Brazilian Butt Lift Research Articles

Multidisciplinary Experience for Gluteal Fat Grafting.

Gluteal fat grafting, colloquially known as Brazilian Butt Lift, has experienced a significant rise in popularity in recent years. Despite this increase, potential complications associated with the procedure have also been observed, necessitating a thorough examination of the current practices and outcomes. This study collected experiences of a multidisciplinary group of surgeons through a detailed survey sent in April 2022. This study aimed to shed light on the practices employed by these surgeons, the frequency and types of complications they encounter, and the overall outcomes of their procedures. Of the 100 surgeons surveyed, 86 responded. The study identified that pulmonary fat embolism (PFE) was the most serious complication, with fatality due to PFE recorded at a rate of 1:23,878. Liposuction site seromas were the most common complications, with an overall rate of 2.45%. Although there were no overall differences in complications between plastic and non-plastic surgeons, plastic surgeons were found to have a sixfold increase in the odds of experiencing a liposuction seroma. The survey also revealed substantial practice variations, particularly regarding fat preparation methods, recipient-site preparation, antibiotic use, and postoperative care protocols. Despite known complications, a strong tendency to continue performing these procedures was observed among surgeons, demonstrating the sustained demand and acceptance of the procedure. This study underscores the need for continued surveillance and research to enhance the safety and effectiveness of gluteal fat grafts. The experiences and data gathered from practicing surgeons provide valuable insights, paving the way for refining techniques, building consensus, and facilitating informed discussions with patients about the risks and benefits of the procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Black women, Brazilian butt lifts and body image: A qualitative study on the role social media play in promoting the thick ideal

Black women, Brazilian butt lifts and body image: A qualitative study on the role social media play in promoting the thick ideal

Brazilian Butt Lift: An Experience Over 3000 Patients.

The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gluteal Fat Grafting Technique and Mortality Update Among Surveyed ABCS Surgeons

Background: The demand for gluteal fat grafting (colloquially known as Brazilian butt lift [BBL]) has seen a dramatic increase in the past decade. Brazilian butt lift has been the fastest-growing cosmetic procedure in the United States for several years. During this time, the incidence of pulmonary fat embolisms (PFEs) associated with this procedure has raised safety concerns. Several professional organizations have responded to these concerns with investigational reports to identify the causes and provide recommendations to decrease the mortality associated with this popular cosmetic procedure. Awareness and implementation of these safety recommendations have been a cornerstone to decreasing the mortality rate associated with gluteal fat grafting. Objectives: To provide a comparison of current technical approaches and a mortality update on gluteal fat grafting among surgical members from the American Board of Cosmetic Surgeons (ABCS) within the last 6 years. Also, to determine if specific technical changes in the manner this procedure is performed are improving safety. Methods: An online (emailed) survey regarding perioperative gluteal fat grafting techniques and postoperative outcomes performed by ABCS surgeons within the previous 3 years was collected in 2 different 3-year time frames. Initial data were collected in 2019 for the preceding 3 years 2016-2019. The survey was again repeated in 2022 to collect similar data as before from ABCS member years 2019-2021. The data, which included the total # of BBLs performed, incidence of major infection or fat emboli, cannula size, and injection methods details was compared for each 3-year period. Both sequential studies provided a comparison of the techniques employed as well as morbidity and mortality outcomes. Results: Sixty-four ABCS surgeons who reported performing BBLs responded to the survey in 2019 and reported performing a total of 22 800 (BBLs) gluteal fat grafting cases in a previous 3-year window from 2016 to 2018. More surgeons used a closed system peristaltic pump in the second part of the study as compared to the first (51% vs 22%) ( P < .01). Two cases required in-hospital treatment of infection in the first survey while zero cases were reported for the second survey period ( P = .07). Twenty-five of 64 (39%) reported injecting fat at least into superficial gluteal muscle during this earlier time frame. In this earliest study, there were 3 total cases of PFE reported (2 fatal PFEs and 1 nonfatal PFEs). In 2022, 85 ABCS surgeons who reported performing BBLs responded to the survey. Around 12 172 gluteal fat grafting cases were reported in the second 3-year study from 2019 to 2021 compared to 22 800 in the first study ( P < .01). There was a total of 34 972 BBLs during the entire 6-year study. Most surgeons (82 of the 85) in the second-phase 3-year study reported injecting fat “exclusively” above the muscle ( P < .01). There were no fatal and non-fatal PFEs reported in the follow-up 3-year study in 2022 of ABCS member data from 2019 to 2021 ( P = .03). Conclusions: The mortality report associated with gluteal fat grafting from this survey among surgical members of the ABCS suggests using the current safety recommendations proposed, including injection of fat in the subcutaneous layer only, have led to a decreased risk of PFEs associated with gluteal fat grafting. The mortality rate was zero (0 out of 12 800) when 96% were injecting above muscle only compared to a mortality rate of 1:11 400 (2 of 22 800 cases) when 39% of 22 800 BBLs performed had fat injected into muscle. While there were more BBLs performed during the earlier 3-year study ( P = .07). The mortality rate significantly decreased in the years when only a small minority of cases had fat injected into the muscle. This study adds to other existing literature from professional organizations’ reports on the safety of gluteal fat grafting using the proper safety measure and recommendations.

