Despite its popularity, the Brazilian Butt Lift (BBL) is among the most controversial cosmetic procedures due to its elevated complication rate and associated mortality risk. But what exactly are these complications, and how can surgeons prevent them?
A recent analysis of patient data provides valuable insights into the safety profile of these procedures and highlights a few critical areas for improvement. Here, we distill key findings and offer commentary on how surgeons can advance patient safety in four areas and refine their practice when performing complex procedures like the BBL.
BBL By the Numbers
Understanding BBL Complications
Between 2019 and 2021 at QUAD A-accredited (a nationally recognized accrediting body for ambulatory surgery centers) ambulatory surgery facilities, BBLs accounted for a disproportionate 37.6% of all fat grafting complications, with the most common complication being wound infection (22.3%), hemodynamic instability (12.6%), and wound disruption (10.7%). Severe outcomes included hospitalizations (35.9%), reoperations (12.6%), and four reported deaths (0.01% mortality rate).
Who’s At Risk?
The mean patient age of 42 years and an average BMI of 28.3 suggest that older and heavier patients may face slightly higher risks of complications due to factors such as slower healing and increased surgical complexity. Interestingly, the study found no significant associations between patient demographics or individual surgical details and the likelihood of complications, highlighting the multifactorial nature of risk with the procedure.
However, a notable finding was the correlation between an increased number of surgeons at a facility and a higher rate of reoperations. This may point to variability in surgical techniques or postoperative care protocols when multiple surgeons are involved. Consistency and communication within surgical teams are critical to ensure optimal outcomes in these facilities.
Trends Over Time
While complications initially declined from 2019 to 2020, they nearly doubled in 2021. This increase may reflect evolving surgical demand or incomplete adoption of updated safety protocols in the aftermath of pandemic disruptions.
Advancing the Safety Standard for Gluteal Augmentation
Improving the safety of the Brazilian Butt Lift requires a multi-faceted approach that prioritizes refined surgical practices, robust infection control, facility-specific interventions, and a commitment to transparent data reporting.
1. Refine Surgical Practice
The adoption of safety protocols such as subcutaneous-only fat injection, the use of blunt-tipped cannulas, and ultrasound guidance has significantly reduced the risk of catastrophic complications in the procedure. Ultrasound-assisted fat grafting has become a critical advancement in this arena, allowing real-time visualization to minimize the risk of intramuscular or intravascular fat injection, which is strongly associated with fat embolism. Surgeons must consistently adhere to these best practices and stay informed about emerging innovations in fat grafting techniques.
Moreover, preoperative patient selection should emphasize the identification of risk factors such as elevated BMI or comorbidities that may predispose patients to complications. Comprehensive counseling about realistic outcomes and potential risks is equally vital for informed consent.
2. Control Infection
Infection, the most common complication, underscores the critical need for comprehensive infection control measures throughout the surgical process. Intraoperatively, proper sterilization techniques are non-negotiable to reduce microbial contamination. The judicious use of prophylactic antibiotics, administered in accordance with evidence-based guidelines, can significantly lower the risk of postoperative infections.
Patients should receive clear, detailed postoperative care instructions, emphasizing the importance of proper hygiene, early but cautious mobilization, and adherence to follow-up visits to promptly address any emerging concerns. Educating patients about recognizing early signs of infection, such as redness, swelling, or fever, empowers them to seek timely intervention. These layered measures create a robust defense against infection.
3. Address Regional and Facility-Specific Factors
The study highlights a higher prevalence of complications in regions with high procedural volumes, such as the Southeast United States, pointing to the potential strain on resources and consistency in practice. To address these challenges, facilities in high-volume areas should implement stricter patient triage protocols to identify those at increased risk of complications and ensure adequate resources are allocated for each case. Measures such as limiting the number of procedures performed per day, as seen in Florida’s regulation of no more than three BBL procedures per surgeon daily, can help reduce fatigue-related errors and improve outcomes.
Furthermore, facilities can invest in advanced training for surgical teams to ensure consistency in technique and postoperative care, regardless of the volume. By closely monitoring procedural trends, analyzing complication rates at the facility level, and adopting region-specific regulations where needed, the aesthetic surgery community can address disparities in safety and deliver more uniform, high-quality care across all practice settings.
4. Advocate for Standardized Reporting
The variability in reported complication rates underscores the need for mandatory, uniform reporting of outcomes across all surgical facilities. QUAD A’s robust reporting system offers a template for best practices, but further refinement is needed, such as mandatory documentation of sequelae details and patient follow-up outcomes.
Accreditation bodies and professional societies should collaborate to create nationwide databases, ensuring transparency and enabling evidence-based advancements in safety protocols. By gathering standardized and detailed data, we can more effectively identify trends, implement targeted interventions, and evaluate the impact of safety protocols over time.
The data presented here serves as a potent reminder that despite advancements in technique, the BBL remains a high-risk procedure demanding meticulous attention to detail at every stage. Moving forward, surgeons must prioritize unwavering adherence to established safety protocols, a commitment to rigorous training and ongoing education, and the establishment of mandatory, standardized reporting systems across all facilities if evidence-based improvements in patient safety are to be made. A data-driven approach to these systemic complications coupled with a culture of transparency and shared learning will be instrumental in mitigating risks for patients seeking a BBL.
SOURCES: Aesthetic Surgery Journal, American Med Spa Association
