Brazilian butt lift (BBL)

What is the Brazilian butt lift (BBL)?

The Brazilian butt lift (BBL) is a type of Butt augmentation procedure which results in youthful, prominent, perky buttocks and a more sensual body profile. The surgical procedure uses your own fat, so it is the most natural way to augment your buttocks. Fat is extracted from unwanted areas, and then re-injected into the subcutaneous area of the buttocks. People of all ages and body types are having the Brazilian butt lift procedure. As this procedure has gained in popularity, it is also being commonly referred to as a BBL with Lipo 360.

Over the past few years there has been much concern in the media over the safety of the procedure. To address these concerns, a multi-society Gluteal Fat Grafting Safety Task Force was formed. In June 2019, they issued a conclusive advisory which summarized the conditions required for safe gluteal fat grafting. In summary, surgeons must perform all fat injections into only the subcutaneous layer of the buttock. Fat should never be injected into the gluteal muscles or the fascia, which are structures below the subcutaneous layer. Injections into the muscle increases the risk of Pulmonary Fat Embolism (PFE), a very serious complication.

All Board Certified Plastic Surgeons who are members of the ASPS have received these safety guidelines. When guidance is followed, the BBL procedure can indeed be performed safely and transform your figure into something great. However, patients should be aware of the risks and most importantly, you should choose a surgeon carefully. Ask your surgeon where he injects the fat!

What problems does the Brazilian butt lift (BBL) address?

My butt is too flat! I want round, prominent, and perky buttocks.

-a patient from Washington D.C.

Candidates usually have these signs or symptoms:

  • flat buttocks
  • sagging buttocks
  • asymmetrical buttocks
  • small (disproportionate) buttocks
  • change of the buttock's shape following massive weight loss

How is a Brazilian butt lift (BBL) performed?

A patient Before & after a Brazilian butt lift with fat injections.The Brazilian butt lift technique varies dramatically among plastic surgeons. The technique that your surgeon uses will affect not only your surgical result, but will also influence how long your results last.

I have been using the same technique for more than 15 years, but I have refined my processing so that you get the purest and most viable fat possible reinjected into your buttocks. This helps ensure the longest lasting result. My technique involves fat extraction with liposuction, processing of the fat, and micro reinjection of fat droplets.

Fat extraction is performed by Liposuction. Fat processing involves decanting and centrifugation. The final step is the process of fat injection back into the buttocks. The procedure is designed to fill the upper quadrant of your buttocks so that the butt appears lifted and perky. The resulting effect is that your profile appears more attractive and sensuous.

Fat extraction

An illustration showing the types of cannulas used for Liposuction.

Suction assisted tumescent Liposuction is used to extract the fat which will be later used for the fat graft to the buttocks.  I first remove fat from selected areas of your body using slender, 3 mm cannulas with 1mm holes. The small cannula holes allow me to collect only the smallest fat particles. I believe that small fat particles make the best fat grafts.

Likewise, I do NOT use use the thicker, 5 mm cannulas to remove fat. There are several reasons I prefer the thin 3 mm cannula for extracting fat:

  • Thicker cannulas do not give smooth, even liposuction results like the thinner 3 mm cannula.
  • During fat extraction, the 5 mm cannula can leave dead space that allows fluid to accumulate and possibly create hematomas. When you hear about patients needing massages following liposuction, THIS is usually the reason why!
  • The thicker 5 mm cannula will extract larger fat particles which are not the ideal size for fat grafting. This can compromise the fat graft results and give poor results. These findings are based on research from Dr. Kotaro Yoshimura, a world-wide fat grafting authority, which I have detailed in a blog post.

During fat extraction, the buttock is first contoured in the areas around the buttocks to make them stand out more. Common areas liposuctioned include the back (directly above the buttocks), the stomach, and the flaks. Note that even the Liposuction alone will give your lower body a more attractive look.

Centrifuged fat from Liposuction.Fat processing

After Liposuction, the fat suctioned from these areas is carefully processed and purified by decanting and centrifugation. Only a fraction of the donor fat removed will qualify for re-injection to the buttocks. In most cases, not more than 33% of the fat cells extracted will be qualified for re-injection.

Only the best donor fat cells are re-injected back into your buttocks for augmentation. In order to get enough qualified fat, I must liposuction at least two areas of your body, and preferably three areas.

