The Brazilian Butt Lift is as popular as it is dangerous
Remember when saying that someone has a big butt was one of the rudest things a person could say? Unless, of course, you were RuPaul, the famous “Queen of Drag,” or “Mother,” to many drag queens. For him, it has always been high praise, and he has carried that through his career all the way to his Emmy award speech this September.
“I’ve got to tell you, the sweetness and the kindness is what I appreciate the most today. In fact, the sweetness and kindness are at the top of my list of human virtues.” RuPaul said, accepting his sixth consecutive Emmy for hosting his self-titled show “RuPaul’s DragRace,” this year. “After that would be a big fat ass.”
RuPaul has carried this sentiment long before 2021, but now in the United States, and around the world, beauty trends are reflecting a similar way of thinking. According to a survey completed in 2019 by the International Society of Aesthetic Plastic Surgeons, buttock augmentation procedures increased by 38.4% just from 2018 to 2019.
A specific type of buttock augmentation procedure known as the Brazilian Butt Lift, or BBL, has had an especially significant increase in demand. The name is a bit of a misnomer, since the procedure doesn’t necessarily lift anything, but instead transfers fat from various areas to the buttocks. If the name doesn’t sound familiar, then the slim waist, wide hips and round butt look should be.
In 2018 alone, the BBL was up 10% according to a plastic surgery statistics report by the American Society of Plastic Surgeons. And, a lot like RuPaul’s opinion of a large butt, the BBL also has a much longer history than its recent surge in popularity.
However, the BBL hasn’t gained notoriety just for its permanent, nearly instant body contour effect, it has garnered just as much attention for having an especially high death rate. At its worst, the annual mortality rate was 1-in-3448 according to a 2017 report on gluteal fat grafting published in the Aesthetic Surgery Journal.
In 2018, the American Society of Plastic Surgeons (ASPS) issued an urgent warning about the BBL, highlighting how the mortality rate for this procedure was greater than any other cosmetic surgery.
The ASPS also suggested that, “the rise in interest has caused more non-board-certified and non-plastic surgeons to perform the operation,” which would contribute to the high death rate. That, combined with the much younger crowd that BBLs are appealing to has brought controversy into its whirlwind of popularity online.
Although a much wider spectrum of people seek plastic surgery for various reasons, the typical BBL patient, and the most common example of someone with a BBL, is a woman. At Feel Beautiful in Sorrento Valley, Dr. Steve Laverson estimated that over 90% of his clients are women.
Dr. Laverson, a board certified plastic surgeon for almost 30 years, has only done about 15 to 20 BBLs, but not for a lack of experience in fat grafting.
“Truth is, fat transfer didn’t get popular until lately,” Dr. Laverson said. “The fat transfer to the buttocks, it’s labeled as one of the most dangerous procedures, and this is another reason why I didn’t embrace it fully at the very beginning. Because first of all, the fat transfer equipment and technology wasn’t that great.”
The BBL is still not a central part of his practice, but as the procedure becomes more popular, he has been doing more of it, and more frequently. Dr. Laverson emphasized how the improvement of surgical technology in the last few years has been essential in creating better, safer results.
More than advanced surgical technology has helped the BBL spread. For better or for worse, social media has allowed surgically enhanced images to thrive on platforms that rely heavily on visuals. For example, on TikTok, the hashtag “bbl tiktok” has over 47 million views and hosts a wide spectrum of videos on the subject.
Among the plethora of videos from happy patients, there are critics. The visibility of particularly young people either getting BBLs or considering them, although they are a stark minority of cosmetic surgery patients, is a point of contention in the BBL discourse.
One woman named Melissa, under the TikTok username @melanated__mel, shared her thoughts on the BBL trend in a video that now has over 1 million views.
“Why are 18-, 19-year-olds out here getting BBLs? Breaking the bank for BBLs, your body hasn’t even finished growing,” Melissa said in a TikTok posted in June this year. “If you don’t have the money to do it properly, don’t do it at all, please.”
