This article was reviewed by Dr. Luis M. Rios Jr. on March 26, 2020.
For the past five years, the Brazilian butt lift (BBL) has been dogged by tragic headlines and an uncertain future. Dozens of patient deaths worldwide and a highly publicized mortality rate of 1 in 3,000 prompted plastic surgery societies to question the safety and necessity of the curve-enhancing procedure—and left BBL proponents bracing for a potential ban.
New studies, however—including a pivotal new survey published in the Aesthetic Surgery Journal—show that the operation is gaining ground on the safety front. As reported by RealSelf News, the BBL’s most up-to-date death rate is 1 in 14,952, when performed by a board-certified plastic surgeon.
To further improve your chances of having a safe BBL and smooth recovery, we’ve laid out the most important rules to follow before and after surgery, according to our experts.
7 Steps to a Safe and Successful BBL
1. Find (and vet) a plastic surgeon who’s a BBL expert and safety advocate.
Any doctor you’re considering for a BBL should be board-certified in plastic surgery (look them up on RealSelf or CheckYourSurgeon.com, which connects to the American Board of Medical Specialties). That said, “board certification is not protective in and of itself,” notes Dr. Pat Pazmiño, a board-certified plastic surgeon in Miami. He suggests asking surgeons if they have hospital privileges (even if you plan on using an accredited outpatient facility). If so, they’ll have undergone a rigorous credentialing process. But “if a hospital doesn’t trust them to do the surgery, neither should you,” he adds.
You’d also be wise to call the state medical boards to make sure your doctor is in good standing.
Next, check to see if your doctor is a member of The Aesthetic Society or the American Society of Plastic Surgeons. “Both societies have a code of ethics that their members must follow, along with requirements for continuing medical education,” says Dr. Herluf Lund, a board-certified plastic surgeon in Chesterfield, Missouri, and president-elect of The Aesthetic Society. “If a doctor is actively involved, they’re being monitored throughout their career.” These societies also share the most up-to-date safety data with their members and keep them abreast of task-force alerts and recommendations.
True BBL experts typically surpass these standards. Like the surgeons quoted in our guide, they’re prolific researchers and authors of BBL studies; they participate in task force activities; and they educate surgeons around the globe on BBL safety by presenting at aesthetics meetings and leading hands-on training courses.
2. Ask the right questions during consultations.
May I see B&As of previous patients with body types and goals similar to mine? What are the risks, and how do you manage complications? What’s the recovery like? You can use our BBL consultation checklist to guide your conversation with potential surgeons. Put these two questions at the top of your list:
- Do you follow the guidelines recommended by the Gluteal Fat Grafting Task Force—and can you explain what they are and why they matter? According to Dr. Lund, every BBL patient should ask this question to ensure their provider isn’t in the minority of those still practicing and promoting dangerous intramuscular injections (injecting fat into the gluteal muscles can cause a fatal pulmonary embolism). Along the same lines, Dr. Constantino Mendieta, a board-certified plastic surgeon in Miami, suggests asking doctors what measures they take to guard against PFEs (pulmonary fat embolisms).
- How often do you perform BBLs? While “there’s no magic number that’s going to automatically make this procedure safe, you’re looking for a surgeon who does it with some consistency,” says Dr. Mendieta. Realize though that geography can affect a doctor’s tallies: While top BBL providers in big cities may perform upwards of a dozen BBLs per week, surgeons practicing in areas where the procedure is less popular may do just one or two a week. Whether they’re in Miami or Boise, however, “they should be performing the procedure with such consistency that it feels routine,” notes Dr. Matthew Nykiel, a board-certified plastic surgeon in Newport Beach, California. Beyond asking straight out for numbers, a good way to gauge BBL proficiency is to ask surgeons to run through the procedure and recovery, he adds. “If they can lay out that information in a well-oiled-machine kind of way, that likely means they’ve done this a lot.” Surgeons’ social media accounts can also give an idea as to the types of procedures they specialize in and the frequency with which they perform them.
Related: 6 Things to Look for in Brazilian Butt Lift Before-and-Afters
3. Choose a doctor who inspires not only confidence but comfort.
“Make sure you’re compatible with your surgeon, because even when a procedure is executed perfectly, there are always inherent risks to surgery—plus the chance that you won’t wind up with everything you’d hoped for—and doctors and patients have to be able to work through those situations together,” says Dr. Nykiel. “If personalities clash, it’ll be that much harder.” While fat embolism is the most serious BBL risk, more common complications include infection, seroma, cysts, lumps, contour irregularities, and unmet expectations.