SAFE BBL: Re-injection of fat into the buttocks, in subcutaneous region only

To avoid the risk of Pulmonary Fat Embolism,(PFE), the ASPS has issued guidelines which mandate that the fat must be injected ONLY into the subcutaneous region of the buttocks. The subcutaneous space is the area above the gluteal muscles and the major blood vessels.

illustration of fat injection paths during brazilian butt lift surgeryThis technique of injecting the fat into the buttocks can be performed either with 1) manual injections or 2) with an injection pump. For 15 years I have performed manual fat injections, as I believe this technique is safer than the use of high pressure pumping techniques. With the manual injection technique, the fat is placed (or transferred) to the buttocks in hundreds of injections with special cannulas. Small amount of fat (2 cc - 5 cc) are injected with each injection pass.

My injections are performed only in the subcutaneous space above the gluteal muscles. Fat is NOT injected into the gluteal muscles or even the area known as the fascia, which is the wrapper around the gluteal muscles. I inject small amounts of purified fat into the subcutaneous regions of the buttocks. The subcutaneous space is the region right below the skin, and above the gluteal muscle and the associated fascia of the gluteus maximus. Keeping ALL injections in the subcutaneous space is essential for SAFETY. To ensure the utmost safety, I inject fat slowly, and manually with a syringe.

Injection pumping techniques

Within the past decade, certain devices began to be used which use injection pumps to fill the buttocks with fat. Fat injection pumping techniques were designed to pump large quantities of fat (several hundred cc's) at one time so that the procedure can be performed more quickly. Injection pumps can speed the procedure to 2 hours or less, as the fat is pumped very quickly. I do not believe that all fat pumping techniques into the buttocks are safe. I have seen videos of this technique which show that while pumping the fat into the buttocks, some fat streams out of liposuction entry point incisions like a fountain. This single observation where fat is flowing out of the incision tells me that the fat is migrating. If the fat can migrate to another area of the buttocks, it surely could migrate to the dangerous area below the subcutaneous space. In my opinion, this is a risky proposition.

With the manual injection technique, small quantities of 2cc-5cc of fat are carefully injected per injection pass. This manual technique does result in the procedure taking longer, but this fat does NOT migrate, and stays where it is placed. If I press the area that has been injected, no fat migrates out of the incisions. Thus, the manual technique usually involves hundreds of micro fat injections. With the manual technique, I feel confident exactly where my fat is being placed. I am confident that I am always in the subcutaneous space, above the gluteal muscle. In addition to safety, correct injection methods are essential to achieve a uniform, smooth, natural appearance to the buttocks.

How much fat is injected into each buttock cheek?

The average amount of fat that I inject into each buttocks cheek is 580 cc. However, patients who have a generous fat distribution before surgery can expect to get up to 1000cc of fat for each cheek. Read more about the average fat injections amounts of my Brazilian butt lift patients in my blog post.

The importance of surgical technique

You can watch as I explain the details of my technique and the complex series of steps involved in this YouTube video right here.

I perform Brazilian butt lifts several times each month and have been doing so for over a decade. I have years of experience with various Butt lifting and Fat transfer techniques and am uniquely qualified in this area of expertise.

Because the success of this procedure is so highly dependent on the surgical techniques, I recently wrote a post about asking the right questions during consults. Use the information you can get from asking these six questions to help pick the best surgeon for your brazilian butt lift procedure.

While a prominent butt is usually the goal in the patient's mind, it's really not just about getting the biggest butt possible. I wrote this blog post more than 10 years ago and I believe it still holds true: The Brazilian Butt Lift is not just about big butts!

The type of anesthesia used

The BBL procedure can be performed under IV sedation or General anesthesia. However, I believe that IV sedation is a better choice for patients undergoing a Brazilian butt lift. This anesthesia nearly eliminates the pulmonary risks that are associated with General anesthesia. Besides that, patients wake up much sooner than they do with General anesthesia, and experience very little nausea. To learn all about why I prefer the use of monitored IV-sedation anesthesia instead of General anesthesia, see my blog post about the types of anesthesia used in cosmetic surgery.

In addition to reduced pulmonary risks, IV sedation will not dilate the blood vessels as much as General anesthesia does. In my opinion, this could possibly reduce the risk of fat embolism, as it is harder for fat particles to travel in smaller blood vessels.

Lastly, to ensure the utmost safety with your procedure, I employ only board certified anesthesiologists in my accredited Surgery Center.

Other techniques for augmenting the buttocks

The buttocks can also be augmented with butt implants (instead of using your own fat). However, I believe the Brazilian butt lift technique is far superior to implants. In fact, I use only natural fat grafting and no longer use butt implants because they have a higher complication rate and the results are not as good.

