Having just shared in our Learning Center about when you can sit after a Brazilian butt lift (BBL), we were surprised to hear that the Florida Medical Board enacted a 90-day Emergency Rule regarding BBLs. The Rule stipulates that a surgeon may not perform more than three BBLs per day. This came into being because of some recent high-profile deaths in Florida. After 90 days, the Florida Medical Board will be taking public comments on the issue, after which they will decide their next steps.

At the Advanced Institute for Plastic Surgery, we find it tragic that deaths from gluteal fat grafting continue to occur at such high rates. Especially when, since 2017, such huge advancements have been made in understanding how these deaths occur and how they can be prevented.

In 2016, the Aesthetic Surgery Education and Research Foundation (ASERF) founded a task force to examine deaths resulting from gluteal fat grafting.  The following year, they published clear evidence on what factors during surgery lead to deaths and made clear-cut recommendations.  The task force’s recommendations were almost instantly and universally embraced by all board-certified plastic surgeons and accredited surgery centers.

Improved understanding of technique

One example is that, in the early days when the BBL procedure was just taking off, surgeons were specifically taught that fat must always be injected into the muscles of the buttocks. We have copies of medical journal articles from famous surgeons describing this technique.  We now know that this technique is wrong. This is because injecting fat into the muscle can cause fat to enter the bloodstream and lead to death.

Florida has always been at the center of gluteal fat grafting, due to high demand and a sunny location for recovery.  Many world-renown plastic surgeons in gluteal fat grafting are located in Florida.  Unfortunately, Florida (like California) has also attracted a huge number of unqualified or careless providers looking to cash in on the fastest-growing cosmetic plastic surgery procedure. Without keeping up on the latest research and best practices, surgeons are still mistakenly deliberately injecting fat into the muscle today.

Preventing fatigue

We believe that the Florida Medical Board’s limit to the number of procedures one surgeon may perform in a day takes direct aim at ultra-low-cost clinics performing these procedures at a reckless pace to maximize profits. For example, in the case of the fatality at the Seduction Cosmetic Center in Florida, that was the surgeon’s seventh case for the day.

Most well-trained, board certified plastic surgeons operating in an accredited surgery center would have difficulty performing more than 3 BBLs in a typical workday.

At the Advanced Institute for Plastic Surgery, we typically spend several hours on most Brazilian butt lifts because it takes finesse and precision. With that, comes attention to detail, including attention to safety.  There are things we can do as surgeons that are proven to reduce complications, but they can be time-consuming. Quality takes time.

ASERF’s Recommendations

Let’s summarize the 2017 ASERF’s recommendation here:

• Avoid fat injection into the deep muscle
• Use injection cannula 4.1 mm or larger
• Don’t point the cannula downwards toward the muscle
• Position the patient and place incisions that help avoid deep muscle injections
• Always be aware of where the cannula tip is at
• Only inject when the cannula is moving
• When a patient seems unstable during or after surgery, immediately consider pulmonary fat embolism
• Review and understand the relevant anatomy
• Discuss the risk of fat embolism and surgical alternatives with the patient

Clearly, despite every best effort and taking all precautions, all surgery, including a BBL, comes with real risks. If you are considering a BBL, you should understand that the procedure does have increased risks. You should also know, however, that great strides have been made in improving its safety. Take time to find a surgeon you trust, one that will take every measure to keep your health and safety paramount.

If you have questions about a Brazilian butt lift, our board certified plastic surgeons would love to talk with you. We have offices at Redlands and in Murrieta and Temecula. You can also send in a request via our contact form.