Behind the Brazilian butt lift
The Brazilian butt lift is the fastest-growing cosmetic procedure, despite the mounting number of deaths caused by it. What’s driving its astonishing rise? THE BOTTOM LINE BEHIND THE WORLD’S MOST DANGEROUS COSMETIC SURGERY
HER quest is simple: Melissa* wants the perfect bottom. In her mind, it resembles a plump, ripe peach, like the emoji. She’s already halfway there. In 2018, she had a Brazilian butt lift, known as a BBL, a surgical procedure in which fat is removed from various parts of the body then injected back into the buttocks.
But although Melissa’s bottom is already rounder and fuller than before, she believes there’s still scope for improvement. It could be better. It could always be better.
So on a recent afternoon Melissa visits British aesthetic surgeon Dr Lucy Glancey for a consultation.
Glancey performed Melissa’s first BBL at her clinic on the Essex-Suffolk borders, a suite of rooms boasting shining white cupboards, a full-length mirror and drawers stuffed with syringes.
As she waits for Melissa to arrive, Glancey shows me a picture of Melissa on the beach in Dubai, wearing a palm-print bikini and posing in a kind of provocative crouch – arms, breasts, thighs and buttocks all arranged for optimum effect.
“Look how good she looks,” says Glancey, admiring her own work. “I said to her, ‘I don’t see what else we can do’.”
When Melissa walks into the room, she doesn’t exactly resemble her digital self, but then, who does? She’s swapped her bikini for blue jeans and a pink sweater.
After a quick chat, Glancey – dark-blue scrubs, coral toenails – asks Melissa to take off her clothes. Together, doctor and patient stand in front of the mirror and stare.
The surgeon works her way round Melissa’s figure, considering its contours
with bracing candour. “You’ve kind of gained here,” she says, pointing at Melissa’s midriff.
“But here,” says Melissa, pressing the dip she’s detected in her right buttock, a flaw she’d noticed while on holiday. “Can you see?”
Like anyone inspecting their own body, Melissa can see things no one else can. That’s because she’s not just seeing it in its current form but also her former body, her desired body, her digital body.
In her teens, nearly a decade ago, she wanted to be thin and flat like everyone else. Then fashions changed. Explaining why she got her first BBL, Melissa, who’s white, says she’d wanted to fill out a pair of jeans and appeal to the kind of men she liked. “I felt attracted to black men and mixedrace men, and they liked curvier women,” she says.
The surgery, which can cost up to £8 000 (R160 000), also boosts her earning potential. Most of the time Melissa works in a gym, but she also makes money on the side modelling clothes on Instagram.
“When you’re looking at what gets the most attention and what gets the most likes, they’re always girls of this shape,” she says.
Melissa’s digital body, enhanced by the photo-editing app Facetune, acts as a kind of blueprint for her future physical body. She says her friends sometimes edit their pictures on dating apps to the point where they’re unable to meet up with anyone, as the version of themselves they’ve advertised is too far removed from reality.
“If you’ve had a BBL, it’s like you’ve already edited your body in real life,” Melissa says, “so you don’t have to edit your pictures.”
ADECADE ago, Glancey rarely performed BBLs. Now, in the course of a week, she does two or three and receives about 30 enquiries. Since 2015, the number of butt lifts performed globally has grown by 77%, according to a recent survey by the International Society of Aesthetic Plastic Surgery.
It’s the fastest-growing cosmetic surgery in the world. And it’s all because of one woman, Glancey tells me: Kim Kardashian West.
But achieving such beauty can be risky. In 2017, leading American BBL surgeon Dr Mark Mofid published a paper in the Aesthetic Surgery Journal which revealed that 3% of the 692 surgeons he had surveyed had experienced the death of a patient after performing the surgery.
Overall, one in 3 000 BBLs results in death, making it the world’s most dangerous cosmetic procedure. In the past three years, three British women – Abimbola Ajoke Bamgbose, Leah Cambridge and Melissa Kerr – have died as a result of complications arising from BBLs in Turkey, a popular destination for patients seeking cheaper surgery.
Elsewhere, there have been many others. According to local reports, in recent years, 15 women have died after BBLs in south Florida alone. Melissa knows the risks. When she had her first BBL, in 2018, it happened to be the week of Leah’s death. That same year, the British Association of Aesthetic Plastic Surgeons recommended that British surgeons refrain from performing the surgery altogether. Not being a regulatory body, it couldn’t enforce a ban.
