BBL is a dangerous cosmetic surgery

Brazilian butt lift surgery, commonly known as “BBL,” has proven to be a very dangerous, as well as costly, cosmetic surgery.

Surgeon Ivo Pitanguy first performed this procedure after he founded a plastic surgery training center in Brazil in 1960. This surgery is called gluteal fat grafting and involves liposuctioning fat from the abdomen, back, thighs or even arms and then injecting this fat into the buttocks.

According to MedPage Today, April 11, 2023, “in surgical circles, the Brazilian butt lift is known as the deadliest aesthetic procedure ever performed, and despite several calls to improve outcomes, recent data suggest mortality is only getting worse.”

This surgery has become more popular over the past 20 years and has increased 800% over the last 10 years; the American Society for Aesthetic Plastic Surgery noted that in 2011 there were 7,382 internet searches and in 2021 there were 61,387 looking for information and doctors who perform the surgery.

After the fat is liposuctioned, the syringe or a small canula is inserted deeply and repeatedly deep under the skin to distribute the fat across different areas. This is known as a “blind” procedure because the surgeon cannot see exactly where this fat is going, and it can accidentally be injected into blood vessels. The fat can travel through the bloodstream to the lungs or heart, which is often deadly from a fat embolism. This can happen during surgery, or when a patient is turned onto her back, putting pressure on the buttocks. The cost can range from as low as $3,000 to as high as $30,000 depending on location, surgeon and after care.

This surgery has really taken off in the United States, especially in Miami. Dr. M. Mark Mofid, associate clinical professor of plastic surgery at the University of California San Diego, was one of two surgeons in the United States doing this procedure a few years ago. But as the demand for the surgery grew, so did the number of surgeons, many not adequately trained or qualified. The number of BBL deaths rose and Mofid formed the Aesthetic Surgery Education Research Foundation (ASERF), which published a study in the July 2017 issue of Aesthetic Surgery Journal highlighting the growing number of fatalities associated with this surgery.

It concluded that despite the growing popularity of the procedure gluteal fat grafting had “significantly higher mortality rates” than any other aesthetic surgical procedure and called for more research into its safety.

Dr. Arthur Perry, a plastic surgeon at Lenox Hill Hospital in New York, was also interviewed by MedPage. He said, "Any death from an aesthetic procedure is alarming. One death in a plastic surgeon’s office and you pretty much want to retire from medicine. It’s terrible. It’s not like we need to operate because you’re going to die. The risk-benefit ratio has to be better in cosmetic surgery."

The New York Times Magazine, May 11, 2022, published an article titled “Butt Lifts Are Booming. Healing Is No Joke.” It describes the huge increase in both the numbers of surgeries performed and the profusion of recovery houses with little oversight or regulation. Some of these facilities are good; some are not and have a high incidence of injuries and infections. The risks are great and the benefits cosmetic.

Plastic surgeon Dr. Lara Devgan, in an interview with Harpers Bazaar (September 2022) warned that the results may vary depending on how much of that fat transfer lives.

“In most cases 70% to 80% of the grafted fat survives, while some of it absorbs,” she said. She and her colleagues advise women seeking this procedure to look for a surgeon with board certification by the American Board of Plastic Surgery. And it is important to know where the doctor does the surgery. “A reputable surgeon will perform surgery at a certified surgery center or hospital with a board-certified anesthesiologist,” she continued.

The New Yorker magazine, April 13, 2023, highlighted the documentary “You’ll Be Happier,” about a woman who underwent a Brazilian butt lift surgery. It starts with her saying, “I want to like myself more, more than I already like myself, because I absolutely love myself. But I just want …more.” Then later as she watched the graphic video of her surgery she said, “Like, do I love myself or do I hate myself? I can’t tell what it is.”

The female “ideal” in the ’90s was big breasts and overall thinness and now wider hips and bigger buttocks are considered the best look. Not too many years ago women tried to look like Pamela Anderson and Kate Moss. Now it’s Kim Kardashian and Jennifer Lopez.

When will we stop the nonsense of trying to be something we are not? Breast implants have been around for 50 plus years and many who underwent this augmentation suffered the consequences of silicone leaks, systemic illness such as lupus and connective tissue disease, scarring, impaired breast feeding, breast cancer, breast implant associated anaplastic large cell lymphoma and the list goes on.

Fatigue, depression and anxiety have been associated with implants. These and other illnesses have been termed breast implant illnesses – BBIs. And the latest story circulating on social media is a woman whose (removed) breast implant was full of mold. It is easy to assign blame for conditions with no concrete tangible causes but the anecdotal evidence for breast implant illnesses is mounting and research is ongoing.

Small breasts and buttocks should not be something needing repair. “Remember, no one ever died of skinny buttocks,” remarked Dr. Perry in the MedPage interview.

Mia Smitt is a longtime nurse practitioner. She writes a regular column for Tucson Local Media.