What are the BBL preoperative requirements?

No smoking sign.The pre-op requirements for a Brazilian butt lift procedure are:

  • Your BMI (Body Mass Index) must be less than 35 kg/m2. This is calculated based on your height and weight, and is important to reduce the risk of post op complications.
  • Stop smoking 4 weeks prior to surgery. Smoking adversely affects your ability to heal and recover.
  • Stop taking aspirin, motrin, and herbal products 2 weeks prior to surgery to minimize blood loss during surgery.
  • History and Physical (H&P) and a CBC blood test are minimum requirements for a healthy adult. If you have ongoing medical issues, you must be cleared for surgery by your primary care physician. Medical clearance is required within 30 days of your surgery.
  • Discuss the risks and complications of this surgery with your surgeon. Ask him/her WHERE he injects the fat and how.
  • Read and sign the Informed Consent for BBL surgery. Ask questions about anything you don't understand.
  • Evening prior to surgery, NPO (nothing to eat or drink after midnight).
  • Pregnancy test the morning of surgery (administered at Surgery Center).

More on BMI limits for the BBL

My BMI cut off for a healthy patient is 35 kg/m2. This is generally higher than most surgeons, meaning that I accept patients who have a higher weight. The reason I can do this is primarily related to the fact that I use monitored IV Sedation instead of General Anesthesia. Here is a video of a BBL with Tummy tuck patient with a BMI at the upper limit of 35 kg/m2. She did great! However, do note that if you have any conditions such as diabetes or heart disease, the BMI requirement will be stricter (lower number).

What is Brazilian butt lift (BBL) Post-Op recovery like?

Following your plastic surgeon's post-operative instructions is crucial for ensuring fat cell survival following your Brazilian butt lift. Recovery for this procedure involves these important protocols:

  • bed rest and drink lots of fluids for the first week
  • no sitting directly on your buttocks for two weeks
  • sit only on a Roho cushion during third week of recovery
  • no driving for two weeks
  • minimum 2 weeks off from work, if you can sit on a Roho cushion during the third week
  • follow up office appointment at post operative day 6-8
  • wear compression garment for 24 hours/day for the first 2 weeks

Most importantly, you must not sit directly on your buttocks for two weeks post-op and sit only on a Roho cushion in your third week. This allows the best take of the fat graft in your buttocks and ensures the most long lasting result. If you do not follow these instructions, you may loose some of the fat graft!

You must wear a special compression garment (to control swelling) for two weeks. There may be a small amount of swelling for up to 6 weeks. However, you should be able to resume all normal activities at 4 weeks post op.

If you live out of town, you'll need to plan to stay in Baltimore a minimum of 7 days. When possible, my staff will provide courtesy transportation to and from our office throughout your stay. Our office will also provide courtesy transport from the BWI airport or Baltimore train station to your hotel. To read more about accommodations for out of town patients, please refer to our out of town patient section.

What are the risks and possible complications for a BBL?

As with any surgery, there are risks and complications associated with the Brazilian butt lift. Possible complications include, but are not limited to:

  • swelling and bruising
  • numbness and pain
  • pulmonary embolism
  • pulmonary fat embolism (PFE)
  • stretch marks
  • hematoma
  • partial loss of fat graft due to not following post op instructions
  • asymmetry between buttocks cheeks
  • revision surgery to add more fat

Risk of Pulmonary Fat Embolism (PFE) with a BBL

The most serious risk of the Brazilian butt lift procedure is pulmonary fat embolism. Although the risk is very small, this complication can be fatal. A pulmonary fat embolism, also known as a PFE, occurs when the injected fat finds its way into veins that feed directly into the pulmonary circulation. There is undeniable evidence that fat embolisms occur when fat injections are performed into the deep planes below the subcutaneous space. The fat injected below the subcutaneous space can find its way into an injured vein and then travel directly into the pulmonary circulation. There is a danger zone in the vicinity of the inferior and superior gluteal veins.

To read my comprehensive summary of Pulmonary Fat Embolisms (PFEs) in BBLs, please see my blog post which was published in December 2017. I discuss a number of cases that have appeared in the media as well as published literature on the subject.

Does type of anesthesia have anything to do with risk of PFE's in BBL?

