How safe is BBL? Should I wait?

hello,Is is fantastic that you are researching these issues! The pulmonary fat embolism (PFE) is a mechanical blockage of the pulmonary veins by fat particles. It occurs when injection technique injures a vein and fat particles travel through the venous system and the pulmonary veins to the heart. While not all PFE’s are fatal, many do result in death within the first 24 hours following surgery.  The Pulmonary Fat Embolism (PFE) issue came to our attention in 2015 with a publication by Plastic Surgeons in Mexico and Columbia . It cited the high number of PFE's with BBL.  In  2016, a Task Force was created by the Aesthetic Surgery Education and Research Foundation (ASERF) , to study these PFE complications.  Then in 2017, a multi-society Gluteal Safety Panel Task Force team of Plastic Surgeons was set up to study the issue in depth.This new Task Force Team invited 19 Plastic Surgeons from ASPS, ISPRES, ISAPS, and ASAPS, and IFATS. I am on this Task Force team and we have spent a great deal of time over the past ~2 years discussing and studying autopsy reports along with cadaver injection sessions to see where fat goes when it is injected with different techniques. Technically speaking, he main point that we have agreed upon and made public are that fat injections in the buttocks should only be made in the subcutaneous plane, and not into the muscle or deeper. The problem still remains that many surgeons THINK that they are in the subcutaneous plane (when injecting), but are not.  I have employed ultrasound techniques to confirm my subcutaneous plane of injection.  I also inject small amounts in each injection pass.  I do not blindly pump fat into the butt.  I am fully confident that all of my fat goes into the subcutaneous plane. Manual fat injection techniques do result in the surgery taking longer, but I sleep very well at night. More information has been obtained since the Task Force's injection sessions last summer and will be published in a paper describing our findings.  I have been performing this procedure for 15 years and I will say that my original beliefs about technique have been validated.  Some of this is just common sense. Do you rather a high pressure injection technique where the fat is pumped in quickly and blindly over a 1 hour session, or do you want a manual technique where small amounts are injected with each pass? Which do you think offers more control and less damage to the blood vessels?Another common sense thing is to make sure your Plastic Surgeon is Board Certified by the American Board of Plastic Surgery. There are many doctors who are performing the BBL who do not even have any type of Surgical Residency, which is utterly mind blowing. The public should beware that there has very recently been an organization founded of 'Gluteal Surgeons'  who accept as members NON Board Certified Plastic Surgeons.  While they may have good intentions to follow Task Force guidance, beware. I have been writing about PFE's for some time. Please see my original guidance from 2017 in the link below. I continue to believe that when performed with these principles by a Board Certified Plastic Surgeon this procedure is safe and produces amazing results.Good luck! Ricardo L Rodriguez, MDBoard Certified, American Board of Plastic Surgery

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

hello thank you for your question and provided information as well.. based in your question All surgery has its risks, but if all the prevention protocols are carried out and it is evaluated by specialists and does not have any basic pathological condition, the risk is lower.Time does not influence.

Hello, I have done a lot of research on this exact topic. Please see a board certified plastic surgeon for an in person consultation to discuss having this procedure performed. Every surgery procedure has its risk but having the procedures done by an experienced board certified plastic surgeon makes it safer. Of course technology gets better with time, but theres no need to hold off on a procedure that is performed everyday with no issues. Again please see an experienced board certified plastic surgeon. Hope this helps,Dr. Germán Newall Houston Board Certified Plastic Surgeon 

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.
With regards to your specific question, the procedure is clearly high risk. However, as more is learned about the procedure one of 2 things will occur: BBL will become safe or BBL will no longer be performed. It is difficult to say where we will be in 1-2 years. However, the best advice is to be informed of the risks and the measures that can be employed to mitigate these risks.
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 submitting your questions.The pulmonary fat embolism is a mechanical blockage of the pulmonary veins by fat particles. It occurs when injection technique injures a vein and fat particles travel through the venous system and the pulmonary veins to the heart. While not all PFE’s are fatal, many do result in death within the first 24 hours following surgery. Another common sense thing is to make sure your Plastic Surgeon is Board Certified by the American Board of Plastic Surgery. There are many doctors who are performing the BBL who do not even have any type of Surgical Residency, which is utterly mind blowing. The public should beware that there has very recently been an organization founded of 'Gluteal Surgeons'  who accept as members NON Board Certified Plastic Surgeons. I highly recommend you consult with a Board-certified plastic surgeon for maximum results. Best of luck. 

There is currently a 1/3000 death rate here in the US and even higher when traveling out of the country for surgery. I am not sure more time will make the case 100% safe but I think more physicians will follow the recommendations that are in place for safety. Find a board certified PS that has a lot of experience with this procedure and ask about complications including previous deaths. 

Brazilian Butt Lifting is essentially a form of high volume fat grafting into the buttocks. Fat grafting itself is a very safe procedure which is performed around the world. BBLs have a higher rate of fat embolisms when patient are being injected with large volumes near larger blood vessels. In order to minimize this risk, the surgeon should treat the BBL as carefully as they would be with fat grafting of the face. Small volumes with every injection in the tissue away from the blood vessels. This definitely takes a longer time during the surgery but this will increase the fat grafting success and minimize any risks. Surgeons who short-cut the procedure by placing large volumes per injection or inject randomly into the muscle and other vascular are placing themselves at higher risk. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

A BBL can be unsafe when injecting fat underneath the muscle.  In US, the ASPS (the main society of   plastic surgeons) has mandated that fat only be injected above the gluteus maximus muscle to avoid fat embolism.  Recent anatomic, cadaveric studies authored by Del Vecchio, one of the luminaries behind the advancement of this procedure, have clearly demonstrated that as long as injections stay superficial to the muscle, and in particular, the muscles fascia, no fat can leach down into the submuscular space where big veins live that can be injured and allow fat to enter the blood stream.  The problem is that in certain regions of the US and in certain other countries, the cosmetic industry is poorly regulated and often populated by poorly trained surgeons or even non-plastic surgeons staffing high volume chop shops where the surgeon only meets the patient the day of surgery.  The price is often cheap, and that is part of the draw.  Certain clinics in the US have had multiple deaths, and they simply rebrand and change their name and keep rolling.  When patients demand a pornographic, unnatural bubble butt, jamming fat into the submuscular space to provide extra projection is felt to be necessary.  Do your homework before engaging any surgical practice, and see multiple surgeons.  Ignore flashy Instragram promotions and hustles and bargain basement pricing.  Use your God-given intuition.  If you feel uneasy about the procedure, don't do it.