Abdominoplasty, Liposuction and Brazilian Butt Lift (BBL) in Kinshasa in the Democratic Republic of Congo. My Experience in This Aesthetic Plastic Surgery with Black African Women in a Low-Income Country

Abdominoplasty, Liposuction and Brazilian Butt Lift (BBL) in Kinshasa in the Democratic Republic of Congo. My Experience in This Aesthetic Plastic Surgery with Black African Women in a Low-Income Country

Plastic Surgery Tourism: Complications, Costs, and Unnecessary Spending?

The liability of plastic surgery tourism in patient health and postoperative resource allocation is significant. Procedures completed within the context of medical tourism often lack rigorous quality assurance and provide limited preoperative evaluation or postoperative care. Not only does this jeopardize the patient's well-being, but it also increases the financial burden and redirects invaluable resources domestically through often unnecessary diagnostic tests and hospitalizations. This manuscript will examine the complications and associated costs following plastic surgery tourism and highlight unnecessary expenses for patients with outpatient complications. A retrospective review was conducted of all patients 18 years or older who underwent destination surgery and were seen within 1 year postoperatively in consultation with plastic surgery at our health system between January 11, 2015 and January 7, 2022. Patient admissions were reviewed and deemed necessary or unnecessary after review by 2 physicians. The inclusion criteria were met by 41 patients, of whom hospitalization was deemed necessary in 28 patients vs unnecessary in 13 patients. The most common procedures included abdominoplasty, liposuction, breast augmentation, and "Brazilian butt lift." The most common complications were seroma and infection. Patients deemed to have a necessary admission often required at least 1 operation, were more likely to need intravenous antibiotics, were less likely to have the diagnosis of "pain," necessitated a longer hospitalization, and incurred a higher cost. The total financial burden was $523,272 for all 41 patients. Plastic surgery tourism poses substantial health risks, the morbidities are expensive, and it strains hospital resources.

Complications From Fat Grafting and Gluteal Augmentation in Outpatient Plastic Surgery: An Analysis of American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, QUAD A) Data.

Gluteal augmentation with autologous fat grafting, colloquially referred to as Brazilian butt lift (BBL), is an increasingly common procedure with a highly reported complication profile. In this study we aimed to analyze the prevalence and characteristics of complications that accompanied these surgeries at ambulatory surgery facilities. Adults patients who experienced fat grafting complications from 2019 to 2021 were identified in QUAD A, formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, Highland Park, IL, USA), database. Patients and complications were analyzed based on sociodemographic, surgery-, and facility-specific variables with descriptive statistics and logistic regression. Overall, 436 fat grafting procedures with complications were reported to QUAD A, with an overall complication rate of 0.94%. Of these complications, 164 (37.6%) were confirmed to be from gluteal augmentation procedures. Notably, the number of gluteal augmentation with fat grafting complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%), with a mean age of 42.0 years and a mean BMI of 28.3 kg/m2. Wound infection was the most commonly documented complication (22.3%). Of the patients who experienced complications, 35.9% presented to a hospital for their complications and 12.6% required reoperation. Four deaths were described. There was no association between sociodemographic or surgical variables and increased odds of readmission or reoperation (P > .05), except for increasing surgeon number and reoperation (P = .02). Gluteal augmentation accounts for a large proportion of complications from fat grafting procedures. Increased reporting requirements may aid in future determination of incidences of complications and improve patient safety.

