Brazilian Butt Lift Safety in 2021

Brazilian butt lift procedures represent one of the most popular procedures in cosmetic surgery today. The number of people requesting this procedure, commonly known as a BBL, has been increasing year after year for the past several years. The procedure involves removing fat via liposuction from the places you do not want it, and then re-injecting that fat into the places you do want it, such as the butt and the hips. The procedure offers the benefit of liposuction in addition to the advantages of fat transfer. The end result is usually a smaller waist with perky butt and rounder hips.

Unfortunately, the Brazilian butt lift procedure has been getting a bad rap in the press over the past several years. It has been called “the deadliest plastic surgery procedure”. There have also been recent Internet clips from a well-known Hollywood plastic surgeon claiming that this procedure is so deadly that it should not be performed. The backlash over this procedure stems from a study that was performed in 2017. This study showed that there was a significant death risk when having a BBL procedure performed. However, this is certainly not the case and evaluation of the actual data shows that this procedure is safer than a tummy tuck.

The 2017 Study

The study was published in 2017 using data from surveys to plastic surgeons. The data study showed there was a 1 in 3000 risk of death after a Brazilian butt lift procedure. This is certainly an extremely high death risk and understandably, this caused great concern amongst plastic surgeons as well as the general public. No plastic surgeon would ever advocate for procedure that carries a 1 in 3000 chance of death. Those of us who have been performing Brazilian butt lift procedures for a very long time and specialize in this procedure, immediately knew that this number just didn’t make sense.

When experts in Brazilian butt lift procedure as well as people knowledgeable about scientific studies looked at the results of the survey, it became apparent that the study was just simply flawed on many levels. There were errors in statistical analysis and study design. But the damage was already done. Global media picked up on this reported death rate of 1 in 3000, and there was an immediate call to ban the Brazilian butt lift procedure. There were some countries in Europe that went so far as to actually prohibit plastic surgeons from for performing this procedure. Additionally, there were some hospitals in the United States that placed this procedure on the list of prohibited operations. During this period of public uproar, there was also criticism of this procedure from other plastic surgeon who, quite frankly, never even performed this operation. It became a very hot topic within the plastic surgery community and caused a great division.

The 2019 Study

Luckily a better designed study was performed in 2019. This study did not have the flaws seen in the original 2017 survey. The results of this 2019 study show that the actual risk of death from the Brazilian butt lift procedure is 1 in 15,000.  This was quite different from the 1 in 3000 death rate that was originally reported. And shows that this procedure is actually quite safe when performed correctly. In fact, for comparison, a tummy tuck procedure carries a death risk of 1 in 14,000. So, this means that the Brazilian butt lift procedure is actually statistically safer than a tummy tuck.

Fat Embolisms

Obviously, there are risks with any surgical procedure. In addition to the usual risks of infection, bleeding, anesthetic reaction, and scarring, the Brazilian butt lift procedure carries a unique risk because of the procedure itself. The procedure relies on injection of fat to fill up areas such as the butt and hips. Injecting fat into the body carries the potential risk of what is called a fat embolism. A fat embolism is when droplets of fat travel through a blood vessel to the heart lung and brain. This is a potentially fatal complication. So how does a fat embolism occur during a Brazilian butt lift procedure? In order for fat to travel through a blood vessel to other organs, fat needs to get into the blood vessel to begin with. When fat is being injected into the buttock, the surgeon needs to be very aware of the location of normal blood vessels in that area as to avoid accidental injection of fat into these vessels. It is these instance of fat embolism’s that are responsible for the majority of unfortunate deaths associated with a Brazilian butt lift procedure.

Ways to Minimize the Risk of a Brazilian Butt Lift Procedure

Regardless of whether or not reported data was flawed, it became quite obvious that the BBL procedure is a procedure growing in popularity and that we need to focus strongly on safety surrounding this procedure. This meant that plastic surgeons created guidelines to help minimize the risk associated with a BBL. These guidelines were extremely important given the increasing popularity this procedure, as well as the increasing number of plastic surgeons who are starting to perform this procedure and may not have many years of experience that the experts have.

The majority of the guidelines focused around techniques during fat injections to minimize the risk of fat injections into blood vessels. This included:

  • improved knowledge of the anatomy of the area so that blood vessels can be avoided
  • patient positioning during the surgery
  • surgical instruments used to inject the fat
  • injecting the fat over the muscle as opposed to in the muscle or below the muscle
  • Rapid recognition of a potential fat embolism

Any plastic surgeon performing Brazilian butt lift procedures needs to be intimately aware of these guidelines in order to keep their patients safe.

How to keep yourself safe during your Brazilian Butt Lift

In addition to plastic surgeons being aware of techniques to reduce your risk during a Brazilian butt lift procedure, there are also things you can do as a patient to reduce your risk. These include appropriately selecting your surgeon who is performing your procedure, and appropriately selecting the facility in which your procedure is going to be performed.

As you are probably familiar, you should always select a board-certified plastic surgeon for your plastic surgery procedure. More importantly though, you want to make sure that your board-certified plastic surgeon is experienced in the Brazilian butt lift procedure. This BBL procedure is very specialized and carries unique risks as described earlier. You want to make sure that they are an expert at the BBL procedure. This means that you should ask your surgeon how many of these BBL procedures they perform per month or per year. You also want to specifically ask what techniques they will use during this procedure. This is because you want to make sure that they are following all safety guidelines in order to reduce your risk of potentially fatal complications. And experience board-certified plastic surgeon will not be offended by these questions. They will recognize that this is a potentially risky operation and they should appreciate your involvement and concern for your safety. If they get offended, then that may be an indication that they are not the right surgeon for you.


  • Choosing your facility

All plastic surgery procedure should be performed in accredited operating facility. This means that it could be a hospital, an ambulatory surgery setting, or an accredited office operating room. You want to make sure that wherever you are having the surgery is up-to-date with all safety standards and there is a board-certified anesthesiologist who will be administering your anesthesia and monitoring you throughout the procedure and stay in the recovery room.  As someone who has performed over 5000 Brazilian butt lift procedures safely, I never perform this operation under local anesthesia. I find that general anesthesia is safer, more comfortable for you, and allows me to provide you with a better surgical result.

If you would like to learn more about the Brazilian butt lift procedure and how you can get this procedure done safely, you can contact New York City board-certified plastic surgeon Dr. Matthew Schulman. Dr. Schulman is considered an expert at this procedure having performed more Brazilian butt lift procedures in his career than most other plastic surgeons.