You can exercise your way to bigger glutes—or for those wanting immediate or more dramatic results—there’s the option of a Brazilian butt lift (BBL). The aesthetic procedure continues to grow in popularity, despite the health risks. According to the American Society of Plastic Surgeons, more than 20,000 people had a BBL done by board-certified surgeons in 2017, rising steadily from the 8,500 people who did it in 2012.
A BBL uses a combination of liposuction and fat-grafting, resulting in added volume, defined curves, and a lift. There are serious concern about whether this surgery is safe at all after reports surfaced that the death rate following a BLL is a terrifying 1 in 3,000. We spoke with plastic surgeons Dr. Lara Devgan and Dr. David Shafer to walk us through all the controversy.
A BBL starts with liposuction, where a surgeon will suck fat out of areas in the body then process and re-inject it into the buttocks and hips. The areas of planned liposuction (Shafer says fat is usually taken from the abdomen or the lower back) and the outline of planned fat grafting are marked before surgery. Once the patient is positioned on the operating room table face-down and under anesthesia, the liposuction is performed in the desired areas and the fat is collected in a specialized system that separates live fat cells from liposuction fluid. That fat is then injected in the marked areas of the butt. Shafer says surgeons will sometimes graft fat into the thighs or hips, depending on what body shape the patient wants. The procedure requires a few very small incisions that sutured closed at the end.
How Much Do BBLs Cost?
Devgan says the cost of BBLs can vary depending on the provider performing the surgery and where you live, but it can range anywhere from $3,000 to $30,000.
Shafer says some patients just don’t have enough excess body fat for a BBL. “[Curvy patients] have fat available for harvesting through liposuction and enhancing their buttocks and thighs fits their body type,” he says. Devgan recommends patients be healthy adults within 15 pounds of their goal weight.
Before surgery, you’ll also need to have a medical clearance from your general practitioner. Shafer explains that doctors will make sure you’re healthy for surgery and screen for risk factors associated with surgical complications such as blood clotting disorders or any cardiovascular issues.
What Is BBL Recovery Like?
Shafer says recovery happens in three stages: first few days, first several weeks, and first several months. During the first few days, you can generally go back to work. During the first several weeks, most of the swelling reduces and the bruising starts to heal. This is when you can go back to the gym and are approved for travel. The last stage is where any remaining swelling will resolve and the transferred fat has pretty much settled.
Devgan says you’ll want to avoid pressure on areas where there is grafted fat. If you’re a back or side sleeper, this means you’ll need to sleep on your stomach and avoid strenuous exercise for several weeks.
Expectations also need to be managed: the results are only semi-permanent. Shafer and Devgan note that only up to 80 percent of the grafted fat survives, so many patients may need to revise some aspect of the surgery in the future.
“In most cases 70 to 80 percent of the grafted fat survives while some of it absorbs,” Shafer says. “The fat is living tissue and will change with weight fluctuations in the body so if you lose weight, the fat can shrink just like anywhere else on your body. Likewise, if you gain weight, the fat can expand just like anywhere else on your body when you gain weight.”
Why Are BBLs Dangerous?
Brazilian butt lifts are controversial—and dangerous—because patients are dying on the operating table. Studies show that from 2011 to 2016 there were 25 Brazilian butt lift-related deaths. In 2017, a plastic surgery task force reported that three percent of plastic surgeons who performed the procedure had a patient die. Last August, it was reported that BBLs have the highest death rate of any aesthetic procedure, with a death rate of up to 1 in 3,000.
“This is a level of risk that is extremely alarming and totally unacceptable for an elective cosmetic procedure,” say Devgan. “That risk of death is a statistic that factors in the outcomes of highly trained American board-certified plastic surgeons, so this is not just an issue of who is doing the surgery; it is a risk inherent to the operation.”
Devgan explains that when the injection of fat inadvertently goes into one of the deep blood vessels, fat can travel back to the heart and lungs. This results in cardiopulmonary collage that is often times not reversible or treatable.
“There are risks involved with the injection of the fat and this is where training and experience is so important,” says Shafer. “If the fat is injected too deep or in the wrong area, the fat can enter the blood stream can cause issues such as pulmonary embolus or clotting.”
Shafer stresses the importance of doing your research before committing to any surgery. He says to make sure your surgeon is certified by the American Board of Plastic Surgery (“This is the highest level of certification,” he adds) and to be wary of the lure of going outside the United States just because it can be done at a lesser price.
“The prices may seem tempting, but there are associated costs such as travel, lodging, return flights and also followup care,” he says. “Additionally, countries offering bargain plastic surgery do not have the stringent ethical and patient safety requirement that are followed by board certified plastic surgeons.”
Are BBLs Worth It?
Devgan and Shafer differ on whether this procedure is something anyone should try at all. Devgan wouldn’t suggest her patients try this. “This is my litmus test, my personal golden rule of plastic surgery: if you wouldn’t let your mother or sister or brother have a procedure, you shouldn’t let your patients either,” she says. “The Brazilian butt lift is an operation that I do not perform any longer because the mortality data speaks for itself. The risk benefit calculus simply does not add up.”
Shafer on the other hand thinks it could be a great procedure for the right patient. “That is why it is essential to have a thorough consultation with a board-certified plastic surgeon to review your options,” he says.
Are There Safer BBL Alternatives?
A Brazilian butt lift isn’t the only option for a perkier bum. Shafer says one alternative to consider is Sculptra Aesthetic, an off-the-label injectable that helps boost your body’s natural collagen. He says that although it is FDA-approved for increasing volume in the face, it can be used to add volume in other parts of the body. He does warn that this treatment can be cost prohibitive; many vials of Sculptra (costing upwards of $20,000) are required to gain a noticeable result in the butt. He recommends this for anyone who can afford it and for anyone who wants to avoid invasive surgery. Devgan says she frequently injects poly-L-lactic acid (the main ingredient in Sculptra) into the butt to improve contour, shape, texture, and cellulite.
For something completely non-invasive, you can also consider VelaShape III, EmSculpt, and CoolSculpting. VelaShape III uses radio-frequency tecnology to boost collagen production and reduce the appearance of cellulite; EmSculpt stimulates the muscles deep in your abdomen or glutes and causes massive contractions, resulting in muscle hypertrophy with subtle fat reduction; CoolSculpting freezes and therefore kills the fat cells in the areas under your butt, which can help make the area appear perkier.
No matter which route you decide to follow, just make sure to do your research before committing.
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