Still, Melissa feels safer having the operation in the UK. She trusts Glancey and, after all, she’s been through the process before – she knows what to expect.
She’ll have to take a few weeks off work to recover, but it will be worth it. Soon there’ll be no asymmetries, no dips, no flaws; she’ll have a Facetuned bottom made real.
While the fashion holds, the perfect bottom is a taut orb, like a bauble wrapped in skin.
“Sticky-outy” is Glancey’s preferred term. Working in concert with the perfect breasts, the perfect bottom turns the body into the shape of an S.
“It’s the classic hourglass figure,” Melissa says. “That’s what you go after.” The perfect bottom is also an angle: 45 degrees from the base of the spine to the top of the buttocks.
In that sense, the perfect bottom is really the result of having the perfect spine, the kind that naturally protrudes at its base.
(From previous page) According to a paper by a group of evolutionary psychologists published in the journal Evolution and Human Behavior in 2015, “lumbar curvature” signified a woman’s ability to bear children, and so made her attractive as a mate.
For those lacking the optimum degree of vertebral wedging, there are options. In the 18th century, you’d have been yanked into a corset. Now, you can buy padded knickers or you can have implants or inject filler. Or you can have a BBL, which fulfils two briefs in one mission, removing fat from places where you don’t want it and putting it where you do.
THE BBL began in Brazil, birthplace of aesthetic surgery and the myth of the naturally “sticky- outy” bottom, the kind seen in countless tourist board images of bikini-clad women on Copacabana Beach.
The surgery itself was pioneered by the Brazilian doctor Ivo Pitanguy. In a country rich in plastic surgeons, Pitanguy was known as “the pope”. He performed a variety of procedures, and was rumoured to have prettified celebrities from Frank Sinatra to Sophia Loren while offering poorer patients subsidised treatment in his Rio clinic. Beauty, Pitanguy believed, was a human right. A nice principle, but not the one that made him enough cash to buy himself a private island off the coast of Rio.
In 1960, Pitanguy founded the world’s first plastic surgery academy, teaching his techniques to a new generation of surgeons. “He had a gift for sharing knowledge,” says Dr Marcelo Daher, a leading Rio plastic surgeon who trained with Pitanguy. “And his students spread all around the world.”
One of Pitanguy’s protégés was another Brazilian, Dr Raul Gonzalez, now the leading international expert on buttock enhancement. He in turn trained Glancey, who travelled to São Paulo for the experience.
“That must have been at least 17 years ago,” Glancey says. “He was the best.”
Sitting in her clinic on a break between patients, Glancey scrolls through Instagram messages from potential patients. “Look,” she says, as the feed of messages updates itself endlessly. “This is just the last 24 hours!” Each post contains pictures the women had taken of themselves in their underwear.
Glancey needs to see what she’s dealing with before she even agrees to a consultation; she can tell how successful surgery might be, or how unrealistic their desires are, simply by looking at a body.
She also requires vital statistics: age, weight, height, body mass index (BMI). “If it’s above 30 [which indicates clinical obesity], I don’t operate, I just tell them to lose weight,” she says, bluntly. “It’s liposuction, it’s not a cure for obesity.”
Around half the enquiries she receives about BBLs are from black women. “They feel ugly not having the curve of the back,” she says. But it’s also a desired shape among certain white women, who are in turn emulating a body shape popularised by Kardashian West, an American-Armenian woman who’s often accused of appropriating a black aesthetic, which some black women then feel compelled to copy – not having the idealised body shape they believe they’re supposed to have naturally.
The irony of the situation isn’t lost on Alisha Gaines, author of Black for a Day: White Fantasies of Race and Empathy. “She’s [Kardashian West] made an empire on appropriating blackness and selling it to all types of people, including black folks.”
Aesthetic surgery has always been inseparable from the politics of race. Gaines traces the fetishisation of black women’s bottoms back to the toxic legacy of slavery and colonialism, and more specifically to the case of Saartjie Baartman, a South African woman who was brought to London in 1810 and exhibited in Piccadilly, then around the country.
Crowds would pay to examine her body, and her buttocks in particular.
When Kardashian West posed for Paper magazine in 2014, a champagne glass balanced on her bottom, disconcerted observers compared the image to pictures of Baartman used to advertise her “performances”.