The Brazilian Butt Lift Remains the Deadliest Aesthetic Surgery Procedure: Are Plastic Surgeons Adjusting Their Surgical Practice to Promote Safety?

The number of Brazilian butt lift (BBL) fatalities remains high in the United States despite numerous practice advisories geared towards patient safety and reducing the incidence of fatal pulmonary fat emboli. This study aimed to evaluate US board-certified plastic surgeons' opinions, understanding of BBL-related mortality, and current risk-reducing surgical practices for BBL procedures. An online 18-question survey was distributed via email by the Aesthetic Surgery Education and Research Foundation to national board-certified plastic surgeon members of the The Aesthetic Society. Survey responses were collected over 21 days on the Qualtrics platform. The survey response rate was 10% (n = 178). Of the 77% who performed BBL procedures, 48% (n = 80) did not use ultrasound. Approximately 60% (n = 102) of all respondents disagreed with imposing regulations to require ultrasound, with the most frequent reason being that it was unnecessary with adequate surgeon experience (45%). Plastic surgeons thought that high-volume budget clinics (n = 64) and a lack of regulations imposed on individual surgeons by boards of medicine (n = 31) were the greatest contributors to BBL mortality. Most US plastic surgeons did not use ultrasound for BBL procedures and did not agree that ultrasound should be required, which may partially be the result of unsuccessful educational outreach for risk-reducing practices and training for ultrasound. Regulations by the boards of medicine imposed on individual surgeons, in combination with new legislation targeted at ownership of high-volume clinics, are strongly backed by surgeon respondents as measures that may improve patient safety.

Infectious and Noninfectious Complications After Gluteal Augmentation Surgery

Abstract Public demand for gluteal autologous fat grafting, also known as a “Brazilian butt lift,” has increased over time, but these surgeries are not without risk of complications. Surgical infections range from 1.9% to 5% of the total complication rate for gluteal augmentation, including both superficial and deep infections. We present a case of Staphylococcus lugdunensis infection after gluteal autologous fat grafting and review the literature to discuss pertinent infectious and noninfectious complications of this procedure. Staphylococcus lugdunensis is a common cause of skin and soft tissue infections and is probably underrated by many doctors and laboratories. Hence, S lugdunensis should be accepted as a significant pathogen in skin and soft tissue infections and should be looked for in all routine bacteriological examinations, and clinicians should be able to be acquainted with the name and the pathology of the bacterium. With increasing popularity of fat grafting for buttock augmentation, it is more important than ever to continue researching and learning to safeguard the satisfaction and safety of our patients.

New Data Show Board-Certified Cosmetic Surgeons Safely Performing Brazilian Butt Lift Surgery

New Data Show Board-Certified Cosmetic Surgeons Safely Performing Brazilian Butt Lift Surgery

Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better.

Although the Brazilian butt lift (BBL) is one of the most popular procedures in body contouring, it has been associated with the risk of pulmonary fat embolism when fat graft is injected into the gluteal muscles. The subcutaneous plane has been identified as a safe site for fat graft injection, but deaths from fat embolism continue to occur because there is no mechanism to confirm consistent subcutaneous placement. The aim of this paper was to determine if real-time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space. In total, 4150 BBLs were performed with real-time intraoperative ultrasound being used to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared with BBL performed by expansion vibration lipofilling without ultrasound. Real-time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments. Real-time intraoperative ultrasound allows the surgeon to confirm a subcutaneous-only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.

The Rising Trend of the Reverse BBL and the Implications for Aesthetic Surgeons: A Google Trends Analysis

