Bringing up the rear

Brazilian butt lifts are among fastest-growing plastic surgeries, despite the high mortality rate

The Brazilian butt lift, commonly known as the BBL, is one of the fastest-growing plastic surgery procedures ever — and one of the deadliest. The procedure, designed to provide a bigger, rounder rear like the ones popular among influencer and Instagram models, has a mortality rate of around one in 3,000.

In 2012, 8,500 Americans got BBLS. By 2017, that number was more than 20,000. Globally, the number of BBLS performed has risen by 77.6 per cent between 2015 and 2021.

The name, first of all, is a bit of a misnomer: it's not actually a lift, and there's some debate over just how Brazilian it is. It's thought to be the brainchild of Brazilian doctor Ivo Pitanguy, but some claim the first surgery may have been performed on a patient from Brazil by an American doctor.

The process involves three steps, according to the American Board of Cosmetic Surgery: first, liposuction is performed on the hips, thighs or abdomen, the fat removed from those body parts is then purified, and then it's reinjected into the buttocks.

That last step is the risky one. On average, British plastic surgeon Lucy Glancey told the Guardian, only about half of the injected fat will properly sit and reshape the rear — the rest will be reabsorbed by the body and passed through the lymphatic system. And if the fat is not reinjected properly to the right areas, it might not be absorbed by the body, which can result in fat necrosis — where the fat forms as a lump under the skin.

If the fat is accidentally reinjected into the veins, it could travel to the heart, lungs or brain, or forming a blood clot that does the same thing. Either one can stop blood flow, which can cause death.

In 2018, alarmed by the procedure's popularity and high mortality rate, the American Society of Plastic Surgeons proposed guidelines for safer BBLS — among them, injections with bigger instruments that are easier to control.

But most of the deaths aren't occurring in the offices of doctors likely to follow those protocols: they're happening in clinics where procedures are much cheaper and doctors are much less likely to have the necessary skills or training.

Many of these “chop shops” are in countries with less robust medical requirements.