanced proportions. Last year alone, more than 61,000 patients received a combination of fat grafting and liposuction to lift and augment their buttocks while also contouring the waist.

But while rising in popularity, BBL surgery is controversial among board-certified plastic surgeons, because it currently has the highest mortality rate of all elective, aesthetic procedures. Within five years, at least eight patients died after undergoing the procedure at a Miami clinic. In other parts of the world – like the U.K. – BBL procedures are strongly discouraged due to the potential risks.

The known risks prompt the question: is BBL surgery worth it?

As a plastic surgeon, I take a conservative approach and always prioritize patient safety. Reading stories about cosmetic patients dying after receiving an elective procedure gives me pause – that’s simply an unacceptable and unavoidable complication. Thankfully, as the Brazilian butt lift procedure becomes more well-studied, new best practices and safety guidelines have come to light.

In this article, I’ll break down how I safely approach BBL surgery, the surgical procedure, potential risks, procedure techniques, recovery expectations, and what to look for when selecting your BBL plastic surgeon:

• What is BBL Surgery?
• What to Expect During BBL Surgery
• Recovery and Aftercare
• Brazilian Butt Lift Potential Risks
• Safe and Effective Techniques
• What to Look For When Selecting Your Surgeon

What is BBL Surgery?

Many patients who ask me about BBL surgery want to achieve a curvy, toned hourglass shape with more pronounced and rounded buttocks. While the procedure was not developed in Brazil, nor is it a traditional “lift,” which predominantly addresses sagging skin, the BBL is one of the most popular cosmetic procedures in the U.S. During the procedure, we remove fat from the hips, low back, thighs, or abdomen and graft it into the buttocks to achieve more projection.

What to Expect During BBL Surgery

Brazilian butt lift surgeries are performed under general anesthesia, and the entire procedure usually takes less than two hours.

First, we inject a tumescent solution into the areas we’re going to liposuction to facilitate safe tissue removal while reducing bruising and soreness. Fat can be harvested from the hips, low back, flanks, thighs, and abdomen, depending on the patient’s desired results and physiology before surgery.

Next, we separate the harvested fat cells and extract the healthiest cells for transfer. The healthy fat cells are evenly distributed superficially, above the muscle in the desired areas of the buttocks that we want to accentuate and fill out. The entire procedure is done through small, <1 cm incisions, which are closed with tiny stitches placed under the skin. There are no drains necessary, and patients can go home after the procedure is done.

BBL Surgery Recovery and Aftercare

Patients can typically return to work and activity within two weeks and will see final results within three to six months post-operatively. During the healing process, up to 40% of the fat cells can be reabsorbed by the body, which means patients may lose volume within the first few months after surgery.

What to Expect During Recovery

• Recovery Symptoms: BBL surgery patients can expect to feel mild pain, bruising, and swelling. If a patient is experiencing fever, chills, increasing redness in the area, increasing swelling or pain, shortness of breath, or chest pain, then they should call their plastic surgeon right away.
• Compression Garment: After the procedure, patients will wear a post-surgical garment that provides compression to liposuctioned areas for four weeks.
• Bathing: Patients can shower the day following their procedure.
• Return to Work/Activity: It can vary, but patients can expect to return to normal activities within two weeks. Some patients say they experience soreness similar to a hard workout following the procedure. Listen to your body and don’t try to overdo it while you’re recovering.
• Minimize Sitting: Patients must minimize the amount of pressure they put directly on the grafted fat during recovery. Make sure to get up and move around often, and avoid seated positions. Foam padding can help relieve pressure.

Expect Long-lasting Results

Brazilian butt lift surgery is semi-permanent, but many patients have long-lasting, positive results – particularly if they don’t experience any dramatic weight changes. In most cases, patients are happy with the results after one procedure. Patients who want to attain significant volume may need to undergo multiple rounds of fat grafting to safely get the results they’re looking for.

Brazilian Butt Lift Potential Risks

While some plastic surgeons avoid performing BBL surgery altogether, there is mounting evidence that the formerly high complication rate for this procedure is downtrending. A few years ago, the American Society of Plastic Surgeons – of which I am a member – joined other accredited plastic surgery organizations worldwide to assemble a task force exploring BBL safety issues. Through increased surgeon training and widespread education, many board-certified plastic surgeons are following new, evidence-based procedure guidelines to prevent the following risks associated with Brazilian butt lifts:

Pulmonary Embolism
The biggest concern surrounding BBL surgery is the risk of pulmonary fat embolism, which can be fatal. This occurs when a piece of fat enters the gluteal vein and travels to the lungs. Unlike blood clots, fat emboli cannot be dissolved. Fat embolisms are very unlikely to occur when the plastic surgeon avoids certain anatomical areas and takes care not to inject fat into muscle tissue.

Fat Necrosis and Infection
The next potential complication is fat necrosis and infection, which can happen when surgeons place far too much volume. Fat cells – like any other cells – need oxygen and nutrients to survive, which means they need an adequate blood supply. When large fat volumes are injected without proper technique, many of the fat cells will not survive which can lead to contour irregularities, harmful infections, and further surgical operations.

Overall Poor Outcomes
Finally, there are aesthetic risks. Patients are paying for this procedure electively because they want to look better – not worse. Surgeons who don’t remove or inject fat properly, at the correct tissue depths and into the right areas, can cause unwanted “cobblestoning” or “dimpling” in the buttocks and surrounding regions. It’s important to hire a qualified and experienced plastic surgeon who knows how to avoid contour irregularities when harvesting and distributing adipose tissue.

Safe and Effective BBL Surgery Techniques

When done correctly, the Brazilian butt lift body contouring procedure can yield long-lasting results and a relatively quick and easy recovery period. Here are some ways that I minimize risks and maximize results when performing BBL surgery:

Prevent Dimpling
We want the buttocks, back, and abdominal tissue to appear toned and smooth – not cobblestoned. To achieve this natural effect, I avoid contour irregularities when harvesting and grafting fat tissue through careful and even distribution.

Prioritize Patient Health
I feel most comfortable performing this surgery on patients who are close to their ideal body weight, non-smokers, and otherwise in good health.

Procedural Safety Guidelines
BBL surgeons should always avoid injecting fat cells near the gluteal veins, which are located in the muscle. As long as your plastic surgeon is injecting fat superficially and on top of the muscle, the risk of pulmonary fat embolism is low. When filling in “hip dips,” I like to inject in an outward direction – always superficially over muscle planes – to avoid veins.

Additional Techniques and Tools
Some surgeons use ultrasound guidance for extra assurance. I also like to use larger bore cannulas for fat grafting because they reduce injection pressure, which can improve overall fat cell viability, as well as reduce the risk for fat embolism.

What to Look For When Selecting Your BBL Surgeon

Many people are surprised to learn that anyone with a medical degree – regardless of their training – can call themselves a “cosmetic surgeon” without completing any formal surgical training. These providers often operate out of surgical facilities that aren’t accredited, which means they aren’t necessarily following strict standards of patient safety and ethics. They also don’t have privileges at nearby hospitals in the event of a complication.

That’s why it’s critical to book your BBL with a board-certified plastic surgeon. The American Board of Plastic Surgeons is the only agency that issues accreditation to surgeons who have undergone rigorous plastic surgery training. In my case, that involved four years of medical school, one year of general surgery training, and six years of specialized plastic surgery training. You can search for board-certified plastic surgeons near you on the ABPS website.

Our team of board-certified plastic surgeons at Plastic Surgeons of Northern Arizona can answer your questions and discuss surgical options for your BBL surgery.