Abstract Goals/Purpose Aesthetic surgery trends continue to evolve and are often popularized by social media, particularly with celebrity influence, as exemplified by gluteal fat grafting or Brazilian Butt Lift (BBL). There appears to be a trend for reversal of this procedure, but there is a paucity of research describing associated operative techniques and precautions, with most discussion limited to media publications. The aim of this study was to evaluate public interest in reverse BBL surgery over a 5-year period using Google Trends and bring attention to this emerging trend in aesthetic surgery. Methods/Technique A Google Trends analysis was completed using the term “reverse BBL”. Trends were analyzed over a 5-year time period and included an assessment of regional searches by state. Changes in search frequency were further analyzed based on media articles describing reverse BBL trends, with the first mention being in August 2021, followed by another series of publications from November-December 2021, and June 2022. Results/Complications There was a steady increase in the relative search value (normalized search volume in comparison to total search volume over 5 years) for “reverse BBL” beginning in January 2020, with a peak in December 2021 and June 2022 (Figure 1). The states associated with the most search interest in BBL reversal were: Florida, New York, California, Texas, and Illinois (Figure 2). Average relative search volume significantly increased with media publication of reverse BBL procedures among celebrities, corresponding with August 2021, November- December 2021 and mid-2022 (p<0.05) (Figure 3). Conclusion These data indicate there is increasing public interest in reversal of gluteal fat grafting, which appears to correlate with social media trends. As patient’s remorse trends surrounding reverse BBL’s rise, aesthetic surgeons should counsel patients accordingly prior to gluteal augmentation surgery. Furthermore, for patients having undergone gluteal augmentation seeking reversals, pre-operative consultation of risks associated with reverse BBL procedures should be discussed. More research is needed regarding best operative approach for BBL reversal, including approaches with liposuction and additional revision surgeries, and strategies to mitigate postoperative complications, while enhancing cosmetic outcomes.

Medical Tourism and Budget Brazilian Butt Lifts: A High Cost to US Healthcare Systems and a Danger to Patients.

In 2017, Adabi et al1 published one of the first studies to examine the complications, management, and medical system cost of medical tourism with a relatively large patient cohort (n = 42). The most common complication was infection, followed by abscess and wound dehiscence. Of the 20 patients requiring hospitalization, over half underwent a surgical procedure for treatment. Cost is the most frequently reported consideration for medical tourism, but the cost of associated complications often far surpasses that of the primary procedure. Average reported cost for treatment of cosmetic surgery complications in the United States ranges from $15,000 to $40,000.1,2 This burden often does not fall on the patient, but on insurance companies, hospitals, and public health programs. To avoid the dangers associated with obtaining cosmetic surgery abroad, patients may elect to have their procedures done at budget clinics in the United States, where low costs are balanced by the high volume of procedures performed by personnel who are, at times, not adequately trained to perform the procedure safely. Unfortunately, the risks of low-cost procedures are not limited to medical tourism alone; the incredibly high mortality rate of up to 1:3000 due to pulmonary fat emboli (PFE) after gluteal fat grafting, or Brazilian butt lift (BBL), performed in an unsafe manner (resulting in fat deposition deep to the muscle fascia) has become a widely acknowledged concern.3 A review of fatal BBL PFE in South Florida from 2010 to 2022 demonstrated that 92% of deaths occurred at high-volume, budget clinics; two-thirds of these cases were performed by American Board of Plastic Surgery certified surgeons.4 There have been 14 deaths since 2018, with six fatal PFE cases and two nonfatal PFE cases in 2021 alone. Despite recent recommendations, enacted legislation, and patient education, patients continue to be harmed from cosmetic procedures performed both abroad and domestically. In May of 2022, six patients presented to our institution for treatment of complications from BBLs that were performed abroad (Dominican Republic and Mexico) and in the United States (Florida). All patients were women, age range 20–49 years, and none had health insurance at the time of presentation to the emergency department. Four patients experienced postoperative infections, one leading to severe sepsis requiring surgical intervention. Imaging confirmed intramuscular injection of fat in two patients, one with PFE causing severe pneumonitis. There were no mortalities. All patients reported finances as the motivating factor for medical tourism. Our institution contributed to the formation of The Multi-Society Task Force for Safety in Gluteal Fat Grafting to help address BBL-related complications. Guidelines were recently published in our joint safety statement to maximize patient safety, and we encourage their review.5 The guidelines include procedures only being performed by surgeons with privileges in state-approved or licensed ambulatory surgical centers or hospitals; the use of real-time ultrasound during fat injection; establishing appropriate doctor–patient relationships; comprehensive pre- and postoperative care plans, including availability and direct care for complication management; and prioritizing patient safety and ethical business models over profits. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Nanotechnology and Artificial Intelligence: An Emerging Paradigm for Postoperative Patient Care.