Melissa pointed out one of the most important factors in elective cosmetic surgery to her 400 thousand followers: the cost.
In contrast to an emergency surgery that is done for an urgent medical condition like acute appendicitis or trauma, procedures like BBLs, face lifts, liposuction and the like are elective.
Elective cosmetic surgeries like the BBL are typically not covered by insurance. This means that patients have to pay for entire procedures completely out of pocket, whether they’re able to pay in full at the time of the procedure, or they’re willing to finance it.
This is a reason why the ASPS suspected, “non-board-certified and non-plastic surgeons,” were performing BBLs. It’s a phenomenon called “practice drift,” and is another reason for patients to do their research, but this complexity can be lost when patients are price shopping for procedures.
The cost of a liposuction with fat transfer to glutes or breast at Dr. Laverson’s office is estimated to be about $8,500 to $9,500. In Coronado, with double board-certified plastic surgeon Dr. Moneer Jaibaji, his website estimates that the cost for a BBL would be between $8,000 to $12,000.
According to the ASPS, the average cost of the BBL procedure is $4,807. Remember, that’s just the price of the procedure itself, and the final total still varies greatly.
20-year-old Iyla, TikTok user @iylafl, shared a breakdown of the cost of her BBL in a TikTok posted in May which now has over 2 million views.
She outlines how the cost started at $4,700 for the procedure, but after care costs added about $2,084.
Dr. Moneer Jaibaji talked about how seeing plastic surgery so commonly on social media tends to peak people’s interests. In the ’90s, cosmetic surgery was considered taboo, but as time goes on he has seen it become accepted a lot more.
Neither Dr. Laverson nor Dr. Jaibaji see a problem in operating on young adults as long as their body and mind are in the right state, and they understand that surgery does not solve all your problems. Younger patients are even able to get more mileage out of their results, if successful, of course.
Dr. Emily Roberts-Parker is a psychologist, and full-time faculty member at San Diego State University. She is interested in working with college aged people, and may not necessarily disagree with the surgeons.
“I don’t think that wanting surgery is inherently unhealthy,” Dr. Roberts-Parker said. “I would tell someone [under 25] to wait if they were seriously considering altering their body surgically. I would want to talk about why they decided that changing their body was the answer, and what they expect it will do for them. If we look back in the United States, the history of beauty trends changes very rapidly and, long term, I doubt that one procedure would satisfy someone trying to achieve happiness through surgery.”
Above all, what surgeons, psychologists and critics alike can agree on is that the decision to undergo cosmetic surgery needs to be made carefully.
Dr. Jaibaji and Dr. Laverson both recommend looking for someone certified by the American Board of Plastic Surgery. Having this certification shows that the surgeon has voluntarily been assessed in the full spectrum of cosmetic surgery in addition to the broader areas of plastic surgery.
When the potential complications for the BBL include fatal pulmonary fat embolism, it’s worth looking into.
But, luckily for people still craving a BBL, the surgical equipment isn’t the only thing that’s been improving.
In 2020, an article published in the Plastic and Reconstructive Surgery Global Open reported the mortality rate had significantly improved from about 1-in-3000 to 1-in-20,000.
“It’s a much safer procedure now,” Dr. Jaibaji attested to better informed techniques. “Now they know why people were getting all these fat embolisms. Technique has improved in a way where the fat is placed.”
The future of BBLs is bright, both in terms of increasing safety and popularity. Whether the BBL look will be standard is still yet to be decided, but beauty trends will continue to fluctuate.
What remains is the understanding among Dr. Jaibaji, Dr. Laverson and Dr. Roberts-Parker that, regardless if a person chooses to get surgery or not, it is essential for any individual to see the beauty inherent in themselves.
“Imagine if everybody woke up tomorrow and they were completely fine with their bodies. Imagine how many businesses would collapse,” Dr. Roberts-Parker said. “Not just surgery, but beauty, makeup, exercise, etc. It’s important to not forget the role that capitalism plays in this, and how entire industries financially benefit from people wanting to change their appearance.”
