I just learned that the facility where I am having my BBL done has had 4 deaths in the last five years. Is this normal?

You want to make sure you are having your surgery in a properly accredited surgical facility.   If this is a hospital that deals with very sick or complicated patients, 4 deaths in 5 years would be understandable.   If this is an outpatient surgery center, 4 deaths in 5 years would seem like a lot.  You should address your concerns with your surgeon and the management of the facility prior to your procedure.

There are 2 key points to consider when undergoing cosmetic surgery:There are numerous practitioners of plastic surgery. However, only a select few are board certified by the American Board of Plastic Surgery (the only board recognized by the American Board of Medical Specialties). Board certification ensures completion of a rigorous training program of at least 6 years (with at least 3 years of dedicated plastic surgery training. Board certified surgeons have also completed written and oral examinations to determine competency and participate in a continuing medical education programs as a prerequisite of maintaining certification. Ultimately, certification ensures a measure of certainty when comparing surgeons. You can be assured that your board certified plastic surgeon has seen and treated it all before and is uniquely qualified to manage you pre-operatively, intra-operatively, and most importantly post-operatively.Patients should ensure that the procedure that they are undergoing is being performed in AAAASF or Medicare/JCAHO approved facility. This will ensure that the highest standards of safety are being adhered to.With regards to your specific question, the record of 4 deaths is concerning. I would recommend getting as much information as possible before proceeding. You want to compare "apples to apples." Same procedure, same surgeon but different patient will make this sort of comparison difficult. You do not (and likely will not) have specific details surrounding the deaths. That being said, complications can happen and any surgeon or facility should be forthright regarding patient concerns as it relates to these issues. They should be able to address your concerns and allay your fears.A few points specific to BBL: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.
At the recent American Society of Plastic Surgeons Hot Topics (2016), data from AAAASF (ambulatory surgical certifying body) was presented, suggesting that BBL/gluteal lipoaugmentation demonstrates a dramatically higher risk profile than other surgeries. The Aesthetic Surgery and Educational and Research Fund is convening 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, aspiration prior to injection. Using a supra-gluteal approach to minimize the risk of inadvertent intravascular injection has also been proposed.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Those statistics would certainly raise red flags in my mind.  The quality of the surgeon and the facility are both critical.  I would make sure that the surgeons are board certified by the american board of plastic surgery (this is different than board certified in cosmetic surgery - not a recognized board certification).  Safety should always be your surgeon's and your first priority.  4 deaths in 5 years is extremely high.  Sometimes lower cost surgery is achieved by cutting corners.

I think that you need to find a top surgeon, but there is a risk of complications that can happen and may or may not be related to the surgical technique.

this is a very important topic in plastic surgery. Deaths due to bbl are typically due to surgical technique and have less to do with the facility that you are having the surgery in.   you should choose a bbl surgeon who has performed thousands of these operations and who has had no deaths. Death is typically due to incorrect surgical technique and incorrect instrumentation. If there is any doubt in your mind you should follow your gut. Best regards,

What you describe is disturbing.
The fatality risk for these procedures should be one in 10,000 at most.
Unless that facility did more than 50,000 BBL cases their fatality rate it's disturbing.
Please confirm your doctor is a board-certified plastic surgeon with an excellent reputation using fully accredited operating room.
If that is the case then you should be in good hands.
Still, the numbers are disturbing.
Best,
Mats Hagstrom M.D.