An increasing number of aesthetic surgery procedures are being performed in an ambulatory fashion in office-based settings. Postoperative monitoring of these patients has historically required paid private-duty nurses measuring vital signs, encouraging ambulation, and monitoring overall comfort level. Recently, advancements in nanotechnology have permitted high-acuity data acquisition of multiple clinical parameters that can be transmitted to the surgeon's mobile device in a continuous fashion. The aim of this study was to describe the authors' early experience with this emerging artificial intelligence technology in the postoperative setting. Twenty-three consecutive patients underwent radiofrequency-assisted liposuction and Brazilian butt lift surgery, and were placed in a monitoring garment, SimpleSense (Nanowear Technologies, Brooklyn, NY) postoperatively. The primary outcome was device usability, reflected by compliance with wearing the device and completeness of data collection. During the first 48 hours, 91% of patients wore the device for more than 12 hours per day. Only 39% were compliant with postoperative positioning. No postoperative events were detected. The quality of data collected enables detection of clinical derangements and can alert the surgeon in real time, prompting interventions such as drug administration, position changes, or presentation to the emergency room.

Artificial intelligence-enabled simulation of gluteal augmentation: A helpful tool in preoperative outcome simulation?

While the buttock region is considered an esthetic hallmark, the Brazilian butt lift (BBL) remains controversially discussed in the plastic surgery community. This is due to its contentious safety profile. Thus, informed consent and patient education play a key role in preoperative planning. To this end, we aimed to program an easy-to-use, widely accessible, and low-budget algorithm that produces reliable outcome simulations. The conditional generative adversarial network (GAN) was trained using pre- and postoperative images from 1628 BBL patients. To validate outcome simulation, 25 GAN-generated images were assessed deploying 67 Amazon Mechanical Turk Workers (Mturks). Mturks could not differentiate between GAN-generated and real patient images in approximately 49.4% of all trials. This study presents a free-to-use, widely accessible, and reliable algorithm to visualize potential surgical outcomes that could potentially be applied in other fields of plastic surgery.

277 - Brazilian butt lift gone wrong: a case of non-$$$tuberculous mycobacterial gluteal infection in an HIV infected woman

277 - Brazilian butt lift gone wrong: a case of non-$$$tuberculous mycobacterial gluteal infection in an HIV infected woman

Brazilian Butt Lift Safety and Florida Legislature: What You Should Know, How You Can Help.

Brazilian Butt Lift Safety and Florida Legislature: What You Should Know, How You Can Help.

Brazilian Butt Lift Patient Safety: Best Practices and Recent Regulatory Requirements

Brazilian Butt Lift Patient Safety: Best Practices and Recent Regulatory Requirements

Gluteal Shape Framework for Augmentation Surgery: A Systematic Review of the Literature and Proposed Classification System.

Gluteal augmentation is used to improve the size and shape of the buttocks. Unlike other anatomical areas, such as the breasts, where there are classification systems for size and projection, no standardized methods for classifying gluteal size and shape exist. Patients seeking augmentation rely on photographs to communicate their desired result to surgeons. The authors' study objectively reviews this topic and proposes a novel classification system for the buttocks that can provide an organized framework for patients and providers. A systematic of the literature was conducted on March 17, 2021, using various combinations of the following terms: "gluteal augmentation," "classification," "size," "gluteoplasty," and "Brazilian butt lift." All eligible articles were included for analysis. The PubMed/MEDLINE searches yielded 49 articles and abstracts. After review, eight publications were chosen for analysis. All publications were found in plastic surgery journals, with the most common journals as follows: Aesthetic Surgery Journal ( n = 4), Clinics in Plastic Surgery ( n = 2), Annals of Plastic Surgery ( n = 1), and Plastic and Reconstructive Surgery ( n = 1). There are no articles in the plastic surgery literature that provide a standardized classification system for gluteal size determination. The authors' study revealed the need for a standardized classification system for gluteal size and shape. Although the publications analyzed discussed various techniques for related procedures and provided ways to improve aesthetic outcomes, none presented a system for reproducibly classifying size and shape. By introducing a classification system, we hope to enable plastic surgeons to more accurately and efficiently discuss their patient's goals.

The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review and Recommendations.

Superficial gluteal lipofilling is a fat grafting procedure performed to correct a trochanteric depression and buttock deflation. Brazilian butt lift (BBL) is a gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in BBL was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques, and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of intraoperative ultrasound for guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling have been demonstrated. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicized risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management.