WHY ARE BRAZILIAN BUTT LIFTS (BBL) SO DANGEROUS?
Written by Fulvio Urso-Baiarda co-founder and plastic surgeon at Eterno 360, Eton, Berkshire
There has been a lot in the news again about Brazilian Butt Lift surgery, which is fat grafting to the buttocks, and I thought I might try to explain some of the science behind the headlines.
Why don’t I offer the BBL?
The mortality from BBL is estimated at 1 in 3,000 to 5,000, which is the highest for any cosmetic procedure. It has been a year and a half since I gave a radio interview about the subject. Around that time my professional society, the British Association of Aesthetic Plastic Surgeons, decided that they would recommend the procedure should not be carried out by its members, and accordingly since then I have been declining requests from patients requesting BBL.
Why is it thought to be such a dangerous procedure?
It all relates to an anatomical structure called the inferior gluteal vein (which is a big vein right in the region of the buttocks) where the work takes place during BBL. In each post-mortem carried out on people who have died following BBL, fat has been shown to have been injected into this vein, causing a fat embolism which is usually fatal.
So is it a high risk procedure just because of that vein? Well actually the anatomy in that region is unusual. First of all, the IGV is a little bit different from many other veins elsewhere in the body. It is a very fat, floppy vein, and unlike other veins that can move out of the way when you approach them, it is fixed in place because it passes under a structure of your pelvis called the greater sciatic notch. This means it doesn’t roll out of the way of approaching surgeons. Even more worryingly, it could be torn without being physically punctured just by wobbling the bottom hard, as surgeons do when they are fat grafting. So the IGV can be torn without being physically punctured, at least in theory.
Next, like other veins it contains valves which only permit blood flow in one direction, so when the vein is compressed by surrounding muscles the blood moves towards the heart. This one-directional movement generates a negative pressure (or suction) effect, meaning anything in the region of a tear in the vein - like fat - could be sucked into it.
So we have a structure that can be torn without the surgeon tearing it and which can suck in fat from the surrounding regions. In all of those post-mortems that were carried out, the surgeon didn’t think that they were grafting fat below the muscle. They thought they were in or above the muscle every time. So either that was incorrect or inaccurate, or the IGV had ruptured and had then suctioned fat in from elsewhere. If that is the case then this is a complication that could happen to anyone, even with good technique, and is potentially a very unsafe operation.
There is a UK Task Force going currently researching the safety of BBL, determining whether it can be carried out safely at all and making sure that if it is reintroduced then precautions will be imposed to prevent the tragic mortalities that have already occurred from happening again. Until that time, I am in agreement with its suspension for the time being.
The only negative consequence has been that I have seen some patients are now travelling overseas for this surgery, and I would recommend strongly against this. Just because someone somewhere is willing to perform the operation for you, it doesn’t mean that they should do. The recommendations of organisations like BAAPS have been put in place to keep you safe - please don’t try to get around them!
