Brazilian Butt Lift – British Association of Aesthetic Plastic Surgeons’ guidance

Feb 13, 2024

There has been a lot in the news recently about The Brazilian Butt Lift (BBL) and the complications associated with such surgery.

To summarise the procedure, this is a process where fat is taken from areas where it is not wanted (tummy, back and flanks) and re-injected into the buttocks, in order to reshape them. The technique has long been used in reconstructive surgery, especially to improve irregularities after surgery for breast cancer, but this process takes much larger volumes of fat using liposuction, and re-injects it into the buttocks.

With a number of high-profile cases, especially some deaths where patients have gone abroad, this surgery has come under scrutiny. It has been found to have a high rate of complications, and most importantly, the highest mortality rate of any cosmetic surgery procedure. This has been estimated at approximately 1 in 3000.

The confusion arises from the fact that this figure includes all forms of fat transfer for buttock augmentation, and does not separate it into different techniques. The main distinction to be made is whether the fat is injected into the muscle (which will help it survive better) or just into the existing fat under the skin. The risk of death comes from accidental injection of the fragile veins in the muscle with fat, which then can travel to the lungs and cause blockages. This risk is therefore much higher when injecting directly into the muscle. It is for this reason that the advice from international plastic surgeons has always been to avoid muscle injection, and to only inject the fat under the skin. As there is a huge discrepancy in the risk associated with these two techniques, it seems inaccurate to lump them both together.

The British Association of Aesthetic Plastic Surgeons (BAAPS) has recently issued guidelines with respect to this surgery. At the October 2018 meeting, it was decided that the advice should be that BBL surgery should not be carried out until further data is available. This is quite a cautious position and goes much further than the advice of the American Association of Plastic Surgeons (which advises care to be taken, but does not prohibit the surgery). However, given that BAAPS is the organisation which is issuing this advice in the UK, this is a directive which cannot be ignored.

It is therefore likely that no qualified and reputable plastic surgeons will be performing this procedure until we have more data and guidelines. My personal feeling is that once this area is investigated further and specific advice is given, some form of this procedure will re-emerge as being safe. Until that time, however, large volume fat transfer for buttock augmentation and lifting should not be performed.