The Dangers of Buttock Lipofilling (Brazilian Butt Lift)

A recent publication by a task force of American plastic surgeons has raised serious concerns about the risks associated with buttock lipofilling, commonly known as the Brazilian Butt Lift (BBL).

What is Buttock Lipofilling?

Buttock lipofilling has gained popularity in the United States and South America as a method of buttock augmentation. This procedure involves liposuction to harvest fat from areas of the body rich in adipose tissue. The extracted fat is then filtered—either by centrifuge or through systems like PureGraft® or Revolve®—to purify it before being reinjected into the buttocks.

This technique is a form of grafting: autologous (from your own body), non-vascularized fat is introduced into anatomical planes where it is expected to “take” and integrate. However, as with any graft, not all of the tissue survives. Typically, about 50% of the injected fat is resorbed by the body.

Why Is This Procedure Risky?

The most significant danger arises from the tendency of surgeons to overfill the buttocks during surgery, anticipating this 50% volume loss. This overfilling can increase pressure in the gluteal region, potentially driving fat into small veins within the gluteus maximus muscle. Once inside the bloodstream, the fat can travel to the lungs and cause a pulmonary fat embolism—a condition that is often fatal when severe.

Although isolated cases of fatal embolism have been reported in South America over the past 15 years, the dramatic rise in BBL procedures in the United States (estimated at over 25,000 in 2016) has corresponded with an alarming increase in fatalities—more than 25 confirmed deaths.

What the Data Shows

An article in the Aesthetic Surgery Journal (ASJ) analyzed responses to an online survey sent to 1,963 U.S. plastic surgeons and 2,880 international surgeons. Among the 610 respondents, there were 32 reported deaths and 103 non-fatal complications from approximately 200,000 procedures.

This data estimates a mortality rate of 1 in 6,000 for BBL procedures. However, cross-referencing with data from U.S. medical examiners suggests the real figure may be closer to 1 in 3,000—making it the deadliest plastic surgery procedure currently practiced.

For comparison:

• General cosmetic surgery mortality rate: 1 in 55,000
• Abdominoplasty (tummy tuck): 1 in 13,000
• BBL: potentially as high as 1 in 3,000

Notably, the risk increases fourfold when fat is injected into deep muscular planes, a common practice in some clinics.

Are Buttock Implants Safer?

While not without their own issues—such as a 10% complication rate primarily from wound separation and infection—buttock implants do not carry the same life-threatening risks. Unfortunately, no large-scale comparative studies have been published to confirm this formally.

What We Recommend

We do not consider BBL a reasonable option for patients seeking large-volume buttock augmentation. Due to the high resorption rate, it often takes two to three procedures to achieve a 500 cc increase. Given the elevated mortality rate, repeating the surgery multiple times is unacceptable from a safety standpoint.

For small-volume buttock enhancement, fat grafting may be an option—but only under strict medical conditions. Patients must be informed, in writing, of the significantly higher mortality risk. The procedure should only be performed in an accredited clinic equipped with a CT scanner to detect pulmonary embolism, and patients should be monitored for at least 24 hours post-op. Any signs of complication must lead to immediate transfer to an ICU.

A Word on Surgical Tourism

Under no circumstances do we recommend traveling abroad for such a high-risk procedure. Safety standards and follow-up care may not be equivalent, significantly increasing the likelihood of fatal outcomes.

Our Alternative Recommendation

We strongly advocate for gluteal implants in cases where patients seek fuller buttocks. While the procedure is not perfect, it offers predictable, lasting results without the excessive risks associated with BBL.