4. Have realistic goals.
In 2020, if you approach the BBL with a “go big or go home” attitude, doctors are apt to send you packing. (Yes, even if you have ample fat to spare.) “In the past, if someone asked for outrageous volume, we could usually accommodate them, because we had the vast muscle surface area as a bed to inject,” says Miami board-certified plastic surgeon Dr. Onelio Garcia. “Now we’re limited to the subcutaneous tissue, which can’t hold as much volume.” And pushing the envelope sizewise can hike the risk of complications, such as lumps and fat necrosis. “If you put fat under too much pressure, blood can’t get to it to nourish it, there’s poor lymphatic drainage, and eventually, those fat cells will die,” adds Dr. Lund. “There’s only so much you add to the subcutaneous space before you reach that pressure point.”
5. Prioritize proportions over volume.
Rather than zooming in on the butt alone, take a more panoramic view of the territory—hips, lower back, thighs—through a body contouring lens. “I often find myself telling patients, ‘Your butt is actually fine—it’s your body that’s too big for your butt,’” says Dr. Garcia, who believes the key to safely creating a shapely rear is taking out more fat from the surrounding areas and putting less into the butt itself to achieve an hourglass silhouette of proper proportions.
6. Prepare for a smooth recovery.
As with any operation, your doctor will give you a complete pre-op plan to follow in the weeks and days before surgery, including supplements to add and subtract along with dietary advice (no binding breads or dairy, nothing spicy or starchy). They may also recommend taking a laxative a day or two before surgery, to sidestep post-BBL constipation.
But generally speaking, the biggest no-no is nicotine in any form—cigarettes, vaping, patches, gum. “Nicotine is the most powerful poison that exists for small blood vessels,” says Dr. Pazmiño. “We’re counting on these vessels for the survival of the fat graft. If nicotine is in your system, the fat graft will not survive and the whole surgery will have been a waste.” Cut it out for at least one month before the surgery and one month after.
The first few days of BBL recovery tend to be “very, very messy,” he adds, with fluids leaking from incision sites. Some patients trade underwear for adult diapers during this stretch, to help with absorption, so you may want to have a pack on hand. Make up your recovery bed with old sheets, to avoid staining your favorite linens, and have clean towels at the ready. To help replenish lost fluids, your doctor may prescribe a steady supply of Gatorade. Again, stock up on suggested foods and drinks before the big day.
Get your prescriptions filled in advance of surgery too and preorder any special pressure-reducing pillows your provider recommends for sitting and driving post-op.
If your surgeon orders a series of post-op massages to help with healing, book those appointments ahead of surgery.
You’ll be out of commission for one to two weeks following a BBL. Be sure to get vacation time cleared at work and line up caretakers for yourself and your family so you can rest easy.
7. Follow your surgeon’s post-op guidelines to the letter.
Built and revised based on years of experience, post-op protocols are designed “to keep patients safe and problem-free,” says Dr. Simeon Wall Jr., a board-certified plastic surgeon in Shreveport, Louisiana. While every doctor’s blueprint looks a little different, all of them tend to have a few commonalities.
Your surgeon will prescribe various medications to combat initial discomfort—most of which arises from the lipo-induced swelling rather than the buttock injections, says Dr. Jennifer Walden, a board-certified plastic surgeon in Austin, Texas, whose patients take narcotic analgesics for the first few days, followed by Tylenol. Other doctors prefer nonnarcotic pain management. Dr. Lund, for instance, offers gabapentin (to address nerve pain) and Celebrex (a nonsteroidal anti-inflammatory) to his BBL patients.
Doctors generally have patients wear customized compression garments for at least six to eight weeks following BBL surgery, “to keep swelling down and get the skin to stick where we want it,” explains Dr. Nykiel. Weekly lymphatic massage can also help ease the aches and swelling of recovery. What’s more, he adds, “it’s been a game changer for decreasing contour irregularities.”
Some doctors place drains after a BBL, to evacuate fluid and minimize swelling. “I’ve found that drains take off about four months of swelling for my patients, helping them to recover much faster,” says Dr. Pazmiño.
You’ll need to keep off your bottom for at least a week, which means sleeping on your stomach and abiding by your doctor’s specific sitting restrictions. “After the first week, patients can use a booty pillow, which elevates the buttocks when sitting and driving,” says Dr. Nykiel. He has patients continue to use the cushion for the entire first month post-op and gives each patient a unique set of sitting instructions based on the precise placement of their fat injections.
After surgery, get up and start moving as soon as your doctor gives you the green light. Being upright and mobile not only prevents blood clots, “it helps with fluid return, diminishes swelling, enhances GI functioning, and gets you feeling better faster,” says Dr. Lund. After two weeks, you can resume non-seated workouts (elliptical machines, stair climbers, and so on). “At three weeks, I have no qualms about using weights, as long as you’re not sitting on a bench for an extended period of time,” he adds.
According to Dr. Walden, your final volume boost should be mostly apparent by eight weeks post-op—but the swelling from liposuction can persist for up to a year, so try to be patient with your results.
This guide was created in partnership between RealSelf and the American Society for Aesthetic Plastic Surgery (ASAPS), the leading professional organization of plastic surgeons certified by the American Board of Plastic Surgery who specialize in aesthetic (cosmetic) plastic surgery.
