A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. With a little more digging however, you will also find women like Nelly Baptiste telling The New York Times, “When the pain came yesterday, I was like: I want my old body back” after undergoing a BBL in Miami. Or Helly Larson describing the first week after her Miami BBL as “absolute hell” to a Vox reporter.^1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumothorax during her 2018 Miami BBL and whose 16-year-old daughter worried that in “just a blink of the eye, I could have lost my mom.”³

Autologous Fat Transfer Procedure

Gluteal autologous fat transfer procedures (AFT), popularly known as “Brazilian Butt Lifts” are gaining prominence in the aesthetic surgery community. A surgical technique to augment a patient’s backside, AFT involves abdominal liposuction followed by re-injection of the fat into the gluteal area. The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase.^2,4,5 The procedure costs thousands of dollars and requires significant post-operative care; in addition to typical post-surgical needs, patients often require aggressive lymphatic massage and have significant movement restrictions that include sleeping face down, avoiding sitting, and wearing constrictive corset-type garments called fajas.¹

The Rise of the Miami BBL

An entire industry has emerged around gluteal AFTs in Miami. Stand-alone cosmetic surgery centers offering the procedure, often at significantly “discounted” prices, can be spotted on nearly every block. Dedicated “Recovery Centers” have also sprouted up to meet the demand from patients who have traveled from out of state to take advantage of the competitive pricing in this area.

Unfortunately, the low prices come at a cost. Opportunistic physicians and entrepreneurs capitalized on the demand for these procedures by opening dedicated cosmetic surgery centers where physicians performed multiple gluteal AFT procedures per day, while providing little to no post-operative care or monitoring. These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation.⁶ The increasing mortality rate led to an additional emergency regulation in 2022 requiring the consenting physician to perform the critical steps of the case, limiting surgeons to three cases per day, and mandating continuous, recorded ultrasound guidance for gluteal AFT procedures.⁷ The impact of this latest set of regulations on the complication rate has yet to be reported.