The dangers of BBL

In 2018, an alert was issued by the American Society of Plastic Surgeons regarding fat transfer to the buttocks, or BBL. After a survey of members and the literature, it was found that the incidence of death from the procedure were about one in three thousand. This is by far the highest for all cosmetic plastic surgery procedures. Clearly, this is very concerning to me, as I have done over 3,000 myself.

The problems that occurred seem to have come from fat being injected into and below the muscles, and that fat entering the bloodstream causing pulmonary embolus and death. These findings made me feel somewhat better for a few key reasons.

When I do a BBL, I am always above the muscle in the subcutaneous plane. A death has never been reported from the procedure when the fat is above the muscle. The only limits are that you cannot always get as much volume that way, but I would rather have someone complain they are not quite as big as they hoped as opposed to someone dying.

Secondly, I always stay away from the lower inner area of the buttocks where the major blood vessels are. I clearly point this out to my patients before the surgery, so that they know where I won’t fill and why.

These findings show the importance of technique and doctor selection. Many non plastic surgeons are now doing cosmetic procedures thinking it is easy money. The experience, skill and anatomical precision required cannot be taught in a weekend course, online videos, or by spending a few months watching someone and calling it a fellowship. Be safe.