Surgery to graft fat to the buttocks, ‘Brazilian Butt Lift’ is a record holder in popularity, but also in risks

The perfect body, in Diana Dayyani’s view, belongs to a cartoon character. Not just any animated character, with Wilma Flintstone or Betty Rubble, but a rabbit: Jessica Rabbit.

“I love that hourglass look,” said Diana, 23, from Houston, USA. “A slim waist with nice hips.”

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Diana was so enchanted by Jessica Rabbit’s body shape that, in April, she decided to purchase one for herself. She went after expert Patrick Hsu, a graduate plastic surgeon from Houston. He suggested a breast reduction ($7,400) and a gluteal augmentation, or the “Brazilian Butt Lift” (BBL), for $9,190, excluding anesthesia and hospitalization costs.

Diana Dayyani, from Texas, who underwent the procedure Photo: CINDY ELIZABETH / NYT
Diana Dayyani, from Texas, who underwent the procedure Photo: CINDY ELIZABETH / NYT

This last procedure, which usually costs about $15,000 and is not covered by health insurance, involves having the fat liposuctioned from your flanks, stomach and lower back and injected into your butt.

“It’s like transferring money from your checking account to your savings account,” Diana said.

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And so she became one of thousands of women around the world who undergo one of the most popular cosmetic surgeries (some men do the procedure too, but not many).

In 2020 alone, there were 40,320 buttock augmentation surgeries, which include implants and fat grafting, reports the Aesthetic Society.

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According to the Brazilian Society of Plastic Surgery (SBCP), gluteal fat grafting, the technical name for the practice, is the most popular cosmetic procedure in the world in recent years, but there are no exact numbers for the number of surgeries performed in Brazil.

On Google, the term “BBL” was searched about 200,000 times a month between January and May 2021.

The deadliest plastic surgery

However, in addition to the high popularity in the offices, the procedure is also one of the deadliest. A July 2017 report by the Foundation for Aesthetic Surgery Research and Education published in the Journal of Aesthetic Surgery noted that one to two patients out of 6,000 undergoing BBL died, the highest mortality rate for any cosmetic surgery.

In 2018, the British Association for Aesthetic and Plastic Surgery advised surgeons in Britain to stop performing it, although they couldn’t ban it altogether.

Due to these restrictions, the SBCP claimed to have created a local task force to investigate the risks, concluding that the serious complications and deaths resulting from the procedure occurred due to fat embolism, closely related to fat grafting into the muscle, a technique that has a mortality 16x larger than when performed subcutaneously.

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Thus, the organization states in a note that “provided that it is performed by trained professionals, gluteal fat grafting is a safe procedure, which has a lower mortality rate than many other universally accepted procedures considered safe, such as abdominoplasty”.

But any ban also mattered: women would travel to Turkey or South America to perform the surgery, where it was significantly cheaper. At least two British deaths were recorded at a clinic in the Turkish city of Izmir.

The reason the procedure is so dangerous is quite simple. The buttocks have a multitude of blood vessels, some as wide as straws. These drain blood into the inferior vena cava, which is a direct line to the heart. The fat is then injected into the buttocks with a cannula or a long metal tube.

But it can be difficult for doctors to know exactly where they are injecting; they sometimes mistakenly inject fat into or just below the gluteal muscle. The fat can then travel directly to the heart and lungs, obstructing blood flow and causing immediate death.

In 2018, concerned about the mortality rate, the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery and the International Society for Aesthetic Plastic Surgery, among others, formed an international task force of””Fat Graft Safety Gluteä” to develop safety guidelines around the procedure.

One of his recommendations is that doctors stop injecting muscle and use larger instruments.

“These cannulas tend to bend, and if they bend when you put them on your buttocks, you have no idea where the tip of the cannula is,” said Luis Rios, Texas certified plastic surgeon and former president of the Education and Foundation Foundation. Aesthetic Surgery Research, research, education and philanthropy arm of the Aesthetic Society.

A 2020 case-follow-up study found that 94% of physicians are aware of the recommendations.

“When done correctly and carefully, it’s safe,” said Steven Teitelbaum, a plastic surgeon in Santa Monica, Calif., who was involved in developing the guidelines but does not perform the surgery. “We know exactly the mechanism that can lead to death and we know how to avoid it. The surgeon just needs to maintain intense focus and concentration.”

However, people are still dying, particularly in the “chop shops,” the low-cost, high-volume patient centers typically found in Las Vegas, Los Angeles and Miami, with doctors who may not be certified or even surgeons.

One of those clinics, Mia Aesthetics in Miami, has had eight patients who have died in the past six years, four from unsuccessful BBLs, according to USA Today and The Naples Daily News. The clinic has not returned to the New York Times counts.