It may. I also believe that General anesthesia may further increase the risk of PFE. My rationale is that General anesthesia and it's associated ventilation create more dilation in the blood vessels. The dilation causes veins to become larger, making them an easier pathway for injected fat to traverse through. Fat could situate itself into these veins and arteries and result in a fat embolism. In addition, General anesthesia creates a pressure gradient which attracts the flow of fat into the veins. For this reason I *exclusively* use IV sedation instead of General anesthesia. IV sedation coupled with tumescent local anesthetic prevents the veins from dilating, reverses the pressure gradient, and thus reduces the risk of fat traveling through the veins and arteries.

Gluteal (buttock) Fat grafting safety task force established in 2017

Due to a number of PFE complications recently reported in Florida and other states, several surgical societies formed an Inter-Society Gluteal Fat grafting safety task force. This task force includes board certified plastic surgeons from ASPS, ASAPS, ISPRES, and IFATS, and has selected 19 members from it's worldwide membership to study what factors influence the safety of the Brazilian butt lift procedure. I am honored to have been chosen as one of 19 members of this important task force team. Since 2017, the gluteal Fat grafting task force has analyzing the reported complications and autopsy reports so that we can issue safety guidelines for the procedure. In the summer of 2018, our team performed cadaver dissections to further evaluate different injection techniques. Results will be forthcoming

Gluteal Fat grafting (BBL) safety advisories

On June 6, 2019, the Florida State Medical Board Issued an emergency gluteal fat grafting (BBL) rule that took effect on June 17, 2019. This rule essentially states that a surgeon would lose his/her license if it is determined that the surgeon is injecting into the deeper planes below the subcutaneous space OR the fascia of the gluteus maximus muscle. In conjunction with the above, the Gluteal Fat Grafting Safety Task Force issued the following Safety Advisory:

June 11, 2019 Gluteal Fat grafting safety advisory: This advisory reiterated the conclusion of the Florida Sate Medical Board to state that injections into the buttocks must never cross the gluteal fascia, intramuscular or submuscular areas of the buttocks.

We will continue to update you on further safety advisories issued by any of the societies. Until then, be sure that your plastic surgeon uses injection techniques that ONLY penetrate the subcutaneous space of the gluteal region.

Common concerns with Fat transfers to the buttocks

The two most common questions I get are: 'how long does the fat graft last?' and 'what happens when I lose weight?'

How long do the fat injections last?

If the fat is harvested, processed, and injected correctly, the result should be long lasting. The procedure should not require touch ups or a second round of fat injections. Please read Dr. Rodriguez's personal blog about why fat injections are permanent when done correctly. The brazilian butt lift result is highly dependent upon the experience of the surgeon. Surgeons who are not using correct purification or injection methods will not obtain long lasting results. Be sure that your surgeon is experienced in this procedure!

What happens to my new buttock if I lose weight?

Patients often ask if they will lose the affect of the Brazilian butt lift if they lose weight. In this video, I discuss a specific patient case where a 5'2", 135-lb woman lost 12 pounds (nearly 10% of her body weight) following her Brazilian butt lift procedure.

If the procedure is performed correctly - the fat grafts should be unaffected. During both the loss and gain of her weight, the case patient kept her new figure.

How much does a Brazilian butt lift (BBL) cost?

Total cost of the Brazilian Butt Lift depends on how many liposuction areas are performed. The more fat removed, the more enhancement you will see as a result. The procedure with three areas of liposuction (lipo abdomen,flanks and full back) is the most popular, but some people have a generous enough fat distribution in abdomen and flanks, such that two areas of liposuction (lipo abdomen and flanks) are more than adequate.

Total BBL costs for procedures performed in 2020 are as follows:

Brazilian butt lift, BBL, cost including: 2020 Price
lipo abdomen and flanks $10,300
lipo abdomen, flanks, and scapular (back) $12,500

Total cost includes the surgeon's fee, OR fee, Anesthesia fee (Board Certified physician) and 2 post operative garments.

These are amazing prices considering I have been performing the procedure for over 17 years! I am a former President of IFATS, an international research organization which studies the properties of adipose tissue, and a co-investigator with 2 FDA registered clinical trials which study the properties of stem cells in adipose tissue. Our surgical facility is a donation facility for a phase III clinical trial.

Pink money box.Can I finance my Brazilian butt lift (BBL)?

Yes, we work with a number of finance companies so that you can have a low, affordable, monthly payment. Please call our office at 410-494-8100 or see our financing section for more information.

Dr. Ricardo L. Rodriguez's signatureModified on |
Board Certified Plastic Surgery, ASPS Member

NOTICE

Patients depicted in our before and after galleries have provided their written consent to display their photos online. Every patient is unique, and surgical results may vary. Please contact us if you have any questions.