Y​​ou can exercise your way to bigger, more chiseled glutes. But for those wanting immediate or more dramatic results, there’s the option of a Brazilian butt lift (BBL). It’s become one of the most popular plastic surgery procedures—but it’s also the deadliest. Even so, according to the American Society of Plastic Surgeons, the BBL continues to increase in popularity.

Using a combination of liposuction and fat grafting, a successful BBL results in added volume, defined curves, and a butt lift. Sound familiar? Many point to the popularity of influencers as one of the main sources of the procedure’s steady rise. But there are serious concerns about whether this surgery should continue after reports surfaced that the death rate following a BLL may be a terrifying 1 in 3,000. Ahead, we speak with plastic surgeons Samuel Lin, Lara Devgan, and David Shafer, and ask each one to walk us through the surgery itself, as well as the controversy.

What Is a BBL?

A BBL starts with liposuction, where a surgeon sucks fat out of areas in the body, then processes and reinjects it into the buttocks and hips. The areas of planned liposuction (Shafer says that fat is usually taken from the abdomen or the lower back) and the outline of planned fat grafting are marked before surgery. Once the patient is positioned on the operating room table facedown and under anesthesia, the liposuction is performed in the desired areas and the fat is collected in a specialized system that separates live fat cells from liposuction fluid. That fat is then injected into the marked areas of the butt. Shafer says that surgeons will sometimes graft fat into the thighs or hips, depending on what body shape the patient wants. The procedure requires a few very small incisions that are sutured closed at the end.

The results? A rounder, perkier, fuller-looking derrière. “The body transformation provided by the BBL may be a reason for the surgery’s popularity,” Lin says, adding that many are open about their surgeries as well. “The procedure’s visibility on social media and in popular culture may also contribute to its growing popularity.”

How Much Does a BBL Cost?

Devgan says that the cost of a BBL can vary depending on the provider performing the surgery and where you live, but typically, one lift can range anywhere from $3,000 to $30,000. If that range seems wide, it’s because many people go to “chop shops” (yes, that’s actually what they’re called) that do these surgeries at a high frequency, with—more than likely—less expertise.

“To ensure that they are going to a reputable surgeon, patients can look at the surgeon’s board certification,” Lin advises. “Board certification by the American Board of Plastic Surgery is a sign that the surgeon has undergone extensive training and continued maintenance of certification in plastic and reconstructive surgery, which includes cosmetic surgery.” Lin also notes that the location of the doctor and surgery is just as important to consider. “A reputable surgeon will perform surgery at a certified surgery center with a board-certified anesthesiologist or at a hospital,” he says.

And be wary of the lure of going outside the United States just because it can be done at a lesser price. “The prices may seem tempting, but there are associated costs such as travel, lodging, return flights, and also follow-up care,” he says. “Additionally, countries offering bargain plastic surgery do not have the stringent ethical and patient safety requirement that are followed by board-certified plastic surgeons.”

Who Is a Candidate for a BBL?

Shafer says that some patients just don’t have enough excess body fat for a BBL. “Curvy patients have fat available for harvesting through liposuction and enhancing their buttocks and thighs to fit their body type,” he says. Devgan recommends patients be healthy adults within 15 pounds of their goal weight.

Before surgery, you’ll also need to have medical clearance from your general practitioner. Shafer explains that doctors will make sure that you’re healthy for surgery and screen for risk factors associated with surgical complications, such as blood clotting disorders and any cardiovascular issues.

What Is BBL Recovery Like?

Shafer says that recovery happens in three stages: first few days, first several weeks, and first several months. During the first few days, you can generally go back to work. During the first several weeks, most of the swelling reduces and the bruising starts to heal. This is when you can go back to the gym and are approved for travel. The last stage is where any remaining swelling will resolve and the transferred fat has pretty much settled. Devgan says that you’ll want to avoid pressure on areas where there is grafted fat and also avoid strenuous exercise for several weeks. If you’re a back or side sleeper, this means that you will need to sleep on your stomach.

