The Brazilian butt lift is on the rise.
It’s not surprising, considering popular culture’s growing obsession with large, perky derrieres. From Jennifer Lopez to Nicki Minaj to Kim Kardashian — to paraphrase Sir Mix-a-Lot, we like big butts and we cannot lie. But according to a recent report from the American Society of Plastic Surgeons, the BBL, as it’s also called, is one of the most dangerous cosmetic procedures out there.
As with any surgical procedure, there are risks. But BBL patients have an alarming mortality rate: As many as 1 in 3,000 people who undergo the procedure die, or 0.033 percent, compared with 0.002 percent for all office-based cosmetic procedures, according to a 2016 study published in Aesthetic Surgery Journal. That has raised red flags in the plastic surgery community. And the cause of these deaths is disturbing: Fat that’s injected too deep can enter your circulatory system, possibly leading to a pulmonary embolism.
According to Dr. Douglas Senderoff, a board-certified plastic surgeon based in New York City, the BBL is associated with the highest complication rate of any plastic surgery procedure or elective surgery for healthy people. It’s “unacceptably high,” he said.
Of course, any death or complication from an elective procedure is by definition unnecessary.
To find out more about the procedure and why it’s so dangerous, HuffPost spoke to Senderoff, as well as Dr. Alan Matarasso, the president-elect of the American Society of Plastic Surgeons, and Dr. Lara Devgan, the chief medical officer of RealSelf, an outlet for people to share their cosmetic surgery experiences and connect with doctors.
What is a Brazilian butt lift?
The first thing you should know about the BBL is that it’s not really a lift.
“It’s a little bit of a misnomer,” Matarasso said, explaining that the cosmetic procedure enlarges the buttock area through the injection of fat. That fat is usually taken from other parts of the body ― usually the abdomen and thighs ― for additional contouring effects.
The procedure has become increasingly popular over the past few years (perhaps a result of the Kardashian effect). The American Society of Plastic Surgeons reported that its members and other certified surgeons performed 20,301 buttock augmentations with fat grafts in 2017 — up 10 percent from 2016.
According to Matarasso, the rise in popularity makes sense. “People like the concept of using their own body fat,” he said, noting that there’s more of an “overall change” to the body shape. “For example, you may reduce the thighs and enlarge the butt, and they sort of go hand in hand.”
Devgan agreed, saying that people are attracted to the BBL because it leaves patients with more of an hourglass figure. “You’re losing prominence and fullness of the abdomen and waist, but you’re gaining some prominence and fullness of the buttock,” she said.
Why is it so dangerous?
The BBL is a risky surgery because of a number of different factors.
For instance, there are a lot of blood vessels in the buttock area that can be torn or punctured if the fat is injected too deeply, Senderoff said. As a result, the fat can make its way into the circulatory system and travel to the lungs, which could lead to a pulmonary embolism, he explained.
“[A pulmonary embolism] is basically a blood clot in the lungs, and you can’t get oxygen to your body because there’s obstruction, and that’s fatal,” he said. “You really don’t have much time to do intervention. It’s something a patient can’t [always] recover from, and it can be immediate.”
Other elements that can affect the outcome of the procedure, according to Matarasso, include the amount of fat that’s injected, the angle at which it’s injected and the type and size of instrument (a cannula) used.
Devgan said that other factors like a patient’s position on the operating table, a patient’s weight and the procedure’s length, which “can be a little longer in duration, so there’s a little bit more anesthesia time,” can have negative effects on the outcome.
The BBL can have a number of non-life-threatening complications, including bleeding, infection and issues with skin healing, Matarasso said. According to Senderoff, patients can also experience fat necrosis, in which the injected fat cells die, resulting in firm lumps that can lead to infection.
There’s very little regulation
“Plastic surgery, in some ways, has become the Wild West,” Devgan said, adding that “all sorts of physicians of all descriptions, whether or not they have formal training in the discipline, are going out there, hanging up the shingle and performing plastic surgery.”
Senderoff agreed that it’s scary to think about how many uncertified individuals are performing BBLs but noted that there are also board-certified plastic surgeons who have experience with these complications.
“The operation is risky in and of itself, and if you put it in the hands of people who aren’t well trained, it’s even more dangerous,” he said.
Of course, “back alley” surgeries are still happening (as rapper Cardi B can attest.) That is, people who aren’t doctors are performing cosmetic procedures, injecting “inappropriate substances” like silicone into people’s bodies, which is extremely dangerous, Matarasso said.
“It’s unfortunately not as uncommon as you’d hope it would be,” he said, adding that there are a number of medical journal articles on how to treat the complications of these shoddy procedures. “On any given day, there is somebody going into the emergency room with siliconomas,” or hard lumps of tissue that form around silicone gel that has migrated from an implant or injection site.
What are the alternatives?
A Brazilian butt lift definitely isn’t the only option out there for those considering enhancing their backsides. But every procedure comes with its own risks, so it’s wise to speak to a doctor before making any decisions.
Senderoff said buttock implants are still a common procedure for patients looking to increase the size of the area permanently. There is also an actual surgical butt lift, which Matarasso said is typically done on individuals who have lost a lot of weight.
It’s also possible to combine fat injections with implants, Senderoff said. That way, the doctor doesn’t have to rely on the fat to build the core volume of the buttock. He called this method a sensible approach because it allows for more precision.
Doctors can also do what’s called an auto-augmentation, Matarasso said, which involves lifting the buttock and refashioning the extra tissue into a flap, resulting in a more shapely backside. He said this surgery is typically safe but noted that it’s associated with cutting and scarring that doesn’t necessarily come with the Brazilian butt lift.
Nonsurgical options are available too, with the most popular being the Sculptra buttock augmentation, Devgan said.
“That’s an injectable filler that stimulates the body’s own collagen, and it can be injected to make the buttock more shapely and reduce the appearance of cellulite,” she said. “The limitation of that technique is that it takes a lot of product and a long time for the results to come to be.”
The fillers last two to five years, and the resulting collagen induction lasts indefinitely. Patients need to return after four to five years for another treatment.
There’s also EmSculpt, which Devgan said is “basically electric muscle stimulation” that’s meant to encourage your body to build muscle mass. While it’s typically used to shape and contour the abdominal area, she said EmSculpt is also being marketed as suitable for nonsurgical butt lifts.
Exercising, of course, is the most natural alternative. Matarasso noted that while it’s possible to build muscle and enlarge your buttock area, it’s harder to reduce the size of other areas.
What needs to be done to make the BBL safer?
In response to the high mortality rate associated with the BBL, the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, the International Society of Aesthetic Plastic Surgery, the International Society of Plastic Regenerative Surgeons and the International Federation for Adipose Therapeutics and Science formed a task force that aims to develop safety guidelines for the procedure.
Devgan, Matarasso and Senderoff agreed that the mortality rate associated with the BBL is too high, and they called for a few changes to be made.
“I think more awareness and regulation of the industry needs to happen, Devgan said. “I think that people who aren’t trained in plastic surgery shouldn’t be doing this procedure. I think the public should be more aware of the risks out there.”
“It’s really unacceptable, what’s going on. It’s outrageous,” Senderoff said. “The question is, is it avoidable, or is this something that’s going to continually happen with this operation? I think it’s up to every plastic surgeon to really explain the risks and not be so nonchalant about this operation.”
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