This transcript was exported on January 17, 2023 -view latest version here.

Skin care can sometimes feel overwhelming, whether it’s finding the right products, ingredients, or treatments, there’s a lot out there. But not always for people of African, Hispanic, Middle Eastern and Eastern South Asian descent. That’s why I set out to educate myself and others so that we can all feel beautiful in our skin.

Hello and welcome to The Skin Report. I’m Dr. Dr. Simran Sethi, an internal medicine doctor, mom of three, and CEO and founder of Renew MD Medical Spas and Skin by Dr. Sethi.

It’s 2023 and I think it’s about time to talk about an extremely popularized aesthetic procedure, the Brazilian butt lift, or the BBL. From celebrity Instagram to TikTok the BBL seems to be everywhere, with talk and speculation and rumors only growing. But what does a BBL entail exactly? What are the risks and alternatives? What should you look for in a surgeon if you’re getting a BBL? Listen to this episode to find out these answers and more.

Appearing in medical journals around 1969 buttock procedures have only become popular in the past decade or so as beauty trends have shifted. In a retrospective analysis using international data, or Journal of Aesthetic Surgery articles showed that gluteal augmentation with fat, or BBL, increased by 3,267% from 2002 to 2015. More than 400,000 buttock procedures have been performed in 2015 alone according to the American Society of Plastic Surgeons. Since then the global demand for BBLs has risen by about 77% from a survey conducted by the International Society of Aesthetic Plastic Surgery.

Before we go any further I wanted to say that we will also be covering the risks of a BBL later in the episode, so be sure to stick around for those. But for now, let’s cover the basics.So what is a Brazilian butt lift? What is the procedure like? When it comes to enhancing the appearance of the buttock there are two popular procedures. The first being a traditional butt lift. A butt lift addresses loss of volume and sagging of the buttocks that typically occurs with age or excess weight loss.

A cut is made above the buttocks and the skin is pulled up to reduce the sagging. This procedure does not involve grafting or surgically transferring fat from one part of the body to the buttocks. It only involves cutting excess skin and lifting it up much like a facelift or a tummy tuck. In fact, people sometimes combine a butt lift with their tummy tuck as a tummy tuck also just involves cutting excess skin to give the abdomen a tighter appearance.

So how does a Brazilian butt lift differ? During a BBL fat is removed from another part of the body, usually the abdomen, and grafted into the buttock area to increase the volume of the buttocks and lift at the same time. Unlike a butt lift, which occurs when there is sagging, a successful BBL must be done when you have tight to moderately tight skin in the buttocks to start with, and enough fat tissue in another part of the body to be taken out to relocate to the gluteal area. Again, people can also combine a tummy tuck with their BBL, but this recovery is more complicated as after a BBL surgery you must sleep on your stomach, which becomes more difficult when you are simultaneously recovering from a tummy tuck.

A Brazilian butt lift can also be performed with implants, but this is not as popular amongst plastic surgeons as implants carry their own risks, which we will see when we look at Cardi B’s recent experience.

Which brings me to my next point, the death rate of BBLs. Before considering this procedure I urge you to take the risks of BBL seriously. I want to talk about this because as this procedure grows in popularity we rarely hear about the risks associated with it. My purpose for this episode is not to scare people away from a BBL, but to help you understand what it involves, some alternate less invasive options and what to look for in their surgeon before making the decision to go under the knife.

Aesthetic procedures and plastic surgery have very low death rate, usually one in 55,000. However, buttock augmentation with fat or BBLs have had the highest death rate compared with any other aesthetic procedures at one in 3,448, according to the Journal of Aesthetic Surgery. While this is still low the Brazilian butt lift still carries an almost 16 times greater risk of death compared to other aesthetic or plastic surgery procedures. This is important to understand because plastic surgery is really only performed on healthy individuals who should have an exceedingly low risk of complications to start with, so, to have such a higher death rate is alarming.

The cause of death in all cases has been a condition called a pulmonary fat embolism. A fat embolism is essentially a small droplet of fat which accidentally find its way into the bloodstream and eventually travels into the heart and lungs. All fat embolisms are not fatal, but if the embolism is large enough it can result in death. A large fat embolism that ends up in an artery in the lung can interfere with oxygen exchange, which is vital to survival, and in some cases can lead to death.

Around 2017 medical society started identifying a concerning uptick in both fatal and non-fatal cases of fat embolism with BBLs. The American Society for Aesthetic Plastic Surgery conducted a study of 692 surgeons, 3% of which experienced a patient fatality from gluteal fat grafting, while 7% saw at least one pulmonary fat embolism in a patient over their careers.

When this complication was identified we learned that it occurs with a certain surgical approach to BBLs rather than with all the different approaches.

Fat can be grafted into the area in two ways, injected under the skin but above the muscle so it becomes sandwiched between the two, or injected directly into the gluteal buttock muscle, this approach is the one associated with an increased risk of pulmonary fat embolism.

