How Safe Is A Brazilian Butt Lift?

Often, much of the discourse around cosmetic procedures comes down to risk versus reward. The Brazilian butt lift (BBL) has risen in the zeitgeist as a body contouring option for those in search of a curvier backside. The procedure, used to enhance the posterior and shrink the waist, saw a spike of 28 percent from 2014 to 2015, according to the American Society of Plastic Surgeons (ASPS), and it’s shown no signs of slowing down since.

Celebrities like Jennifer Lopez, Beyoncé, and Kim Kardashian have all been credited with popularizing the hourglass figure in recent years, while stars like Cardi B have admitted to seeking a butt augmentation through dangerous means. No matter how mainstream it becomes, it’s impossible to ignore the headlines that call the safety of the BBL into question. With a mortality rate once reported at one in 3,000, the procedure had the dubious distinction of being the most deadly cosmetic surgery.

So, when countless glute sessions and a strict diet can’t carve out your desired rump, a body contouring procedure can do the trick. But – and it's a big butt – are the risks of BBL worth the reward? We ask the experts for everything you need to know about the Brazilian butt lift procedure, the ideal candidate, the risks, the recovery, and more.

What Is a Brazilian Butt Lift?

In the simplest of terms, a Brazilian butt lift is a fat transfer procedure. It consists of performing liposuction on one or more areas of the body (think: thighs, abdomen, flanks) to harvest fat that is then transferred to another (i.e. the buttocks). It’s a minimally invasive, two birds, one stone procedure that offers a solution for those wanting to slim down certain areas while augmenting another.

But, as Nima Naghsihneh, MD, a board certified plastic and reconstructive surgeon and director of Dr. Nima Plastic Surgery in Pasadena, California, explains, the name ‘Brazilian butt lift’ is a bit of a misnomer. “In plastic surgery, ‘lift’ typically implies incisions,” he says. “In this particular case, there are no incisions. Instead, the ‘lift’ is a result of adding volume in the form of one's fat.”

Unlike a traditional butt lift, which requires the removal of excess skin (often after major weight loss), a BBL does not require surgical dissection because it solely addresses the volume of the buttocks via fat transfer. It can, however, provide a more lifted appearance for patients who are experiencing drooping as a result of volume loss. “It is essentially a buttock augmentation,” Dr. Nima notes, and some prominent surgeons have even argued for officially changing the name.

What Happens During a Brazilain Butt Lift

During a BBL procedure, “fat is harvested via liposuction from various body areas (a.k.a. ‘360 lipo’),” says Ryan Stanton, MD, a board certified plastic and reconstructive surgeon in Beverly Hills. Once it’s retrieved, “the fat is prepared by a wide variety of modalities – because there is no proven best one – then re-injected into the buttock cheeks and/or hips,” he adds. What lures many patients in is the minimal scarring that accompanies this procedure because “no surgical dissection required,” Dr. Stanton says. But he is quick to add that the benefit is also “why many uncertified plastic surgeons can and do perform it” (more on that below).

When it comes to anesthesia, Kevin Tehrani, MD, a double board certified plastic and reconstructive surgeon and founder of Aristocrat Plastic Surgery and Medaesthetics in New York, says he typically uses general anesthesia because it “is safe in young, healthy patients.” It also is the best way to ensure patient comfort. “The biggest problem with local anesthesia is that there is a limit of how much can be used,” he explains. “If it’s not enough, the patient will be in pain.” Local anesthesia may be an option, however, for patients undergoing what Dr. Tehrani calls a “small” or “skinny BBL.”

Recovering from a Brazilian Butt Lift

To ensure a smooth recovery from a Brazilian butt lift, some thoughtful planning is in order. Dr. Nima recommends getting fitted for a compression garment prior to the procedure. “These garments are critical and decrease swelling and bruising but can be difficult to put on if they do not fit properly,” he cautions. Additionally, you’ll want to purchase the right pillows to offload pressure on the buttocks while you rest, consider your pre- and post-op meal plan, and proactively inquire about lymphatic massages to help reduce swelling.

Preparing for a Smooth BBL Recovery

• Get fitted for compression garments
• Find the right pillows
• Pre-plan your meals
• Book post-op lymphatic massages

Once you get home from surgery, don’t expect to be sitting around much — if at all. “Sitting is prohibited for at least two weeks (six weeks for some surgeons’ protocol), except for 10 to 15 minutes sitting up for eating or using the restroom,” Dr. Stanton explains. Because this procedure involves multiple areas of the body, the first few weeks can be uncomfortable. Swelling and bruising are to be expected, and Dr. Stanton says that “several different types of pain and anti-inflammatory medications are prescribed” to ease discomfort. Another tip? “Icing around the clock is also extremely helpful,” he adds.

As it relates to resuming normal movement and activities, Dr. Stanton says some patients are cleared to sit up for 20- to 30-minute intervals around the two-week post-op mark. They are also allowed to stand up and take short walks “for at least 30 seconds before sitting back down.” By week three, patients can move around for up to an hour, and “unlimited walking” returns at four weeks.

Patients can usually return to work after two or three weeks (as sitting and basic daily activities become easier), but you will be advised to be careful with exercise and sexual activity until the six-week mark. At that point, most restrictions are lifted. If introduced gradually, more intense physical activity (think: squats, lunges, and sports) can be resumed as well, Dr. Stanton says.

