Supply and demand: How surgeons are navigating the BBL boom
Plastic surgeons are racing to meet demand from the fastest-growing cosmetic procedure in the world

If you spend enough time scrolling Instagram and TikTok, you could easily – and understandably – start to feel as if you're the only person left in the world who hasn't had their butt done.

The Brazilian butt lift – a plastic surgery procedure in which fat is liposuctioned from the abdomen or another fleshy part of the body and injected to enlarge and shape the buttocks – is everywhere. And in most cases, a BBL silhouette is unmistakable, with a teeny waist giving way to a voluptuous, smooth bottom, revealing itself largely due to the fact that the man-made contours are perfect.

If you've had BBLs on your mind, it's likely not just due to social media. The number of augmentation surgeries increased by 90.3% between 2015 and 2019, making it the fastest-growing plastic surgery procedure in recent memory.

The skyrocketing demand for this two-in-one body procedure is clear, but less clear is how plastic surgeons have been meeting the rush of BBL-hungry patients. We spoke with two board-certified plastic surgeons and American Society of Plastic Surgeons members to get their take on the supply and demand challenge.

What's causing the BBL demand?

Like most trends, it's never just one thing that pushes the movement forward, but geography is a good place to start.

"The first thing that comes to mind is that people are for sure traveling more now, post-COVID," said David Sieber, MD, a board-certified plastic surgeon who practices in San Francisco. "People are going to a lot of places where they're in swimsuits, where they're enjoying warm weather, and they want to look good and feel good, and because of that, more people are seeking out surgery."

Yet, one city in the United States stands far above the rest in terms of BBL demand.

"Miami is often regarded as ground zero for BBLs," said Josef Hadeed, MD, FACS, a board-certified plastic surgeon with offices in Beverly Hills and Florida, who adds that the procedure's popularity likely strengthened because of the predominant influence of South American culture – hence the name.

"Oftentimes, you see patients coming in and they say they want the overly enhanced look, but it's not really a cookie-cutter approach," said Hadeed. "Every patient starts off with a different body and that may not look appropriate relative to their body frame."

Interestingly, public demand for the BBL remains high, even as the sought-after aesthetic continues to evolve.

"Most of my patients aren't asking for huge BBLs anymore," said Sieber, referencing the inspiration photos his patients bring in. "They're not these exaggerated hips with tons of projection or a super crazy waist-to-hip ratio."

Instead, patients want "to fill in their hip dip or they want a little bit more projection, a little bit better shape," he says. "That kind of fuller, rounder shape seems to be going away a little bit to something that's more athletic and sporty looking."

Often referred to as a 'skinny BBL,' this growing surgical offshoot is reserved for petite patients (defined as those with a BMI under 25) who still want an hourglass shape and fuller bottom, which can often be achieved from careful and well-done liposuction alone.

Has the surging demand impacted surgeons and their practices?

"Yes," said Sieber, adding that these ripple effects are both subtle and strong.

He recalls listening to a speaker at a plastic surgery conference where the speaker drilled down that it is the surgeon's responsibility to make sure their patients look as best they can post-op – a sentiment that seriously resonated.

"We started providing patients with this whole BBL post-op kit of all the tools they need – the compression, the foam, the pillow, everything – to make sure they're going to get the best results possible. The responsibility is not on them to go search out and find these things because they might end up getting something that ends up causing more harm than good," said Sieber. "So, we give them a huge bag of help during their pre-op visit."

Setting patients out on the right foot can be time-consuming for surgeons, but investing a little more time at the onset will ensure a smoother path forward for all – not to mention, a more beautiful result.

Performing a BBL is taxing too

As profitable as it may be for surgeons to pump out patients as fast as they can, it's simply not safe – or even possible – to do so.

For a BBL procedure, Sieber estimates that he spends three and a half to four hours total in the operating room: three hours performing a 360 liposuction procedure followed by 30 to 45 minutes of fat grafting – and none of them are easy.

"Liposuction takes a huge physical toll on a surgeon's muscles, tendons, everything," he says, adding that performing two per day would put him at a full day's work – and one that he does his best to avoid. "I try to break them up throughout the week, just for my own sanity."

There are ethical ways to meet demand, but cramming patients into the OR isn't one of them. Buyer beware if your prospective plastic surgeon boasts of performing more than two per day. Before booking a BBL, check your surgeon's credentials to confirm not only board certification, but safety record and surgery center accreditation.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.