Brazilian Butt Lifts have the highest death rate of any cosmetic procedure: Top plastic surgeons explain why and how the risks can be avoided.

Made popular by celebrities like Kim Kardashian, the Brazilian Butt Lift involves transferring fat from an area where you don’t want it – such as the abdomen, thighs, upper arms, flank (love handles) or back, to somewhere  where you do want it – in this case, the buttocks.

The aim is to restore or add volume to the butt, giving it a more curvaceous appearance, while contouring the areas that you’d like less volume in.

Not surprisingly it’s a popular operation. In the US last year there were more than 20,000 Brazilian Butt Lifts and, in the UK, the British Association of Aesthetic Plastic Surgeons (BAAPS) says 1468 fat transfers were performed here in 2017. That equates to about 5% of all the cosmetic surgeries performed in the UK, although not all that fat may have gone to the buttocks.

“So you’re taking fat from where you don’t want it and putting it back where you do, which in theory is great, and it can be a very safe procedure if done properly,” says Consultant Plastic Surgeon, Mr Naveen Cavale.

But when it’s not done properly, it can be deadly. The procedure has the highest death rate of all cosmetic surgeries performed – one on 3000 people who have it done have died.

What does a Brazilian Butt Lift entail?

The procedure is done under a general anaesthetic and, according to Consultant Plastic Surgeon Mr Mo Akhavani, takes anywhere between 1.5 -3.5 hours.

The patient is usually on their back while the fat is removed from the chosen area and then is swapped onto their front – so bottoms up – for the re-injection.

In order to get the fat ready for reinjection it is ‘processed and washed’ Mr Cavale says, and once this is done “what’s left are living, healthy fat cells. These are then implanted back into the buttocks to give the desired effect.”

And this is where the problems begin.

What can go wrong?

Mr Ahkavani says only about 40-50% of the fat transfers survives once it’s reinjected. The transplanted fat needs a good blood supply to survive so the chances are that about  half of them will die off and be resorbed by the body while the blood supply is being established.

To boost the chances of survival, surgeons have in the past made what would prove to be a fatal mistake for many. Mo explains: “Fat is a graft and we know grafts survive much better in an area where there’s a rich blood supply. So, people thought that if you inject the fat into the muscle it would have a higher chance of survival.”

Plastic surgeon Mo Akhavani

“Now this has its own problem because when the fat is injected into the muscle the fat tends to migrate to the bottom of the muscle where it can go into the space between the muscle and the iliac crest or the hip bone,” he says.

Once it gets into that space it tends to puts pressure on the veins that drain that muscle, causing the walls of the veins to break.  When that happens they start “acting like a siphon and bits of the fat globules get suctioned into the vein… and into the inferior vena cava, which is the big vein of the body, that goes straight into the heart.”

The result is a cardiac arrest.

“It’s the unique anatomy of the buttock area that lends itself this phenomenon and so patients actually die on the table,” he says.

It could also end up in your lung as a fat embolus, which may also be fatal, Mr Cavale says.

Plastic Surgeon Naveen Cavale

“Various US and UK societies have talked about the dangers saying don’t inject it into the muscles as that’s where the blood vessels are.”

If however, the fat is injected more superficially into the subcutaneous level (between the skin and the muscle) the procedure is considered safe, but unfortunately “this is something not many people know,” Mr Akhavani says.

“Although the message is being put out there, patients are still going to clinics all across the world where they’re doing it the old fashioned way of injecting fat into the muscle or aren’t really being careful when they’re doing the injections and are putting patients at risk.”

There are a host of other risks as well including infection and death of tissue in the area (see below).

While there are many good surgeons abroad, Mr Cavale says travelling for a cheaper operation increases the risks of something going wrong.

Is cheaper really worth it?

“If you travel abroad you don’t know what you’re getting. You don’t know the quality of the hospitals or the surgeons. In the UK as long as you go to a certified, accredited and qualified surgeon in a good hospital you’re minimising the risks.”

He recommends that people check:

• the General Medical Council register to see that the surgeons they choose are registered and legally allowed to practice
• that their surgeon is a member of appropriate professional bodies like BAPRAS and BAAPS
• that they’re insured
• that they’ve done the training for the procedure that you want and that they do it regularly, and,
• that they have an aftercare plan.

As Mr Ahkvani says, surgery for £2000-3000 might look like a bargain, but you could end up paying the ultimate price.

Other possible risks with a Brazilian Butt Lift include:

• Bruising
• Stretch marks
• Infection
• Blood clots
• Excessive blood loss
• Cardiac and pulmonary complications (as mentioned above)
• Deep vein thrombosis (DVT)
• Necrosis (death) of fat cells or surrounding tissue