Resuming Normal Activities After a BBL

• 2-Weeks Post-Op: Sit up for 20 to 30 minutes; stand up for at least 30 seconds
• 3-Weeks Post-Op: Stand up and move around for up to an hour; return to work
• 4-Weeks Post-Op: Unlimited walking resumes with limits on more strenuous activity
• 6-Weeks Post-Op: Most restrictions lifted

Each surgeon has their own unique recovery protocol, so recovery looks different for everyone. It’s also important to note that your healing will also be influenced by where your fat was harvested from. “If we do liposuction on several areas like arms, thighs, back, the recovery may take longer,” Dr. Tehrani says.

The Ideal Candidate for a Brazilian Butt Lift

As with any cosmetic procedure, not everyone will be a candidate for a Brazilian butt lift, and, as Dr. Tehrani says, “safety comes first.” As such, “patients with high BMI are generally considered to be at a higher risk of complications after any surgery, and BBL is not an exception,” he explains. After all, “liposuction is not a weight loss but a contouring procedure,” he adds.

The best candidate for a BBL is a patient who is close (within 10 pounds) to their ideal weight, is active, and takes the necessary health precautions given by their surgeon of not smoking, drinking, and monitoring their supplement intake pre- and post-op. This will help to ensure the surgeon can perform “the procedure safely” and the patient “gets the best results after the procedure,” he notes.

The Risks of a Brazilian Butt Lift

While all procedures come with risk, the Brazilian butt lift has a somewhat dangerous reputation. Below are some of the potential risks, complications, and short- and long-term effects of the procedure:

1. Volume Loss & Asymmetry

Volume loss is to be expected after any fat transfer procedure, including a BBL. Dr. Nima says you can “expect to lose 20 to 40 percent of the volume that is injected” during the initial establishment period. The benefit of fat grafting is that there is no risk of the body rejecting it, but, on the flip side, the body will continue to reabsorb the tissue. “For most patients, only about 20 or maybe 30 percent of the fat survives and is permanent,” Dr. Stanton says.

Additionally, asymmetric results can occur as a result of uneven sitting post-procedure or the surgeon’s technique. While it may be possible to correct, it will depend on the health and stability of the patient.

2. Fat Necrosis

Fat necrosis occurs when an area does not have adequate blood supply. It manifests as “firm lumps of fat that have turned to scar,” Dr. Nima explains. “These can be tender but often improve over time.” The lumps are not cancerous.

3. Oil Cysts

These small cysts are “composed of liquefied fat as a result of fat that did not ‘take,’” Dr. Nima says. They are typically not painful, but, if they begin to cause discomfort, it is recommended to speak with your provider.

4. Death

The controversy surrounding BBL and its mortality rate mostly centers around the placement of fat. “The real killer, literally, with this surgery is where the surgeon is transferring the fat into,” Dr. Stanton says. “After extensive research over the last five years, it is now well known and globally accepted that fat injected (a.k.a. ‘transferred’) into the gluteus muscles is the fat that embolizes into the bloodstream up into the lungs, heart, or brain and causes death in approximately 3,000 to 10,000 patients.”

Plastic surgery societies around the world do not advise placing fat into the gluteus muscles but rather the subcutaneous buttock cheek fat layer. However, he acknowledges that “fat survival is quite poor in the fat layer when compared to the muscle layer.” Herein lies the BBL conundrum: “[Surgeons are] damned if you do, and damned — but life-saving — if you don't,” Dr. Stanton says.

Data indicates that these new techniques have gone a long way toward increasing patient safety. While a 2017 survey from the Aesthetic Surgery Education and Research Foundation (ASERF) determined the BBL mortality rate to be one in 3,448, it decreased to one in 14,952 in 2019. The 2019 figure indicates mortality has reached an acceptable level that is similar to that of abdominoplasty (one in 13,193).

A Note on Finding the Right BBL Provider

Finding the right provider is crucial for any procedure, but it is of added importance for BBL. As we mentioned above, the minimally invasive nature of the procedure paves the way for uncertified providers to offer it, yet proper training and technique are a matter of life and death. “There were several cases all over the news when unqualified practitioners performed BBL and their patients died,” Dr. Tehrani says. “As long as your board certified plastic surgeon takes all precautions, uses a blunt cannula, and stays superficial, death should never happen.” As all surgeons should, he also recommends the patient is in optimal health at the time of the procedure.

Alternative BBL Treatments

A Brazilian butt lift isn’t the only way to enhance the buttocks. For those looking to add volume, hip or butt implants can provide a permanent augmentation solution. If excess fat is a concern, liposuction alone can offer some benefit, while non-surgical body contouring procedures like SculpSure®, CoolSculpting®, or Emsculpt Neo® can be strategically employed to create the illusion of a more augmented behind.

Filler can also be used in place of fat to add volume, though the results are often short-lived and/or not as dramatic. Dr. Nima says Sculptra®, a collagen-stimulating poly-L-lactic acid (PLLA) filler, can offer temporary enhancement, while newer-to-market injectables, like Renuva®, can work over the long-term to help you grow your own fat. The drawback is often the price. “It is an excellent product for some volume correction and cellulite treatment, but can get quite pricey for volumes typically needed for a full BBL,” he shares.

The Takeaway

If days in the gym and a strict diet still can't develop those enviable curves, a Brazilian butt lift can enhance the backside — but buyer beware. When it comes to the procedure, it is important to fully vet the surgeon who will perform the BBL to ensure they have the experience and technique to carry it out as safely as possible. While the rate of fat retention is enough to maintain a rounder posterior and a slimmer waist, it is important to weigh both the risks and rewards of a BBL.