The Brazilian butt lift, or BBL, has become more popular in recent years. In this body enhancement procedure, fat usually from around the hips, bra strap roll, and thighs is removed with liposuction, processed to remove the water and non-viable cells and then injected into the buttock to increase its projection. Its advantage over that of an implant is that it is natural fat, that once survives the transplant, will last forever without some of the added risks of a foreign body such as a silicone buttock implant. The American Society of Plastic Surgeons (ASPS) has been closely following this procedure’s meteoric rise as well as its associated complications.
In the USA, over the last few years, there has been a concerning number of deaths associated with this procedure. Most have been caused by fat that has been injected deeply into muscle that makes its way into large veins that then can pass this fat through the heart and into the lungs, (fat embolus). The national societies associated with Aesthetic Plastic Surgery, (ASPS and ASAPS), have made recommendations from the data associated with these cases. It seems the trick is to not inject deeply into the gluteal muscles where these large veins are located. The technique, as it is used now, is done by feel without any corroborative visual evidence of injection location. Ultrasound can be used easily in an operating room, under sterile conditions, to easily observe the location of the injected fat. That is just what I have begun doing since mid 2017. Under ultrasound, the injection cannula can be visualized, and the actual dispersion of the fat can be watched in real time. There is a tremendous safety advantage in doing Brazilian butt lifts using this technique. In the coming years, I would hope that this would become the way this procedure is done by all plastic surgeons.