The possible dangerous complications of Brazilian butt lifts and how to prevent them

With the rise of celebrities like Kim Kardashian and Nicki Minaj in the 2000s came an intense focus on curves – especially bigger booties. As celebrities caused a shift in societal beauty standards toward this more voluptuous aesthetic, people tried to follow the trend. Some women dedicated themselves to squats at the gym, while others turned to plastic surgery and the Brazilian butt lift.

This procedure, also known as a BBL, transfers fat from other parts of the body to the buttocks to increase cheek size and create a more rounded appearance. Its popularity grew exponentially thanks to celebrities with sizeable derrières and the prevalence of social media, but this procedure is also controversial due to its risk for complications. These can be attributed to a variety of factors, including going to a surgeon who is inexperienced or opting for a clinic that offers discounted BBLs performed by unlicensed practitioners.

We spoke with ASPS Member Surgeon Ravi Somayazula, DO, one-on-one to discuss the popularity of BBLs, examine the potential complications and explore what you can do as a patient to set yourself up for the safest possible outcome.

ASPS: How popular is the Brazilian butt lift at your practice? Have you seen its popularity grow or fade in recent years? What do you attribute this to?

Dr. Somayazula: BBL, otherwise known as fat transfer to the buttocks, is quite a popular procedure in our practice. In the United States, there has been a steady growth in the interest of this procedure year over year over the last 10 years. This growing interest is likely related to the current aesthetic trends mainly seen in social media and has become more of a mainstream option for buttock contouring.

In our practice, it is commonly performed with other procedures, such as abdominoplasty and breast procedures, to globally optimize the aesthetic appearance of the body. This procedure is popular among young females who are looking to further increase buttock volume, as well as older females who have lost buttock volume with age and weight fluctuations and desire restoration of buttock volume and improved buttock shape.

ASPS: What are the most common methods and techniques in performing a modern BBL?

Dr. Somayazula: Liposuction is first performed to harvest the fat. Contouring the abdomen, back and sometimes the thighs and upper extremities can be a very useful way to improve the overall aesthetic of the body while improving buttock shape and size. These are frequently the donor sites for harvesting fat. In general, surgeons utilize various methods of fat collection.

In my practice, we use a closed system to collect the fat. The fluid is drained, and the remaining supernatant fat is then reinjected precisely and safely into the buttock utilizing the EVL roller pump technique. This method is extremely efficient and safe. Tactile feedback of the cannula tip ensures placement of the fat in a subcutaneous plane, minimizing intramuscular injection and optimizing overall safety with the procedure.

ASPS: What are some of the most common complications that patients experience with BBLs? What are the reasons behind them, and how can they be avoided?

Dr. Somayazula: Inadvertent injection of fat intramuscularly can lead to a fat embolus and result in death. This is an uncommon complication of this procedure. Knowledge of buttock anatomy and consideration of the use of ultrasound guidance can improve safety and outcomes with this procedure.

Fat necrosis is another potential complication of this procedure. This may occur when bolus injections of fat are placed in an area where there is less vasculature and an abundance of fat is placed in a small recipient area. This may result in hardening fat. This can be minimized by spreading the fat after injecting to create a more homogeneous ratio between the resulting fat grafts and the surrounding vasculature, as well as ensuring the proper volume of fat is placed per recipient volume.

It is also important to discuss any preexisting areas of true cellulite of the buttock with the patient, as fat grafting alone will not improve these areas. Consideration of the use of mechanical subcision preoperatively may be required prior to fat grafting to address cellulite and optimize overall gluteal aesthetics with the procedure.

ASPS: Do you have any advice or best practices for patients who are interested in pursuing a BBL, but wary of the complications that can come with it?

Dr. Somayazula: Make sure to see a board-certified plastic surgeon who has competency with the procedure. There are many discount, "cheap" clinics that perform many procedures in one day at a very low cost. Patients should be extremely cautious of these clinics. In the media, there are many reports of such clinics in Miami, although they are spread throughout the country as well as in other countries.

This procedure becomes dangerous in the wrong hands. Such cheap clinics have a dangerous business model in which many procedures are performed in various rooms simultaneously by people who are not board-certified plastic surgeons. In such discount clinics, these are only physician assistants, nurses or even non-medical personnel with very little to no oversight by a physician or plastic surgeon.

Undergoing your BBL procedure by a board-certified plastic surgeon who performs many of these procedures yearly – but no more than two or three procedures per day – and considers the use of ultrasound is a critical part of ensuring safety with this procedure.

ASPS: Do you have any additional insights around this topic that you'd like to share?

Dr. Somayazula: The main concept of gluteal shaping with fat conceptually involves a subtraction-addition approach. When considering buttock shaping, it is essential that the surgeon understands artistic anatomy. Knowing where fat should be removed and where the opportunities lie to enhance subadjacent aesthetic units to enhance the buttock shape is critical to an excellent result.

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.