Terrified of getting a BBL. What is the risk of death from a fat embolism?

In several reports available in our literature it seems to be as high as 1 in 4000 major fat transfers like  BBL!!! It is currently "the most dangerous procedure in cosmetic surgery" but interest between patients is in constant increase. 
It seems that injection of small particles of fat grafts into muscles and between buttock muscles where the large veins of buttock and lower extremity are located, creates a possibility to inject small amount of fat tissue or fat oil directly into the vessel. This lump (embolus) travels with vein blood stream into organs like kidney, lungs, brain and heart and creates occlusion, damage and ultimately death in some patients. When injecting fat grafts surgeon can not see tip of cannula but can control it by his free hand; however, it is possible to damage the vessel and inject fat into the vessel without knowing it. Signs of organ failure (lungs, heart, kidneys) and fast deterioration of patient condition that happens within few minutes to hours after incident are the first to show that something serious is happening, unfortunately. 
Most experienced surgeons will inject fat only in the layer between skin and muscles to avoid this to happen. Vessels in this area are generally smaller and for that reason likelihood of vessels injury is significantly lower. This concept is supported by the fact that in all cases which ended with lethal outcome there were signs of muscle injury and violation of the muscles which confirms above statement. Injecting fat in subcutaneous space at the time being seem to be much safer. Individual technique of the surgeon, adequate selection of cannulas and avoidance of injecting huge volumes are some of the aspects of safety that patient should discuss with the surgeon before fat transfer surgery. Good luck.

While a Brazilian Butt Lift is generally a safe procedure it has the same risks as liposuction with the added risk of fat necrosis.

Thank you for your question.
BBL in untrained hands can be a dangerous procedure. Please discuss your concerns with a Board Certified Plastic Surgeon who is experienced in this technique.  All The Best !

Fat embolus is a very serious and known complication of fat transfer (which has been recently spotlighted in the media). While it is true, injection of donor fat into the infra-muscular plane (within the muscle) increases fat viability, this does come with a significant increase in risk. There are large vessels deep to and within the muscle which can be inadvertently injected while grafting leading to a fat embolus. The consequences of such a complication are very serious and life threatening.
BBL/gluteal lipoaugmentation demonstrates a dramatically higher risk profile than other surgeries. The Aesthetic Surgery and Educational and Research Fund has convened a task force as well. The hope is that we will have more concrete guidelines for addressing these very serious complications.
That being said, the safest way to avoid fat emboli is to stay in the subcutaneous plane (at the expense of fat viability) and avoid the deeper muscular plane. If grafting of the deep plane is planned, surgeons should consider blunt cannulas and aspiration prior to injection. Using a supra-gluteal approach to minimize the risk of inadvertent intravascular injection has also been proposed. While this will likely impact graft viability negatively, it will also lower the risk of a serious complication.
According to AAASF data the risk of death from BBL will range from 1:3000 (subcutaneous grafting should reduce this risk relative to intramuscular grafting). By comparison the risk of fatal complication from abdominoplasty is 1:13,000. It is unclear how the relative risk falls with subcutaneous injection vs. intramuscular injection (however, in all likelihood, it is less).
No result is worth risking one's life for. I find that the patients who focus not on the volumization but rather the contouring benefits of the liposuction are happier than those whose sole goal is size. Relatively speaking, the subcutaneous plane is the "safe" plane.
In summary, the procedure can be safely performed, however, they should be performed by a board certified (ABPS) plastic surgeon with experience. These risks should be discussed as well as the strategies being employed to avoid them.

Thank you for this great question. Recent compiled data has shown that the death rate from the BBL procedure is the highest of any cosmetic procedure. The death rate has been published at 1 in 3,000. The deaths are from fat embolism when trauma to the gluteal veins and a pressure gradient causes fat to enter the bloodstream. Many surgeons think the solution is to just stay superficial to the muscle and while this is true from a safety standpoint, cadaver studies have shown that whether or not surgeons think they are injecting deep to or superficial to the muscle, on examination, all those surgeons had fat that was into or deep to the muscle. So it is easier to do than you think. The bottom line is this is a risky procedure and you have to gauge the risk vs the benefit. A great start is to make absolutely sure you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery and thoroughly discuss the risks and benefits of any procedure.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery