Are Brazilian Butt Lifts Safe?

Brazilian butt lift surgery (BBL) has usurped traditional options like butt implants in popularity for its natural-looking and customizable results. It involves transferring fat from areas like the abdomen or lower back to the buttocks to create a smaller waist and rounder derrière — a.k.a. an hourglass shape. The ability to address both the waist and the buttocks makes the BBL one of the most transformative procedures available in cosmetic surgery. And in the hands of a qualified cosmetic surgeon, a BBL can certainly be performed safely.

Still, Brazilian butt lift surgery is a complex procedure that requires your surgeon to have specific experience and training, as well as an intimate understanding of the functional systems of the body, in order to perform the operation safely and correctly. 

The unique risks of gluteal fat grafting

In addition to routine surgical safety precautions and hygiene practices, there are a number of unique factors that need to be considered for a safe Brazilian butt lift, including:

• How much fat can safely be removed
• Where the fat is injected
• How deep the fat is injected
• The amount of fat that can safely be injected

Though your butt may feel like it’s mostly composed of fat, there is a lot of underlying musculature and structures that can be compromised with improper technique. Transferred fat should only ever be injected into the subcutaneous layer of existing fat (below the skin) and no deeper. 

Fat should be injected into the tissues below the skin—NOT deeper into the muscles—or it can enter your bloodstream and cause life-threatening complications.

Injecting fat too deeply into the gluteal muscles, or placing too much fat for a more dramatic result, is incredibly dangerous and can lead to life-threatening complications, such as fat embolization in the heart and lungs. 

Surgical techniques for safe BBLs

• Inject into the skin and fat tissue layer, rather than muscle: The muscles have many more blood vessels than the fat tissue layer, which increases the chance of fat entering the bloodstream (1).
• Blunt-tip cannulas: Your surgeon should also use a blunt-tip cannula, rather than a sharp needle, to perform the fat injections (2).
• Upward cannula angle: Additionally, surgeons should angle their cannula upward or parallel with the skin during injections, as this helps to avoid accidentally piercing the muscles (2).
• Ultrasound guidance: Many surgeons are now adding ultrasound guidance to their BBL safety protocol, as this technology allows them to visualize the subcutaneous space and inject with more accuracy (3,4).

Related: The American Board of Cosmetic Surgery’s April 2024 Consensus Statement on BBL Safe Practices »

How to find a cosmetic surgeon with expertise in buttock enhancement

While it’s important to understand the risks of any procedure, you don’t have to rule out Brazilian butt lift surgery as an option—it is quite safe and delivers very satisfying results when performed by a qualified cosmetic surgeon. Performed properly, the BBL can actually be as safe, or safer than, the commonly performed tummy tuck (5). We’re here to help you make a safe choice. Here’s how to start: 

#1. Check your cosmetic surgeon’s credentials 

Did you know it is legal for any kind of surgeon to perform any kind of surgery in their office? Many patients are shocked to hear this, but it is true in all 50 states (6). Additionally, not all those who call themselves “cosmetic surgeons” can claim the same rigorous training and experience a board certified cosmetic surgeon has received. 

So, when choosing your surgeon, make sure you are working with someone who has had proper liposuction and Brazilian Butt Lift training, and who has received board certification from the American Board of Cosmetic Surgery (ABCS). Data from a recent study by Cuzalina et. al. shows that ABCS surgeons have one of the best safety records for performing BBLs (7). Alternatively, you can work with a board certified plastic surgeon who has had additional, in-depth cosmetic surgery training. You may also want to ask if your surgeon has any special patient safety certifications.

#2. Ask about their experience with the procedure 

How many Brazilian butt lifts have they performed over the years? Can they direct you to patient reviews or testimonials of their work? Are they up-to-date on the latest recommendations for safety and techniques in Brazilian butt lift surgery? 

Make it a point to ask these specific questions. You should be able to take plenty of time to consult with your specific operating surgeon in person, well before the day of BBL procedure. Your surgeon should welcome these questions, which show you have done your homework and refuse to settle for an unsafe, inexperienced, or profit-driven surgeon. 

#3. Make sure your procedure is performed in an accredited surgical facility or hospital

Surgical facilities accredited by agencies like the AAAHC, Quad A, Joint Commission, or Institute of Medical Quality must meet and maintain high standards of safety, cleanliness, equipment, and life-saving emergency preparedness. As a rule of thumb, an accrediting body that is approved by the state medical board where a surgeon operates can be considered acceptable. Cosmetic surgeons who are board certified by the ABCS are required to operate only in these accredited facilities and work with qualified operating room (OR) staff. 

A doctor who does not have access to an accredited facility or is performing surgery in an unaccredited surgical suite is a red flag. These centers have proven dangerous, as a recent Centers for Disease Control and Prevention report has pointed out (8, 9).

Avoid surgeons who charge suspiciously low costs for BBL, who do not have access to an accredited surgical facility, or who do not meet with you personally for a pre-surgical consultation.

