Social media and reality TV have made large buttocks and tiny waists “a thing”.  Before signing up for surgery, though, it’s worth knowing both the good and the bad that come with this.

BBL surgery: how is it done?

First, let’s talk about the word ‘lift’.  Your buttocks are not actually being ‘lifted’.  Instead, they are being filled.  Typically this involves adding fat to both buttocks.  Where does the fat come from?  That depends on you and how you are built.  Almost all cases involve liposuction of the abdomen, flanks, and back.  Liposuction of the thighs may also be done, depending on the amount of fat needed as well as a person’s individual desires.  The fat is injected into your buttocks, adding volume and shape.

Liposuction of the lower back and flanks is a key part of BBL surgery.  By substantially thinning out fat in the lower back and flanks, the buttocks look fuller without having added any fat.  The buttocks look like they ‘project’ more.  Injecting fat into the buttocks results in more roundness and projection.

In some cases, buttock implants may be used.  I personally don’t typically use buttock implants, but some surgeons do.  Implants add some shape and volume but require longer incisions and have a fairly high complication rate.  A study published in 2017 found a 30% rate of complications in buttock implant surgery.  I think that’s too high.

How much fat can be used in BBL surgery?

The short answer?  Maybe 300 or 400 ml fat per buttock.  The longer answer?  It’s about safety.

Brazilian butt lifts started becoming popular in the U.S. in about 2010.  Before that, it was pretty uncommon to do much grafting of fat into the buttocks.  A few surgeons, both in the U.S. and abroad, started doing aggressive liposuction and injecting a lot of fat into the buttocks.  And sometimes that worked pretty well.  Sometimes patients achieved really nice results.  Sometimes.

The bigger issue, though, was that it was a new procedure.  More and more surgeons started doing it before all the “kinks” had been worked out.  And there were “kinks”.  A number of people across the globe died while undergoing BBL surgery.  It turns out that technique is important.  How the fat is injected, and how much fat is injected, into the buttocks matters.

There are some pretty big veins in and below the muscles of the buttocks.  If these veins are torn during surgery, fat can get into them.  If fat gets into them, it can end up in the lungs and that can prove fatal.

Because of problems like that, a lot of research was done to understand the complications and how to avoid them. We know a lot more now.  We know that surgeons have to be aware of where the fat is being injected.  We do not want to inject fat into the muscles or below the muscles.  The devices (cannulas) used for injecting the fat should be directed superficially, not deeply.  And while initial reports of 600 to 1000 ml of fat per buttock were not uncommon, today it is recommended to inject no more than about 350 ml fat into each buttock.  These modifications of the procedure, among others, have resulted in a substantial decrease in complications.

Is Brazilian butt lift surgery safe?

When performed by experienced, conscientious surgeons, BBL surgery can be very safe.  The results can be fantastic, too.  But, unlike 5 or 10 years ago, we don’t typically create extremely large, overly projecting buttocks now.  It’s more about shaping and adding some volume.  Fat grafting of the buttocks is a very nice way to create roundness, filling in those indentations in the outer parts of the buttocks.  It adds some projection.  BBL also helps create a more shapely waist, with enhanced contours in the areas from which the fat was taken.