More so than any other plastic surgery procedure, Brazilian butt lifts (BBLs) get a bad rap. Media coverage of fatal operations performed by “cosmetic surgeons” (or, in some cases, people who aren’t licensed in medicine at all) has scared many into believing that a BBL is equivalent to a death sentence. But the truth is that when performed by an experienced board-certified plastic surgeon, the risk of complications during any surgery drops dramatically. In fact, thanks to shifts in how the procedure is performed, a recent study showed a 76% reduction in the BBL mortality rate.
This is not to say that getting a BBL is risk-free; all plastic surgeries come with risk. The greatest risk factors include seeing an unskilled provider, being in poor health, and not following pre-surgery protocols (for example, you can’t eat before undergoing general anesthesia). There are also complications of surgery like allergies to medications and anesthesia, bleeding, and seromas.
Beyond those fairly standard potential dangers, there are a few that are unique to BBLs. If you’re considering the procedure, it’s best to go into it eyes wide open. Here, with the help of board-certified plastic surgeons, we break down the most common BBL complications and risks—both medical and aesthetic—to know ahead of surgery.
BBL complication #1: fat embolism
Without question, this is the most deadly complication of undergoing a BBL and the cause of the surgery’s once steep mortality rate. “An embolism will kill you—almost right away, on the operating table,” says Dr. John Paul Tutela, a board-certified plastic surgeon in Livingston, New Jersey. A fat embolism occurs when fat is injected into a vessel, blocking healthy blood flow. Like a blood clot, this fat can move through the body and travel to your heart or lungs, stopping them from working. The most terrifying aspect of fat embolisms is, there’s no way to know that one has formed until it’s too late.
This happens mostly when a patient’s harvested fat is injected deep within the butt muscle, where a lot of these critical blood vessels are located. But this technique isn’t used as frequently as it once was, which is why the BBL mortality rate has dropped. “In the U.S. and other major countries—Colombia, Mexico, others—almost all surgeons are on board not to inject fat into the buttocks muscle,” says Dr. Matthew Nykiel, a board-certified plastic surgeon in Newport Beach, California. Now most surgeons (including both the providers interviewed for this article) inject the fat superficially with a large cannula, adding plumpness above the muscle rather than below.
This doesn’t mean that the surgical community has banned butt muscles injection altogether. “It gets you a bigger result,” says Dr. Nykiel. “When you see a very full, round, bubbly, voluminous butt, that’s likely done via a fat injection into the butt muscle.” If you’re looking for these dramatic results with a safer outcome, Dr. Nykiel recommends considering butt implants: “They go into the butt muscle, lifting it up and creating that nice volume and shape.”
BBL complication #2: infection
Though the risk of infection is not unique to BBLs, it is one of the more likely complications to arise, so it’s worthy of a breakdown. “Sterility is key,” insists Dr. Tutela. “Fat is just waiting to be infected—it’s like a piece of meat, a perfect place for bacteria to go overboard.” During the fat transfer process, the fat is removed from its current blood supply and then relocated. As the fat waits to be injected, it’s struggling to survive, making it highly susceptible to infection.
Receiving an IV drip of antibiotics during your procedure, ahead of your actual incision, will go a long way in staving off infection, as will following serious sterility protocols during surgery. But if you do get infected, make sure you see your provider quickly—because if your infection goes untreated, it could turn into tissue necrosis. The risk of experiencing this complication is increased by undergoing liposuction, an essential aspect of a BBL. With tissue necrosis, bacteria can cause not just skin but also fat and muscle to die (it can also be caused by poor blood flow to the area).
Thankfully, it’s easy to tell if you have an infection: “The area gets red, it gets hot, it gets firm, it gets painful,” explains Dr. Nykiel. “If it’s near an incision site, you may have a little bit of drainage coming out.” To treat it, your provider will make a small incision over the area to remove the infected fat and fluid, clean things up, and prescribe you some antibiotics. Some providers also use hyperbaric oxygen therapy as a preventive method, pushing oxygen back into the blood and skin for better healing.
BBL complication #3: skin numbness or sensitivity
As the cannula moves around beneath your skin during liposuction, it disrupts the nerve endings that travel through your fat to the skin’s surface. This can cause changes in skin sensation. “Initially, it’s numbness—people describe it as feeling like a bowl of jello,” says Dr. Nykiel. “Then you’ll get a little tingly, feeling prickly sensations as the nerves wake themselves up, which they typically do.” Don’t be surprised if these sensations last for up to a year post-procedure.
BBL complication #4: contouring irregularities
This is a risk of any liposuction procedure and could occur during the fat removal itself (creating little bumps) or upon its reintroduction to the body. “[With fat transfer,] you’re putting little droplets of fat in a diffuse area, trying to make something perfectly shaped,” explains Dr. Tutela. “The reality is, you’re passing this cannula back and forth, and you could create little areas where it’s deposited a little more next to an area that is deposited a little less.”
To correct the look of contouring irregularities, your surgeon can go back in, anywhere from six months to a year post-procedure, and level out the texture. If the contouring irregularity is caused by lipofibrosis, when those lumps and bumps are actually hardened scar tissue, your provider may suggest lymphatic drainage massage and self-massage to help break up the scar tissue until a year has passed, when they’ll smooth out any remaining bumps.
BBL complication #5: volume loss
“Fat loss isn’t even a risk—it’s a guarantee,” says Dr. Tutela, who says the average resorption rate of transferred fat is about 50% nationwide. “You’re going to get it to some degree, but it’s hard to say how much and where.” It’s almost entirely the luck of the draw, but how your provider processes the liposuction fat can make a difference.
“Humans are 60% water—when we do liposuction, anywhere from 30% to 50% of what we suck out could be tumescent, fluid, or not even fat,” Dr. Nykiel explains. If a provider strains the fat out from the rest of that liquid, you’ll see a more accurate representation of your results post-procedure, though you may still see volume shift. “Fat cells decrease a little bit after surgery, because they’re in shock,” says Dr. Nykiel. “Typically around a year out, you’ll see that sort of regain and regrow.” However, if a provider doesn’t separate the fat from the other liquid, your body will quickly resorb all those fluids, making a much smaller-looking result.
You’ll also see changes in the shape and size of your butt as your weight fluctuates. “When people put on weight, they will notice that their whole body increases in volume,” says Dr. Nykiel. “Even though the butt gets bigger, that loss of definition from the waist to the back to the butt can really change the way those results look.” However, if you lose the weight you’ve gained, your results will be restored.
In the case of significant fat resorption, beyond going back for multiple BBL rounds, a great way to help maintain the appearance of a juicy booty is to follow a solid fitness routine. Says Dr. Nykiel, “perkiness and a toned look to the butt mainly come from your butt muscle—that’s the majority of your butt’s volume.”
