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A brief history of the Brazilian butt lift

From silicone implants and fat transfers to bubble butts and a high mortality rate, we investigate whether the BBL is the most dangerous cosmetic surgery of all

Welcome to Beauty School, the corner of Dazed Beauty dedicated to learning. From guides to histories, this is where we shed light on past subcultural movements and educate our readers on current trends and various goings-on.

On October 11, the British Association of Aesthetic Plastic Surgeons (BAAPS) announced its decision to launch a formal review of the fat-grafting surgery known as the Brazilian butt lift (BBL). Outside of the cosmetic surgery industry, the procedure has become infamous in part due to its unusually high mortality rate. But with the American Society of Plastic Surgeons (ASPS) reporting that 24,099 BBLs were performed in the US last year (up 19 per cent from 2017), it’s fair to say that buttock augmentation is bigger than ever.

Buttock augmentation is the surgical process of altering the size, shape, and contour of the buttocks. This can be achieved using silicone implants or fat transfer, what’s commonly known as the Brazilian butt lift. BBL surgery begins with liposuction to remove unwanted fat from one area of the body (stomach, flanks, and/or thighs). The fat is processed and then reinjected into the buttocks to improve contour. 

Brazilian butt lifts help patients achieve the time-honoured hourglass shape and body contouring that was traditionally only achievable via restrictive undergarments and corsetry. Think back to the hourglass corsets, bustles, and cage crinolines that Victorian women used to achieve their exaggerated figures. True, a corset can’t enlarge a butt, but in narrowing the waist and enhancing the dimensional contrast, it can certainly give that impression.

Extreme body contouring garments went out of style in the early 20th century. Fashion shifted toward loose-fitting clothing, with less focus on the extreme curvature of a corseted form. The 1950s favoured a fuller figure, but still with a large chest, tiny waist, and juicy butt à la pin-up girls like Marilyn Monroe. Styles and so-called body ideals ebbed and flowed through the latter part of the century.

How the buttocks went from natural to surgically enhanced is an interesting story and one that starts within the lifetime of Monroe and her hourglass peers. Buttock augmentation actually dates back to the 1960s. Brazilian plastic surgeon Ivo Pitanguy (1926-2016) is widely credited as the creator of the Brazilian butt lift, though the technique built upon decades of innovations in its field. Pitanguy was initially known for his philanthropic work, as well as the artful touch and keen discretion he employed when operating on the world’s rich, famous, and even royal. He also contributed to the surgical advancement of facelifts, breast augmentations, and tummy tucks. Quite the pioneer. 

In 1964, Pitanguy published a paper on early buttock lift surgery, which removed excess skin and tissue to correct sagging. This method tightened and toned, but wasn’t able to increase volume or projection. A few years later in 1969 Bartels et al documented the earliest butt augmentation procedure using a silicone breast implant to correct atrophy of a patient’s left buttock. Cocke and Ricketson went on to document the first purely cosmetic butt augmentation in 1973. This led to the commercial development of a butt-specific implant. Gluteal implants continued to improve as style and size options increased in line with innovative new surgeries and fabrications over the next decade. 

Throughout the 1980s, liposuction gained traction as a viable technique in body contouring, though the field was still young and relatively niche, for anyone who could afford it. Medical professionals experimented with processing and reinjecting the fat removed through liposuction. The method became more popular in the 1990s, after New York City plastic surgeon Sydney Coleman published a series of papers outlining standardised practices for the complex procedure

“BBL surgery doesn’t just make your butt bigger, it also makes your stomach, flanks, and/or thighs smaller”

Today, the Brazilian butt lift is one of the fastest-growing cosmetic surgeries in the US. The procedure’s rise in popularity has been linked to celebrities like Kim Kardashian-West, Nicki Minaj and Jennifer Lopez – whose ample behinds have sparked an exaggerated resurgence of the once-celebrated hourglass figure. BBL surgery promises a bubble butt with a ‘snatched’ waist. Patients in the US can expect an average cost of $4,341, not including anaesthesia or operating room costs. Patients who receive BBL surgery in the UK may expect to pay anywhere from £2,000 to £7,000. It’s worth noting that BBL surgery should not be confused with butt lift surgery. A butt lift removes excess skin and fat to give a tighter look without adding volume. 

The allure of the Brazilian butt lift goes beyond its ability to produce an apple bottom. BBL surgery doesn’t just make your butt bigger, it also makes your stomach, flanks, and/or thighs smaller. “There are two groups – patients who have a little extra weight and would like liposuction with the extra benefit of putting the fat into the buttocks and hips, or patients who are very skinny and have no butt,” says Johnson C. Lee, MD, a board-certified plastic surgeon who performs BBLs at his Beverly Hills practice. The latter, he says, are not always candidates for this procedure. Instead, he may suggest implants or injecting a filler called Sculptra, which stimulates collagen growth. The non-surgical route is more costly and results aren’t as dramatic.   