In addition to multiple reviews by the Society of Plastic Surgery, a plastic surgeon’s task force reviewed all the deaths and autopsies of patients who died after the BBL, finding that pulmonary fat embolisms occurred when fat was injected directly into the gluteal muscles instead of above the muscle. The gluteal muscles have a lot of blood vessels and if you’re injecting volumes of fat into the muscle there is a higher chance of breaking into the blood vessel and injecting fat into the vein.

Furthermore, the task force also found that this surgical approach was taken by surgeons who were not board certified or trained in plastic surgery, which means they were performing the procedure without proper training and guidelines.

Although much less common some BBLs are done by injecting implants or silicone fillers into the buttock, as with Cardi B silicone injections she got done illegally years ago. In December of 2022, she had over 95% of her implants removed and urged her fans to do their research and not get a BBL if they are at risk. Regardless, injectable silicone for facial or body contouring is permanent. It can move throughout your body and is not approved by the FDA.

Injectable silicone can cause infections, pain, injuries, permanent disfigurement, scarring, and fat embolism as we discussed, which leads to stroke or death. To clarify, injectable dermal fillers are made of materials that the body can eventually break down and absorb, these are hyaluronic acid fillers, and therefore are temporary and approved by the FDA.

If you want more information on dermal fillers and how they compare to procedures like Botox check out Episode 26 of The Skin Report. After the break I’ll wrap up my thoughts on the safety of a BBL and what you should look for in a surgeon.

So we’ve talked a lot about the risks associated with BBLs, which begs the question are they safe? This is an important question and we are lucky that the entire society of plastic surgeons took immediate action and put together a task force to investigate the cause of these fatalities and how to avoid more tragedies from occurring.

A BBL can certainly be safe if performed by an experienced board certified plastic surgeon. The top thing to look for and ask your surgeon if you’re considering getting a BBL are if the plastic surgeon is board certified in plastic surgery, and their experience with the procedure. Remember, the surgical approach that led to embolisms was performed by surgeons who are not plastic surgeons or board certified.

Whether they’ll be injecting the fat above the muscle. Again, fat injections directly into the muscle were the only ones associated with a pulmonary fat embolism, so a subcutaneous approach that stays out of the muscle tissue is safe.

The volume of fat that the surgeon plans to graft. Retrospective studies found that when large volumes, upwards of 400 cc’s per buttock, were injected and injected in larger boluses, the risk of fat embolism increased. Instead, steadily injecting a moderate amount of fat, approximately 400 to 600cc’s per buttock, is a safe way of grafting fat.

Getting local versus general anesthesia. General anesthesia involves being put to sleep and getting attached to a breathing machine or a ventilator during the procedure. This causes blood vessels to dilate all over the body, including the gluteal vessels, which makes the blood vessels bigger and more susceptible to injury during fat injection, increasing the risk of lodging fat droplets into the blood vessels, and eventually having the fat droplet arrive in the lung vessels. Instead, getting the procedure with local anesthesia will prevent dilation of blood vessels and will still be comfortable.

Where will the surgeon perform the procedure? It’s imperative that the surgeon perform the surgery at a certified surgery center. This is not a concern if you’re working with a reputable board certified plastic surgeon, but there are surgeons who are not plastic surgeons who claim to know how to perform a BBL, and they’re likely doing so in non-certified facilities. Getting operated on in a certified facility ensures that you can be safely treated in the case of an intra operative emergency, which is crucial because even healthy people can suffer a complication unexpectedly.

The Brazilian butt lift is an intensive surgery that doesn’t need to be our first option. As we discussed in the beginning of the episode there is a traditional butt lift similar to a tummy tuck in that it will lift but not really volumize, and involves surgery and cutting.

I would also like to point out that scarring and pigmentation in scars is always going to occur in skin types four and greater, and the scars associated with a butt lift are significant in size, which makes pursuing this option less appealing for darker skin tones.

While you may get a lift it will be at the expense of noticeable scarring that cannot be reversed. Scarring occurs with BBLs too, but the incisions are much smaller and in less conspicuous areas.

If you’re looking for something much less invasive you cannot opt for a body sculpting procedure like the ones we recently discussed in Episode 35. To hear more about the different type of non-surgical body sculpting available check out that episode.

However, for now, I will say that there are options that not only reduce fat, but can help stimulate muscle such as Hi-Fem or the Emsculpt. If you want to really see drastic improvements then pairing a body sculpting procedure with a protein-rich diet and targeted exercise can help to achieve your goals without going under the knife.

Thanks for listening, and until next time love the skin you’re in and celebrate your beauty.

If you’d like to hear more about Science Bag Skincare or medical aesthetic treatments please subscribe to and turn on notifications for The Skin Report so you always know when a new episode is up. We have a newsletter that you can sign up for on theskinreportbydrsethi.com so that you can stay up to date on all our new episodes, blogs, products, and more. Additionally, if you have a skincare question or want to make an episode topic recommendation please message me at theskinreportbydrsethi.com, which is linked in my show notes, and I’ll be sure to answer your question in an episode soon. We’ve received some great questions so far and I’ll try and answer them at the end of every episode.

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