What is the Brazilian Butt Lift? what are the safety concerns associated with it?
Urmen Desai, MD: Brazilian butt lift is a colloquial term used for fat transfer to the buttocks. Specifically, in this technique, we start by performing liposuction and harvesting fat from any place the patient has donor fat that can be transferred to the buttocks. The most common location where patients want to harvest fat is from the anterior abdomen just below the belly button and above the belly button, followed by the love handle area.
For many patients, in addition to performing liposuction in that area, we rotate the patient and perform additional liposuction in the bra roll area, upper back, lower back, and then just above the buttock area to cinch the waist. In this way, even before performing the transfer or injecting the buttocks with harvested fat, we are able to give an optical illusion that the waist is more narrow and the buttocks is bigger.
The second part of the “Butt Lift” procedure is the injection of fat into the buttocks. This is where a lot of the safety issues arise—not necessarily from the liposuction, but from the reinjection of that fat that's been harvested, purified, cleaned of any toxic products, and then reinjected into the buttocks.
There's been an increasing number of deaths related to this procedure. Right now, they have a mortality rate of one in 3,000—meaning for every 3,000 procedures that are done around the world, there's one death, which is extremely high for any aesthetic or cosmetic procedure currently.
The high mortality rate, essentially, is because there are a lot of untrained, non-board-certified plastic surgeons performing this procedure where their injection is a bit too deep. They're injecting deep within the muscle. Within the muscle lies the inferior gluteal vein, and if some fat is inadvertently injected into this inferior gluteal vein, that can lead to fat being injected into the venous circulation; particles of fat are going to be brought up into the lungs and to the heart where it can prove to be deadly.
What do the latest warnings say?
Dr. Desai: The main plastic surgery societies, which include the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgeons, and the International Society of Plastic Surgeons, are recommending multiple steps to prevent these needless deaths.
The most important recommendation in this recent warning that's come out is that the doctors should be injecting more superficially—not injecting deep within the muscle. If you inject superficially, you're not going to inject fat into this important venous system or into this specific vein.
The other important recommendation is to use larger-bore cannulas. When injecting fat, the physician shouldn't use anything that's smaller than 4mm diameter because something small can pierce this vein. If you have something wider, it's more blunt, you're not going to be able to pierce this vein. Then the last recommendation is to inject while the cannula's in motion.
You should not stop and inject. If you inject while the cannula's in motion, there's less of a risk of injecting fat into this important vein.
Those are the three main recommendations to minimize this risk.
Is there some inherent risk in the liposuction procedure as well as preparing the fat for injection, especially if someone isn't properly trained and certified?
Dr. Desai: Absolutely. Even for the liposuction portion, if you're not properly trained, if the patient's lying supine or lying on their back and you're harvesting fat or taking fat from the belly, the front of the abdomen, or the love handles, you can pierce the abdominal contents, the stomach, the heart. It's always important to stay superficial.
The primary cause for the uptick in mortality, though, is the injection of large quantities of fat into the buttocks. Partially inspired by celebrities on social media and on television, patients are pressuring doctors into injecting a lot of fat. To get a lot of fat into the buttocks, you have to inject deep, and that can prove to be very dangerous.
Whether it's the harvesting of the fat with liposuction or injecting the fat for the gluteal augmentation portion, board certification is vital for any of these portions of these procedures.
Are there alternatives or adjuncts that can be done for a more dramatic augmentation of the buttocks?
Dr. Desai: There are a few options. Using a gluteal implant in conjunction with a Brazilian butt lift or fat transfer to the buttocks can assist with increasing the degree of augmentation of the buttocks and also help achieve the goals that the patients have and the look the patients want.
In addition, potentially, to buttocks implants, many doctors are injecting Sculptra into the buttocks for a more long-lasting look. Sculptra is a nice option for patients who don't have a lot of donor fat, either.
However, a large volume of Sculptra needs to be used in order to result in any significant augmentation or enhancement. This can prove to be very costly, but I think those are two adjunctive procedures that can be used either in conjunction with using fat or in lieu of using fat if somebody doesn't have enough fat.
How can board-certified plastic surgeons market themselves without contributing to the unbridled popularity of this procedure?
Dr. Desai: I think if board-certified surgeons highlight that they're board-certified by the American Board of Plastic Surgery and that they're showing realistic before-and-after pictures on their website, and during the in-office consultation they're discussing ethical, realistic approaches to this procedure, it can be safe. And patients can achieve the outcome that they're looking for and be happy with their overall surgical result.
I think if doctors are unrealistic and feel pressured by patients and are promising results that are basically dangerous, in that they're potentially injecting larger volumes and are forced to inject the fat deep within the muscle, I think it's very unrealistic to the patient.
If the problem persists, what could happen next? Could the procedure be banned?
Dr. Desai: If the mortality rate doesn't change within the next period of time, I think there is a risk of the FDA banning this surgical procedure. I don't believe that a surgical procedure has been banned or proven illegal by the FDA ever, or at least within plastic surgery, but I think this could be the first with the death rate being so high.
I don't know if the FDA can allow only board-certified plastic surgeons to perform this surgery, but I think that they can certainly ban this procedure altogether, which would force patients to have not fat, but maybe gluteal implant or fillers placed into the buttocks. I think that's a very high risk that we may encounter. We'll just have to see if the mortality rate drops now with this warning by many plastic surgery societies and more education and more media coverage on this topic.