Larger butts have always been looked upon as a sexual asset. This was evident in the ancient world by the Venus figurines from Palestine and Syria and the South African tribes (steatopygia). I’m sure most of you remember the 1992 rap song “Baby Got Back” and the ruckus that it caused. In those days the only way to augment the buttocks was with implants which had a high complication rate necessitating removal of the implant in over 50% of the recipients.
Ten years ago I asked all the female nurses in the OR and recovery room if they would like a “bigger butt” and they all looked at me inquisitively and said: ”Are you kidding…NO.” In the interval years since then, a larger butt has become more desirable made popular by celebrities such as the Kardashians, Lopez, Beyonce, and Minaj among others. In fact now many models have what is considered a “significant backside.”
This American desire for a larger backside may have originated in Brazil. Because of the native population, the Brazilians have always admired an attractive shaped full buttock. I noticed this myself during a vacation on the beaches of Rio de Janeiro in 1983. Prior to that I did not even know thong bikinis existed. In 2011, Brazil started the Miss Butt competition bringing contestants from all over Brazil and yearly crowning “Miss Bumm Bumm.” The American Society of Plastic Surgery declared 2015 the “year of the rear” since the Brazilian Butt Lift (BBL) procedure was increasing at a yearly rate (~35%) more than any cosmetic procedure. BBL procedures are up 61% over the last 5 years with a total of ~25,000 procedures performed last year by board certified plastic surgeons. This figure does not include the large number of procedures performed by non-board certified “plastic surgeons.”
As compared to a butt implant augmentation, the BBL technique uses fat harvested from the back, thighs, and abdominal wall, prepares it, and reinjects the fat into the buttocks. Therefore instead of an implant, the BBL procedure uses the patient’s own fat to shape the buttocks in an aesthetic fashion and not necessarily only to increase the size of the butt as an implant would.
The minor complication rate of BBL is acceptable (~10%) but there have been a significant number of reported deaths after BBL. The incidence is 1:3000 procedures and is the highest of any aesthetic procedure. This is usually the result of fat being injected into the gluteal vein and embolizing to the lungs thereby obstructing the blood going from the heart to the lungs. There is an almost immediate shut down of circulation.
Because of this high operative mortality, the British Association of Aesthetic Plastic Surgery has banned the surgery in the UK. In June 2019, Florida passed a bill recommending limits on the procedure and revoking the doctor’s license in case of patient injury or death. But even an excellent surgeon can have a complication (seizures) or death (heart attacks). Eight of the 16 deaths in the last 10 years were at the hands of a Miami “foreign surgeon without a US license to practice medicine.” How would revoking his “license” help protect his patients? After these deaths he is now no longer doing the procedure but he is supervising a growing number of spa clinics preforming BBL with “doctors” operating around the clock charging bottom dollar prices with a huge clientele.
The take home message is that BBL is a procedure with excellent outcomes in the hands of a few skilled well trained board certified plastic surgeons but as in all plastic surgery: Do NOT bargain shop your surgeon
