Let me start by listing 4 greats myths about the famous Brazilian Butt Lift:
1st myth: BBL is a Brazilian technique: False. The BBL is not Brazilian technique and my Brazilian Plastic Surgeon colleagues always find it funny that we, North Americans and Europeans, call is “Brazilian”. So BBL is NOT a Brazilian technique per se, although it is a popular surgery in Brasil, with and without buttock implants (buttock implants will not enlarge the hip areas so combination procedures are common). YET, for someone who travels to Brazil several times per year for meetings and family (my other half is Brazilian), I can see how ladies here are narrow at the waist but stronger, fuller and curvier, from hips, buttocks and down… hence my association with the Brazilian butt Lift. Likely a genetic feature, inherited from their Latin, European and African genetic pool (slavery was in Brazil until 1888 when it was abolished with the Lei Aurea (“Golden Act”), a legal act promulgated on May 13 by Isabel, Imperial Princess of Brasil). This is MY take on the origin of the term “BBL”. Others say the term came from the first such procedure done on television – episode titled “Building the Brazilian Butt” – performed in USA on a Brazilian woman and the term stuck to this day.
2nd myth: BBL is only for African American or Latin women. False. This used to be true. But today, the search for the very curvy and accentuated body transgresses all cultures, thanks to J. Lo, Beyoncé and the Kardashians.
3rd myth: BBL is not for men. False. Well, yes and no. Men don’t want hips, obviously, but many men want a fuller – more bubbly, more latin – buttock so fat grafting to the male’s buttock for a posterior projection only is also a growing trend, albeit a smaller one.
4th myth: BBL is a simple procedure and can be done by any doctor. False. Fat grafting procedure is a very meticulous technique with associated risks. It should be performed carefully, mindfully and meticulously, by plastic surgeons who are trained in this technique.
The so-called Brazilian Butt Lift is a buttock augmentation procedure with fat grafting/transfer as the technique, where fat is harvested from unwanted areas, rinsed, decanted and then carefully transferred to an area where augmentation is desired such as the buttocks. Fat grafting has been performed by plastic surgeons for decades, first to face, then hands, then now buttocks, hips, breasts, etc. NYC plastic surgeon Dr. Sydney Coleman was a pioneer in fat grafting and all interested plastic surgeons have been following his protocols. In my practice, adding super-rich PRP (platelet-rich plasma) is an important component to my fat grafting procedures for enhanced survival.
We all know that buttock augmentation has been on the rise for a few years now, thanks to the Kardashians, no doubt. But there has been growing concerns in the United States over the last year or so about increasing complications with the Brazilian Butt Lift, including some fatal ones. In the USA, the unusually high mortality rate from this cosmetic procedure is estimated to be as high as 1:3000, greater than any other cosmetic surgery. But this incidence is much lower in Canada. It likely has to do with the fact that in the USA, non-plastic surgeons are still allowed to perform plastic surgery and their training is obviously not the same as true plastic surgeons.
So I wanted to write about why it is still a safer procedure in Toronto, Canada.
I have 17 years of experience in buttock augmentation surgery, with fat grafting and buttock implants.
It was always thought that injecting fat in the very vascular muscles would help survival of the fat cells. And it is likely true, yet, when working on the buttocks, we no longer inject so deeply. The cause of mortality in BBL is uniformly fatal fat embolism due to fat entering the venous circulation and then traveling usually to lungs where it causes serous problems. The gluteal veins are very deep under the buttock muscles. All the muscles are within one single compartment bound by fascia anteriorly and bone posteriorly. It was demonstrated recently that injecting ANYWHERE under the fascia, in the muscles, led to the fat finding its way all the way down and deep close to those gluteal vessels (following path of least resistance); and should one little vein been injured with the cannula during the infiltration, the fat can be aspirated into the venous system, then to the lungs and a blockage of the vascular system in the lung can happen. Hence we now must inject above the fascia.
Unlike the USA, Ontario has, since 2010, strict guidelines as to who can perform plastic surgery and where: simply stated, plastic surgery should be performed by plastic surgeons. It makes sense to about everyone but until 2010, anyone could do breast augmentation and tummy tucks in Ontario, including family physicians. Hence, asking your doctor for his/her specialty of training is important for ALL procedures you might be interested in. Ontario also has strict guidelines and inspection process for all Out-Of-Hospital Premises (OHP), to which VISAGE clinic adheres at 100% (we had a perfect score on our last – and only – 2 inspections since our opening!). VISAGE has the highest accreditation level, level 3 (general anesthesia) and also can keep patients overnight.
The USA has different rules – or should I say the “lack or rules.” Unfortunately, many American jurisdictions lack formal rules and guidelines as to WHO and WHERE plastic surgery procedures can be done.
Safety in gluteal fat grafting, and ALL aesthetic plastic surgery procedures, is always my primary concern at VISAGE, and we, plastic surgeons, owe it to our patients to ensure we are fully informed on the best ways to mitigate risks with any procedure. As many know from following us on social media, I am part of a small number of busy North American plastic surgeons with a strong and safe record with the Brazilian Butt Lift procedures, partly because I follow the rules of safety. I thought I would share with you those rules, established by the various Aesthetic Societies I belong to, such as the American and International Societies of Aesthetic Plastic Surgeons and the Canadian Society of Plastic Surgeons (ASAPS, ISAPS, CSPS).
Here are the new rules I adhere to when performing the Brazilian Butt Lift in Toronto for a safe and gratifying procedure:
- I harvest fat in various areas with a minimal suction to avoid damaging the fat cells
- I use tumescence solution to minimize bleeding during the harvesting/liposuction
- I washed and decant, by vibration, the harvested fat
- I add the patient’s own super-rich PRP (platelet-rich plasma) to the fat to be transferred, hoping to maximize survival of fat cells (I think of PRP as fertilizers for the fat cells).
- I never place fat in the muscle but only in the subcutaneous plane where fat already exists, always staying above the fascia
- I respect the capacity of the subcutaneous compartment to accept a defined amount of fat cells, beyond which safety cannot be assured and fat survival will be diminished; so if the desired outcome is a very large buttock, staging the augmentation is a better alternative as often done with other fat injection procedures, some mommy makeovers and hair transplants for example. FYI, freezing the fat in a freezer for a future use does not work.
- As plastic surgeon, I stay mentally focused, alert, and aware of the cannula tip at every moment as it is easy to unintentionally enter the muscle during injection. It is important for the plastic surgeon to be vigilant about following the intended trajectory with each stroke and feel the cannula tip through the skin.
- I NEVER rush this procedure (I never rush period!) as both the SAFETY and SUCCESS depend on careful slow injections of fat cells in many layers and in different directions. A comprehensive Brazilian butt lift easily takes 3-4 hours to perform well, safely and successfully, not less!
- I put my patients in the “Jackknife position” as it favors superficial injections
- I use only high-quality cannulas (custom-made for me) that are resistant to bending during injection
- I avoid Luer connectors in syringes as those can loosen and bend during surgery.
- I inject fat with a large >4mm cannula as larger cannulas cannot easily cannulate a smaller blood vessel
- I inject with a special slow injector mechanical and electronic device to avoid the more unpredictable thumb and hand pressure.
- I recommend to avoid both direct pressure over the grafted areas (i.e. sitting, lying on the back) and early physical activity as to maximize survival of fat cell.
When performed unrushed, by qualified plastic surgeons who regularly attend meetings and updates on techniques, the Brazilian Butt Lift can be a safe and very rewarding procedures and an excellent alternative – or often a complement! – to buttock implants.
Dr. Marc DuPéré