The British Association of Aesthetic Plastic Surgeons has lifted an October 2018 warning to its members that encouraged them to cease performing Brazilian butt lift surgery.
The association released a series of new safety guidelines for surgeons Saturday, October 8th, that are intended to make the popular procedure accessible again—albeit less deadly.
The association placed a moratorium on the procedure after the widely-publicized October 2018 death of 29-year-old Leah Cambridge, who hailed from England but perished after a BBL done in Turkey.
It now says new research places the procedure’s actual mortality rate as “similar to that for abdominoplasty.”
The abdominoplasty, or tummy tuck, has a mortality rate of 1 in 14,000, while gluteal fat grafting, or Brazilian butt lift surgery, has a mortality rate of 1 in 15,000.
It also notes that Brazilian butt lifts are “currently the procedure with the biggest growth rate in plastic surgery worldwide, with an increase of around 20% year-on-year.”
Though statistically inaccurate, considerable revenue to date has either been being spent out of country, or paid to surgeons not bound by the association’s policies.
Following the ban on gluteal fat grafting in the UK, patients sought out the procedure elsewhere—usually in Turkey—sometimes exposing themselves to more dangers than the procedure already carries when done properly.
“An increasing number of UK based patients are continuing to seek this procedure by surgeons not on the GMC Specialist Register or by venturing abroad.”BAAPS President Marc Pacifico, October 8, 2022
This trend in BBL tourism is likewise seen in the States. Patients travel to Florida for discount work that, too often, turns deadly.
The UK’s new safety guidelines come three months after Florida’s Medical Board mandated very similar rules, including the use of ultrasound and limiting surgeons to doing no more than three BBLs per day.
Florida holds 7% of the US population but accounts for 28% of its BBL deaths, thus the Board’s focus.
On the grounds that using ultrasound didn’t make for a safer procedure, a handful of plastic surgeons appealed the board’s emergency order in court.
That appeal was denied, and America’s largest plastic surgery societies subsequently urged national adoption of the new rules in August.
“Abdominoplasty and BBL appear to have similar safety based on mortality…. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000.”Del Vecchio DA, Wall SJ Jr, Mendieta CG, Aslani AA, Hoyos AE, Mallucci PL, Whitaker IS. Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plast Reconstr Surg. 2021 Dec 1;148(6):1270-1277. doi: 10.1097/PRS.0000000000008599. PMID: 34847113.
The British association says gluteal fat grafting can be safely performed given two key conditions:
That fat is injected only in the subcutaneous plane of the buttocks, and that ultrasound guidance be used while fat is being so placed.
“The evidence shows that the only deaths from the procedure have been when fat has been injected into the deeper muscle layer [of the buttocks],” the association said in a release.
“So, it’s no to BBL but yes to Superficial Gluteal Lipofilling where the fascia is not compromised,” BAAPS President Marc Pacifico said. “To ensure this we are recommending that Surgeons should only perform this with real time ultrasound guidance as the only way to ensure the procedure is performed superficially and safely.”
Drawing on research that suggests surgeon fatigue may also be a factor in patient BBL deaths, the association also recommends that BBL surgery cases are limited to 3 per surgeon per day.
The association says women interested in the procedure should be consulted by their plastic surgeon well prior to the day of their surgery, be given a “cooling off” period of at least two weeks, and have a second consultation before surgery.
These preventative and safety measures are typically not done at high-volume Brazilian butt lift clinics in the U.S. and in other plastic surgery tourism countries.
In a 60-page safety briefing, dated September 30, the association lists the following possible “major and serious complications” of gluteal fat grafting, and it urges member surgeons to discuss them with all potential patients.
- Fat embolism
- Blood loss that may require transfusion
- Thrombosis DVT and PE
- Sepsis, septic shock and necrotising fasciitis
- Injury to the sciatic nerve
- Complications due to patients positioning and turning such as:
- Peripheral nervous system injury due to stretch or pressure
- Joint dislocations
- Ophthalmic complications due to direct pressure, corneal injuries, ischaemic optic neuropathy and blindness
Mild infections, delayed wound healing, seem, hematoma, visible scarring, skin laxity, contour irregularities, numbness, skin necrosis, hyperpigmentation, ulcers and sores, fat loss, fat necrosis, oil cysts, and skin blow-out are listed as potential “minor complications” of the procedure.