Kiwi model and entrepreneur Sarah Harris had a different experience. “Initially I was just getting fat transferred into a divot I had on my stomach caused by a previous beauty procedure. The cost wasn’t much more to do a fat transfer to my glutes and hips, so I decided to do more research about it.” She spent over a year searching for the right surgeon. Few were willing to help her fix the hollow in her stomach, a particularly risky job. When considering surgery, patients should be aware of possible complications ranging from pain, infection and deep vein thrombosis, to scarring, contour irregularities and the need for revision surgery – most of which are on par with liposuction and many other cosmetic surgeries, says Dr Lee. 

So what are the complications specific to BBL surgery? Fat necrosis and “the dreaded fat embolism, where fat gets into a larger vessel and travels to the heart and other vital organs,” Dr Lee continues. This is why BBL surgeries have a higher mortality rate than any other cosmetic surgery – about one in 3,000 according to the ASPS. BBL recovery is slow and painful. “Most people need about 10-14 days of rest before going back to a full day of work,” says Dr Lee, adding that sitting and sleeping are the most difficult aspects of recovery. Patients can’t lay on their backs or sit directly on their butt for a minimum of three weeks. He advises patients to purchase a special BBL pillow, which elevates the butt while supporting the thighs. 

Sarah had her surgery this past summer. She describes her recovery as “difficult, but more mentally than anything else!” From pre-op to recovery and beyond, Sarah has documented it all on her YouTube channel. The videos are raw and Sarah is vulnerable with her followers – a humbling reminder of the gravity of a procedure whose name conjures images of spring break and novelty body lotion. “I think people forget, it’s not just like buying a bag. You really need to do your homework and take recovery seriously. It’s surgery at the end of the day, and any surgery takes a toll on your body.”

Unlike nose jobs and boob jobs, BBLs are complicated by the idea that a bigger, better butt can be achieved through a little dedication and a lot of squats. Sarah and her fiancé often share workouts on social media.“I didn’t want my audience to think I had gained a ‘dream butt’ through exercise alone.” Training certainly had an effect, “but the shape you get from a BBL isn’t the same look you get from training alone. I know a lot of fitness girls on Instagram that sell plans to their followers saying they got their dream booty from their workouts when it’s actually surgery.” This was one of the reasons Sarah decided to speak openly about her BBL. 

Stars aren’t obligated to disclose their cosmetic surgeries to the public. What’s done between them and their surgeon is entirely their prerogative, but that doesn’t stop speculation. Kim Kardashian-West’s butt has long been an object of the did-she, didn’t-she rumour mill, so much so that she underwent an X-ray on Keeping Up With The Kardashians back in 2011. Jennifer Lopez is another star whose butt has received attention, though she insists she hasn’t had work done. Nicki Minaj and Iggy Azalea have also sparked rumours. On the other end of the spectrum, stars like Jenna Jameson, Heidi Montag, and New Jersey ‘Housewife’ Dolores Catania have all spoken openly about their butt jobs.

“As bigger butts become more sought after, the waist-to-butt ratio grows increasingly extreme, and people will do anything to achieve it”

Until recently, skinny was trendy and big butts were not. Having a huge ass used to be an insult. Today, it’s become something to aspire to. In theory, this must be a good thing. Still, as bigger butts become more sought after, the waist-to-butt ratio grows increasingly extreme, and people will do anything to achieve it. In a 2018 GQ profile, Cardi B shared a harrowing story of getting black market butt injections. The revelation came only months before Brazilian plastic surgeon, ‘Dr. Bumbum’ was charged in the death of a patient after over-injecting her butt with a filler called PMMA. Underground butt augmentations are risky. Unless performed by a technically skilled, board-certified plastic surgeon, BBLs can be too. 

A recent report in the Miami Herald claims that over the last ten years, at least 16 patients have died following BBL surgery at clinics in South Florida. Two women from the UK have died following complications from the procedure. The BAAPS recently issued a statement to ‘dissuade’ its members from performing BBL procedures until more safety information becomes available. In the US, there are some board-certified plastic surgeons who refuse to perform BBLs, citing the dangerous risk-to-benefit ratio. In August 2018, the ASPS and several other plastic surgery societies formed the Task Force for Safety in Gluteal Fat Grafting to conduct studies and establish more stringent safety guidelines. 

Yet, all throughout the US, board-certified plastic surgeons continue to perform Brazilian butt lifts for happy patients every day. Safety concerns have given way to more specific guidelines for how to perform the highly-specialised surgery, says Dr Lee. The fat should be injected in small volumes, in the superficial, “upper layers of the buttocks and away from the larger blood vessels and muscles below.” Ensuring patient safety is essential. When performed by a board-certified and properly trained plastic surgeon, a BBL can be life-changing, but should always be approached with caution, as with any huge operation. 

For now, plastic surgery remains a bold, and in some places, under-regulated new frontier. As big butts are glamourised in Hollywood, and much mimicked further down the food chain by “normal” folks, we can only hope for safer techniques and stronger regulations. Everyone has the right to enjoy their body on their terms, and it seems like a positive sea change that influencers like Cardi B and Sarah Harris have spoken candidly about the risky procedures and painful recovery periods. We look forward to future innovations that mean whatever life choices people make, they’re not risking their lives in order to fit new, and less healthy beauty ideals.