What is a BBL and how is done? The Brazilian Butt Lift (BBL), a procedure originally popularised by the Kardashians, currently enjoys significant attention on social media platforms including Tik Tok and Instagram. It involves augmenting a patient’s buttocks to enhance volume and shape. This is done through a fat grafting technique using the patient’s own fat cells. The grafted fat cells survive in much the same way as skin, bone or cartilage grafts. The success of the procedure is dictated by various factors including the Surgeon’s training and experience, the technique used and the patient’s general health. While individual variations occur only two thirds of the graft are typically successful. Fat grafts which fail to ‘take’ are either reabsorbed by the body or can form lumps known as fat necrosis or oil cysts1.  


What is the trend in the US? There has been a disturbing trend post COVID with an increased number of fatalities following BBL surgery in the US; so much so, that there is a nationwide call for regulation around the number of daily surgeries doctors can safely perform. In Florida the Board of Medicine has put new emergency regulations in place where Plastic surgeons can now only perform a maximum of three BBL surgeries per day to avoid the risk of mistakes being made from surgeon fatigue. Surgeons are also being encouraged to use ultrasound guidance during surgery to help avoid arterial puncture, as fat taken from other parts of the body is re-injected into artery laden tissue 2. 


What about BBLs in Australia? It is well recognised that BBL surgery is the most dangerous of all cosmetic surgery procedures and demand post COVID has shown no signs of slowing down – there has been a global increase by 77.6% since 20153. In Australia, The Australasian College of Cosmetic Surgery and Medicine (ACCSM)has spoken of the dangers of BBL surgery and the concerning rise of Body Dysmorphic Disorder (BDD).1  


What are the risks of the procedure? The mortality rate post BBL surgery is estimated at somewhere between 1:1600 and 1:3000. The procedure is responsible for the highest death rate of any cosmetic operation and the president of the ACCSM, Dr Patrick Tansley has called on cosmetic and plastic surgeons to stop performing BBL procedures for the safety of their patients4. The main cause of death is a pulmonary fat embolism when fat cells are mistakenly injected under high pressure into low pressure veins located deep in the gluteal muscles. Other causes include severe infection. There can also be long-term health issues caused by a non-fatal pulmonary fat embolism resulting in permanent or chronic pulmonary morbidity.5 From an aesthetic standpoint, surgical BBL can appear unnatural, and the results may not as attractive as desired.  


Are there less risky procedures available? There are non-invasive procedures which do not carry any of the risks associated with surgery that can deliver quantifiable results in as few as four weekly, 30 minute sessions. At Aesthetique Skin and Body we use a combination of high intensity focused electromagnetic energy and synchronized radiofrequency for concurrent muscle building and fat reduction. The EM Sculpt NEO device from BTL, which is one of only five machines in Melbourne, delivers 20,000 muscle contractions in 30 minutes to build volume and shape to gluteal and other body areas. This number of repetitions cannot easily or practically be achieved in a gym. Our clients typically see results 3 months following their treatment and suffer no ill effect post a relatively painless procedure. The results are subtle and present no downtime or risk associated with more invasive and potentially lifethreatening surgical procedures.  


It is always important to understand the motivation for any surgical or non-surgical procedure. The incidence of BDD among the general population from various epidemiologic studies is between 0.7% and 2.4% in the general population. This number can be as high as 16.0% as evidenced by studies conducted on inpatients looking to undergo invasive procedures6. We recommend an indepth consultation with Dr Rupali to better understand the drivers behind any cosmetic treatment of this nature. The dialogue will allow patients to gain an informed view of what can practically and safely be achieved using both surgical and non-surgical methods. 




  1. Press article: The ACCSM Urges Surgeons to Reconsider Performing BBLs. October 21, 2021  

  1. Aesthetic Medical Practitioner: US Concerns over Butt Lift Numbers. Spring 2022 

  1. and ISAPS annual Global Survery on Aesthetic/Cosmetic Procedures 2019.  

  1. Mofid MT, S. Suissa, D. Ramirez-Montanana, A. Astarita, D. Medieta, C. Singer, R. Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthetic Surgery Journal. 21 March 2017. 

  1. ACCS. Media Statement. Australians cautioned: Brazilian Butt-lifts can kill. Industry needs accreditation. 5 November 2019. 

  1. Conroy M et al. Prevalence and clinical characteristics of body dysmorphic disorder in an adult inpatient setting. Gen Hosp Psychiatry. 2008 Jan-Feb.