Expectations also need to be managed: The results are only semipermanent. Shafer and Devgan note that only up to 80 percent of the grafted fat survives, so many patients may need to revise some aspect of the surgery in the future. “In most cases, 70 to 80 percent of the grafted fat survives, while some of it absorbs,” Shafer says. “The fat is living tissue and will change with weight fluctuations in the body, so if you lose weight, the fat can shrink just like anywhere else on your body. Likewise, if you gain weight, the fat can expand just like anywhere else on your body when you gain weight.”

Why Is the BBL So Dangerous?

Frankly, patients are dying on the table from botched procedures. Devgan explains that when the injection of fat inadvertently goes into one of the deep blood vessels, fat can travel back to the heart and lungs. This results in cardiopulmonary collapse, which is oftentimes not reversible or treatable. Studies show that from 2011 to 2016, there were 25 Brazilian butt lift-related deaths. In 2017, a plastic surgery task force reported that 3 percent of plastic surgeons who performed the procedure had a patient die. Although some surveys estimate that the rate has gone down, it’s still important to be aware of the danger. “The mortality rate from BBL is estimated to be as high as 1 in 3,000. This is greater than any other cosmetic surgery,” Lin says. “Any patient considering BBL should be informed of the risk of death from this procedure.”

For some surgeons, the high risk rules the procedure out completely. “This is a level of risk that is extremely alarming and totally unacceptable for an elective cosmetic procedure,” Devgan says. “That risk of death is a statistic that factors in the outcomes of highly trained American board-certified plastic surgeons, so this is not just an issue of who is doing the surgery; it is a risk inherent to the operation.”

The experts again stress the importance of doing your research to find a highly qualified surgeon. “There are risks involved with the injection of the fat, and this is where training and experience is so important,” Shafer says. “If the fat is injected too deep or in the wrong area, the fat can enter the bloodstream and can cause issues such as pulmonary embolus or clotting.”

Is the BBL Worth It?

Devgan and Shafer differ on whether this procedure is something anyone should try at all. “This is my litmus test, my personal golden rule of plastic surgery: If you wouldn’t let your mother or sister or brother have a procedure, you shouldn’t let your patients either,” Devgan says. “The Brazilian butt lift is an operation that I do not perform any longer, because the mortality data speaks for itself. The risk benefit calculus simply does not add up.”

Shafer, on the other hand, thinks it’s safe to do for the right patient. “That is why it is essential to have a thorough consultation with a board-certified plastic surgeon to review your options,” he says.

The Brazilian butt lift is an operation that I do not perform any longer, because the mortality data speaks for itself.

Is There a Safer BBL Alternative?

A Brazilian butt lift isn’t the only option for a perkier bum. Shafer says that one alternative to consider is Sculptra Aesthetic, an injectable that helps boost your body’s natural collagen. He says that although it is FDA approved for increasing volume in the face, it can be used off-label to add volume in other parts of the body. He does warn that this treatment can be cost prohibitive; many vials of Sculptra (costing upward of $20,000) are required to gain a noticeable result in the butt. He recommends this route to anyone who can afford it and anyone who wants to avoid invasive surgery. Devgan says that she frequently injects poly-L-lactic acid (the main ingredient in Sculptra) into the butt to improve contour, shape, texture, and cellulite.

Lin adds that liposuction alone can achieve some of the results people may be hoping for. “Liposuction of the back, flanks, and/or thighs without fat grafting to the buttocks can enhance the appearance of the lower torso and buttocks by balancing the proportions of the buttocks to the rest of the body, rather than increasing the size of the buttocks,” he explains.

For something completely noninvasive, you can also consider VelaShape III, Emsculpt, and CoolSculpting. VelaShape III uses radio-frequency technology to boost collagen production and reduce the appearance of cellulite; Emsculpt stimulates the muscles deep in your abdomen or glutes and causes massive contractions, resulting in muscle hypertrophy with subtle fat reduction; CoolSculpting freezes and therefore kills the fat cells in the areas under your butt, which can help make the area appear perkier. However, all noninvasive procedures still carry their own sets of risks.

So no matter which route you decide to take, make sure to do your research before committing to the journey.

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