#4. Review before and after pictures of previous patients & read surgeon reviews

One of the best ways to get an idea of a surgeon’s work is by looking at patient results and seeing what past patients have to say about their experience. Most cosmetic surgeon websites will have a before and after gallery showcasing previous patients; spend time looking at their Brazilian butt lift results to see if their work is a good match for your goals. You can also ask to see additional, non-published photos of their own patients during your consultation; they are likely to have many more examples. 

Also, be sure to peruse a surgeon’s online reviews—both positive and negative—to learn about their practice from those who have experienced it first-hand. This can give you a good idea of how their practice operates, the quality of their facilities, and how happy patients were with their results. Don’t stop after just one or two testimonials; to get a full picture, you’ll need to read a number of reviews. 

#5. Do your homework 

While you absolutely should rely on the expertise and experience of your board certified cosmetic surgeon to a point, it’s important that you go into your surgery with a foundation of knowledge. Arm yourself with basic information about the surgical process, any associated risks, and what to expect from recovery—all of which can be obtained from high-authority websites dedicated to cosmetic surgery, including the American Board of Cosmetic Surgery site. 

This not only helps you in your decision-making process, but it can also give you the tools you need to recognize if a surgeon is under-qualified, not providing you the information you need to make a smart choice, or hiding important safety details from you. 

#6. Avoid budget procedures

Though financing options have made it more attainable for a larger number of people, cosmetic surgery isn’t cheap, and you should be wary of a price tag lower than national average. This is because you get what you pay for. When you purchase a cosmetic surgery procedure, you are paying for your surgeon’s time and expertise, an OR staff trained to ensure your safety, access to an accredited facility that is properly maintained, and use of specialized instruments, technologies, and wound-care supplies.

Because the demand for the procedure is so high, surgeons who are not uniquely qualified to perform Brazilian butt lift surgery are offering it—and many patients are lured in by low prices and false advertisements of experience. Unfortunately, the actions of these unqualified surgeons in these high-volume, heavily discounted centers performing Brazilian butt lift surgery have led to a significant number of fatalities and high incidences of post-surgery complications—more so than nearly any other cosmetic procedure (9, 10).

While traveling outside of the U.S. for cheaper procedures is increasingly common, particularly for Brazilian butt lifts, many patients are seeing disastrous results. Waiting to make a change while you budget for your procedure may be difficult, but working with a qualified surgeon who can keep you safe while providing the results you want is priceless (8).

We encourage you to learn more about the nuances of Brazilian butt lift surgery and find a board certified cosmetic surgeon in your area. 

References »

1. Condé-Green A, Kotamarti V, Nini KT, Wey PD, Ahuja NK, Granick MS, Lee ES. Fat Grafting for Gluteal Augmentation: A Systematic Review of the Literature and Meta-Analysis. Plastic and Reconstructive Surgery. 2016 Sep;138(3):437e-446e. doi: 10.1097/PRS.0000000000002435. 

2. Luis Rios, Varun Gupta, Improvement in Brazilian Butt Lift (BBL) Safety With the Current Recommendations from ASERF, ASAPS, and ISAPS, Aesthetic Surgery Journal, Volume 40, Issue 8, August 2020, Pages 864–870

3. Pazmiño P. Ultrasound-Guided Gluteal Fat Grafting: A to Z. Clinics in Plastic Surgery. 2023 Oct;50(4):587-601. doi: 10.1016/j.cps.2023.07.002. 

4. Del Vecchio D, Kenkel JM. Practice Advisory on Gluteal Fat Grafting. Aesthetic Surgery Journal. 2022 Aug 24;42(9):1019-1029. doi: 10.1093/asj/sjac082.

5. Del Vecchio DA, Wall SJ Jr, Mendieta CG, Aslani AA, Hoyos AE, Mallucci PL, Whitaker IS. Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plastic and Reconstructive Surgery. 2021 Dec 1;148(6):1270-1277. doi: 10.1097/PRS.0000000000008599.

6. Darrow JJ. Explaining the absence of surgical procedure regulation. Cornell Journal of Law and Public Policy. 2017;27(1):189-206.

7. Cuzalina A, Mostofi P, Hah W. Gluteal Fat Grafting Technique and Mortality Update Among Surveyed ABCS Surgeons. The American Journal of Cosmetic Surgery. 2024;0(0). doi:10.1177/07488068231215113

8. Hudson M et al. Deaths of U.S. Citizens Undergoing Cosmetic Surgery — Dominican Republic, 2009–2022. Center Disease Control Weekly / January 25, 2024 / 73(3);62–65

9. Pazmiño P, Garcia O. Brazilian Butt Lift-Associated Mortality: The South Florida Experience. Aesthetic Surgery Journal. 2023 Feb 3;43(2):162-178. doi: 10.1093/asj/sjac224. 

10. Wu S, Coombs DM, Gurunian R. Liposuction: Concepts, safety, and techniques in body-contouring surgery. Cleveland Clinic Journal of Medicine. 2020 Jun;87(6):367-375. doi: 10.3949/ccjm.87a.19097. 

Frequently Asked Questions about BBL