{"id":14792,"date":"2022-04-21T09:27:00","date_gmt":"2022-04-21T16:27:00","guid":{"rendered":"https://www.realself.com\/news\/?p=14792"},"modified":"2024-02-16T09:57:57","modified_gmt":"2024-02-16T17:57:57","slug":"brazilian-butt-lift-surgery-less-dangerous","status":"publish","type":"post","link":"https://www.realself.com\/news\/brazilian-butt-lift-surgery-less-dangerous","title":{"rendered":"Is Getting a Brazilian Butt Lift Dangerous? New Risk-Reducing Guidelines Aim to Help Lower the BBL Death Rate"},"content":{"rendered":"

No procedure in plastic surgery has been more scrutinized and defamed in recent history than the Brazilian butt lift<\/a> (BBL), which transfers fat from areas of excess into the butt and hips, for a fuller, shapelier look. Following a spate of highly publicized deaths, the procedure has been relentlessly studied, dissected, and refined over the past several years by BBL leaders—many of whom believe the procedure has now, at last, righted its reputation. <\/p>

Aiming to further enhance the procedure’s safety profile, new BBL guidelines were recently announced at the 2022 meeting of The Aesthetic Society (coinciding with their publication in the Aesthetic Surgery Journal<\/em><\/a>). Per the latest recommendations, plastic surgeons should routinely use ultrasound guidance when placing and navigating the cannula during fat injection to ensure they’re in a safe plane, and they should perform no more than three BBLs per day, to minimize fatigue-related mistakes.<\/p>

The guidelines are based on findings gathered by the Working Group on BBL Patient Safety, which was assembled by The Aesthetic Society in 2021, to protect patient welfare. According to the group’s first advisory, “the majority of BBL deaths [in Florida] occur at the end of the week. Such a non-normalized distribution most likely represents the result of fatigue and\/or distraction, which has been linked to surgical mortality in multiple published communications. In addition, mortality is likely due to uncertainty or lack of documentation as to the correct plane of fat injection.” (Injecting into or below the muscle can cause fatal complications.)<\/p>

Before we explore the full scope of the BBL’s safety shift, let’s catch you up on the problems that have been plaguing the procedure for the past few years and explain why the BBL surgery death rate is a hot topic.<\/p>

Related: <\/em>Your Complete Guide to a Safe & Successful Brazilian Butt Lift<\/em><\/a><\/p>

BBL dangers and risks revealed and researched<\/strong><\/h2>

In 2015, a PRS<\/em> study entitled Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong?<\/em><\/a>, <\/em>led by Dr. Lázaro Cárdenas-Camarena<\/a>, a board-certified plastic surgeon in Zapopan, Mexico, captured the attention of plastic surgeons worldwide. “That was the alarm bell—he warned everyone that there was something going on,” says Dr. Simeon Wall Jr<\/a>., a board-certified plastic surgeon in Shreveport, Louisiana. Dr. Cárdenas-Camarena and his coauthors analyzed a series of deaths resulting from BBLs performed by legitimate plastic surgeons in Mexico and Colombia over spans of 10 and 15 years, respectively. In all cases, fat was injected into the gluteal muscles and the patients died of pulmonary fat embolism (PFE).<\/p>

“Two things have to happen for a pulmonary fat embolism to occur,” explains Dr. Pat Pazmiño<\/a>, a board-certified plastic surgeon in Miami. “A vein in [or below] the gluteus maximus muscle has to be injured, and fat has to enter that vein. Once it does, it can travel throughout the body and end up in the lungs, with a tragic consequence”—death from respiratory and heart failure.<\/p>

In 2016, the Aesthetic Surgery Education and Research Foundation<\/a> (ASERF) assembled the Gluteal Fat Grafting Task Force<\/a>—tapping doctors from leading plastic surgery organizations such as The Aesthetic Society<\/a>, the American Society of Plastic Surgeons<\/a> (ASPS), and the International Society of Aesthetic Plastic Surgeons<\/a> (ISAPS)—to investigate BBL dangers and offer safety strategies.<\/p>

The task force conducted an anonymous survey of 4,843 plastic surgeons worldwide; 692 surgeons responded. A paper<\/a> published in the Aesthetic Surgery Journal<\/em> in 2017 heralded their findings: 32 deaths from fat emboli, including 25 deaths in the United States between 2011 and 2016.<\/p>

Related: <\/em>The Brazilian Butt Lift Consultation Checklist<\/em><\/a><\/p>

How many people die from BBL procedures?<\/strong><\/h2>

Surgeons who reported injecting fat into the muscle “experienced a 403% increase in the risk of pooled fatal and nonfatal PFEs.” The task force calculated the BBL death rate to fall between 1 in 6,214 and 1 in 2,351 cosmetic surgery patients—a range that’s since been averaged out to the oft-quoted BBL mortality rate of 1 in 3,000.<\/p>

While some plastic surgeons have been quick to point out the survey’s limitations<\/a>, its key takeaway has been widely accepted: fat should be placed only<\/em> in the subcutaneous space above the gluteal muscles, and it should never cross the fascia covering the muscles in a safe BBL. (Subsequent studies—here<\/a> and here<\/a>—have shown how fat injected beneath the fascia can migrate through the muscle under pressure, raising the risk of PFE.) “If you stay subcutaneous, your chance of getting fat into the deep vessels is zero—you should never have a PFE,” says Dr. Wall.<\/p>

The report recommended additional safety measures as well, such as using rigid large-diameter cannulas (tubes used to place fat), injecting slowly with the cannula in motion, and—of critical importance—being acutely aware of the location of the cannula’s tip throughout surgery: “It’s about seeing the cannula tip right underneath the skin—that’s how you know you’re in a safe plane,” explains Dr. Constantino Mendieta<\/a>, a board-certified plastic surgeon in Miami.<\/p>

In the past few years, BBL thought leaders have conducted pivotal safety studies and attended autopsies of patients lost to PFE to gain a clearer understanding of gluteal anatomy and danger zones, so BBL risk can be reduced. “We’ve observed seven autopsies under the Miami medical examiner, and we’ve taken those findings into the cadaver labs, where we’ve replicated BBLs under fluoroscopic imaging<\/a> using different injection techniques, cannulas, and styles of injection,” says Dr. Pazmiño. These studies confirmed that “the best way to avoid a tragic result is to stay away from the gluteal muscles and vessels,” he says.<\/p>

Another key revelation: “There is no one perfect way to do a BBL—many techniques can give a good result,” he says. Plastic surgeons are actually split on this issue, with some favoring standard cannula injection and others believing that powered cannulas—in particular, following a technique pioneered by Drs. Del Vecchio and Wall called expansion vibration lipofilling, or EVL—offer superior precision, efficacy, and safety.<\/p>

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