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Juergen Teller, 1995, Courtesy of Juergen Teller

The Brazilian Butt Lift can kill you

So why are so many people still getting it?

The chances are you’ve read about the complications and fatalities associated with Brazilian Butt Lift (BBL) surgery in the media. But let’s start with a clarification on the procedure from the President of the American Society of Plastic Surgeons (ASPS), Alan Matarasso. “The term is really a misnomer,” says Matarasso. “To clearly explain BBL it’s easier to think of the butt as the equivalent to the breasts. With the breasts, we can do an enlargement, or a lift, or both. You can put a breast implant in, or you can do a breast lift and the same holds true for the buttock. You can enlarge it via fat injections, or an implant, or you can do a lift or both.”

From bruising, scarring, fat embolism (clots caused from the injections) and leaking fat, to the untimely deaths of a number of people who’ve undergone the procedure - the dangers of BBL have received much airtime, but as Matarasso explains, the dangers we’ve been reading about do not occur with a straight-up buttock lift that involves a simple incision, tissue removal, and re-stitch (the equivalent of a breast lift). These are the resulting issues of implants or injections of fat (into areas of the buttock to give it fullness and shape), which is exactly what BBL entails (as demonstrated by @drsiamakagha on Instagram). In short, the BBL procedure is actually an enlargement, thus the word ‘lift’ in the name is misleading. The ASPS recorded a 13% rise in buttock lifts between 2016 and 2017 and a 10% rise in those involving fat grafting.

From Cardi B, Kim Kardashian and Kylie Jenner’s much sought after derrières, to the countless reality TV ‘celebs’ who’ve followed suit in emulating their physiques – many famous figureheads have helped popularise the procedure in recent years. While it’s never been officially confirmed that Kim Kardashian and Kylie Jenner have undergone BBL, Cardi B revealed that she had had butt injections, in an interview with GQ, four years ago in a basement for $800. “It was the craziest pain ever,” said Cardi B. “I felt like I was gonna pass out. I felt a little dizzy.” She also told GQ that she experienced fat leakage for the five days following the injections.

It's not just celebrities with cash to burn that are choosing to go under the knife. In 2018, Leah Cambridge, a 29-year-old British mother-of-three, reportedly died during a £5,000 'butt lift’ in Elite Aftercare Clinic in Izmir, Turkey, where she is said to have suffered a fatal heart attack on the operating table after fat was accidentally deposited into her bloodstream. It’s the same clinic that Geordie Shore's Chloe Ferry tagged in a bikini shot on Instagram showing off her surgically enhanced buttock just six months before. She’s not the only one sharing her recently plumped peach – Natalee Harris from MTV’s The Valley’s shared a photo with her fans asking, “do I go bigger again?” And these are just the women. According to ASPS male plastic surgery increased by 325% between 1997 and 2015, forming 10% of all surgical procedures during that time. Within that, there’s a demographic of men undergoing the BBL procedure around the world – 13% of the total buttock lifts in 2016 –  whose experiences are not voiced since many men choose not to come forward to discuss their surgery for fear of being stigmatised. That, and the worrying fact that many surgeries abroad are asking patients to sign non-disclosure contracts that prevent them from speaking out about complications they may have endured.

As Matarasso explains, it’s dangerously easy for fatalities to happen. “The biggest problem we’ve learned is that the anatomy in this area is very, very complicated. When you put fat into other areas of the body you don’t have to worry anywhere near as much about it getting into the blood vessels,” he explains. “But in this area, they are finding that the fat can travel into the blood vessels, through the bloodstream, into the heart and the lungs, and that’s what’s causing these terrible problems and fatalities. This can occur immediately on the operating table, or within the next 24-48 hours. We call that the same spectrum because the end result is, unfortunately, the same. However, there are other problems that can occur later on. The fat can break down and turn into oil, and there can be bleeding and infections. And that’s when fat is used.”

Unfortunately, it gets even worse. According to Matarasso there are communities – or “hotbed areas” – in which non-doctors are injecting waxes and silicone products into the buttocks, which creates other problems – like cists, leaking, sinus tracts – that can occur years down the line. As with all cosmetic surgeries, BBL is costly meaning that many people are heading to these “hotbed areas”, for example, Turkey or South Florida, where procedures are done in “strip malls next to a nail salon, miles from the nearest hospital”. In turn, these patients often require weeks in hospital costing the NHS and other health services worldwide tens of thousands of pounds.

It’s at this point that the legalities of cosmetic surgery come into question. What exactly is considered illegal in the field? “That’s the essence of the controversy,” says Matarasso. “When I go to a hospital as a plastic surgeon, I have to have approval. But a lot of cosmetic surgery can be performed outside of a hospital. Very often it’s done in a doctors office, so you have non-board certified surgeons doing the operation. We just had a big legislation passed in the United States, regarding who can say they are a plastic surgeon. Believe it or not, people come up with these ways of calling themselves a plastic surgeon when they aren’t. And many of the mortalities have been performed by them.”

Meanwhile in the UK, the British Association of Aesthetic Plastic Surgeons (Baaps) told the BBC that one in 3,000 people die worldwide as a result of complications, describing BBL as the "deadliest" cosmetic operation, warning its members not to perform the procedure until more safety information becomes available. But despite these warnings – and cautionary tales that are no longer few and far between – why are people still going under the knife? Instagram #bootygoals, pop culture personalities and reality television shows can all be attributed to the continued desire for surgical procedures – notably the Love Island phenomenon – at least according SISU Aesthetics Clinics, who reported a 200% increase in demand for lip fillers a month after Megan Barton-Hanson appeared on the show. The chief executive of NHS England, Simon Stevens, also spoke out about cosmetic surgery adverts that were being broadcast during breaks on Love Island, to voice his fears about the pressures on young people and their perceptions of body image. When cosmetic surgery is fast becoming inescapable within mainstream media, it’s easy to see why people are still opting in.

Matarasso attributes it to lack of awareness. “Number one, I’m not sure there’s been complete penetration that BBL is such high risk. Number two, it’s human nature. People compare things to walking across the street and getting hit by a car. They think, ‘it won’t happen to me’ and decide to behave dangerously. For those who know there's a risk, they might not realise how high it is. The death rate is 1 in 3,000. The death rate of the next highest risk plastic surgery procedure is around four or five times less.”

“The death rate is 1 in 3,000. The death rate of the next highest risk plastic surgery procedure is around four or five times less” – Alan Matarasso

So how do we work towards a safer future? For people still planning to have the procedure done, Matarasso insists they do their homework. “They need to ask questions. What’s the surgeon’s specialism? What are their qualifications? Where is the procedure being performed? What are the resuscitation facilities? In a hospital, hundreds of doctors will come running if something goes wrong. When you’re in an office it’s just you and the doctor. With a complication rate this high you have to be in a facility at which you’re properly looked after. There are many people around the world who can do this operation safely, without problems.”

Meanwhile, there are measures in place to ensure successful education. In the USA, a consortium of five medical partners including ASPS are working together to fund and facilitate a report – based on a series of cadaver dissections, laboratory tests and first-hand surgeon experience – in place to issue safety recommendations. ASPS are also funding a public education campaign to raise awareness. “When the reports are released it won’t be a eureka moment,” explains Matarasso. “Every operation has risk. But the reports will ensure more media interest which will aid in increasing public awareness about of the dangers of BBL.”