JUST before Melissa’s second appointment with Glancey, a few weeks after the first, we meet in a local pub, and she tells me she has a new plan for her surgery. As well as having fat removed from her stomach, she also wants Glancey to take fat from beneath her chin and her upper arms before inserting it into her bottom.
Later back in front of the mirror, Glancey pinches the flesh around Melissa’s bicep. “It’s doable,” she says. Then she moves up to Melissa’s chin. “What bothers you here?”
Melissa makes a face, as if to say, what doesn’t bother me here? “Like, why is it here? Why is this all like this?” Melissa says, pointing to a tiny cushion of fat beneath her jawline.
Glancey says she’ll remove the fat manually, with a syringe, and probably won’t
Once you start having surgery, she admits, it can be hard to stop
get more than 20 cubic centimetres out. She reminds Melissa she’ll have to wear a compression bandage beneath her chin and a garment around her stomach and bottom after the operation to aid healing.
Recovering from a BBL is painful. Melissa tells me that she hadn’t felt much discomfort in her bottom in the weeks immediately after her first BBL because it was cushioned by the new fat, but the areas where she had liposuction had been so sensitive that when someone brushed past her a few weeks after the operation, she cried out in pain.
For the operation itself, scheduled for a few weeks’ time, Glancey will follow her usual process. First, she marks up the patient with a pen – black ink for where she’s removing fat, red for where it’s going back in.
Then the patient is anaesthetised, and a saline solution, including local anaesthetic and adrenaline, is pumped through their body to help shrink the blood vessels, control the bleeding and to create a “wetting” effect so the fat can be removed more easily. Without it, Glancey says, liposuction would be a bit like trying to scrape dried food off a plate without any water.
Glancey then makes another small incision and inserts a blunt cannula under the skin to “harvest” the fat.
For the fat to stand the greatest chance of survival in the body, it has to be quickly inserted back into the buttocks, once again using a blunt cannula and aided by a foot-controlled pump. Here, the surgeon becomes a kind of combination of a blind sculptor and one of those musicians who can play multiple instruments simultaneously by strapping them to different parts of their body. While the foot controls the pace of the fat coming back up into the body, Glancey’s right hand guides the cannula, and her left hand – which she calls the “seeing hand” – strokes the surface of the skin to feel where the fat should be placed.
“It’s not an open wound,” she says. “You can’t see anything.”
In a series of videos Glancey sends me, she can be seen pumping the cannula forwards and backwards repeatedly, like a particularly involved handheld vacuum-cleaning session.
An operation can last anywhere between three to six hours. By the end, Glancey is often exhausted.
A patient has to wait weeks before they know what their bottom will ultimately look like. The fat takes time to settle, and Glancey has to remind her patients that at best, only about 50% of the fat “takes”. The rest is absorbed by the body and ejected through the lymphatic system.
Glancey sticks to the UK guidelines and limits how much fat she’ll insert – 300 cubic centimetres per buttock, a little less than a can of Coke. She tells her patients to complete the BBL over more than one operation, adding a little at a time.
In Turkey – the third most popular cosmetic surgery destination in the world, after Thailand and Mexico – some surgeons openly advertise on social media that they’ll insert more than 1 000 cubic centimetres into a patient’s buttocks.
Glancey says that she regularly sees patients who have returned from Turkey unhappy with the results, often because a significant quantity of fat has died and left them lopsided or misshapen.
The risk involved in performing a BBL is not only about the quantity of fat, but how it’s inserted. (Also, whether it is fat being inserted at all: a number of recent deaths associated with buttock augmentation occurred because the patient was being injected with silicone.)
During the operation, the danger occurs at a very precise moment: the insertion of the cannula into the buttock. As it goes under the skin, the cannula has to remain above the gluteal muscle. If it goes below, and fat enters the bloodstream, fat droplets can then coalesce, travel through the blood and cause a pulmonary embolism, a blood clot in the lungs – the cause of death in the case of the British woman, Leah Cambridge, who had a BBL at a private clinic in Turkey in 2018.
AFTER her second BBL, Melissa likes to think she’ll be content. But once you start having surgery, she admits, it can be hard to stop. “When someone requests extremely large buttocks,” Glancey tells me, “I always explain to them that fashions could change.” She tells them to opt for a more conservative look, otherwise when the coveted body shape does inevitably switch again, they’ll just need more surgery.
In any case, no matter how much work you do to it, the body remains alive, organic, unpredictable. However hard we try, gravity and time will have their way and eventually even the most perfect bottom will sag.
* Not her real name.