Brazilian Butt Lifts: Complications and Risks to Consider
Among all plastic surgery procedures, Brazilian butt lifts (BBLs) have garnered a particularly negative reputation. Media reports of fatal surgeries conducted by "cosmetic surgeons" (or, in some cases, individuals without a medical license) have led many to believe that a BBL is akin to a death sentence. However, the reality is that when performed by a skilled and board-certified plastic surgeon, the risk of complications during the surgery is significantly reduced. In fact, recent studies indicate a 76% decrease in the BBL mortality rate in 2024, thanks to changes in how the procedure is executed.
It's important to note that while BBLs are not without risks, all plastic surgeries carry some degree of risk. Major risk factors include consulting with an inexperienced provider, being in poor health, and failing to follow pre-surgery protocols (such as not eating before undergoing general anesthesia). Common surgical complications include allergies to medications and anesthesia, bleeding, and seromas.
Beyond these standard potential risks, there are specific complications unique to BBLs. If you're considering the procedure, it's wise to have a thorough understanding of these risks. Here, with insights from board-certified plastic surgeons, we delve into the most common BBL complications and risks—both medical and aesthetic—that you should be aware of before undergoing the surgery.
BBL Complication #1: Fat Embolism
Without a doubt, this is the most lethal complication associated with BBLs and the primary reason behind the surgery's historically high mortality rate. "An embolism can be fatal—almost instantaneously, on the operating table," warns Dr. John Paul Tutela, a board-certified plastic surgeon in Livingston, New Jersey. A fat embolism occurs when fat is injected into a blood vessel, obstructing normal blood flow. Similar to a blood clot, this fat can travel throughout the body, reaching the heart or lungs and impairing their function. The most alarming aspect of fat embolisms is that there's no way to detect their formation until it's too late.
This complication often arises when the harvested fat is injected deep into the butt muscle, where numerous critical blood vessels are located. However, this technique is now used less frequently, which has contributed to the decline in BBL mortality rates. "In the U.S. and other major countries—such as Colombia, Mexico, and others—nearly all surgeons agree not to inject fat into the buttocks muscle," explains Dr. Matthew Nykiel, a board-certified plastic surgeon in Newport Beach, California. Currently, most surgeons (including those interviewed for this article) inject the fat superficially using a large cannula, adding fullness above the muscle rather than below.
This doesn't mean that butt muscle injections are entirely prohibited. "It yields a more dramatic result," says Dr. Nykiel. "When you see a very full, round, bouncy, and voluminous butt, it's likely achieved through fat injection into the butt muscle." If you're seeking these dramatic results with a safer outcome, Dr. Nykiel recommends considering butt implants: "They are placed into the butt muscle, lifting it up and creating that desirable volume and shape."
BBL Complication #2: Infection
While the risk of infection is not exclusive to BBLs, it is one of the more likely complications to occur and warrants detailed discussion. "Sterility is paramount," emphasizes Dr. Tutela. "Fat is susceptible to infection—it's like a piece of meat, an ideal environment for bacteria to multiply." During the fat transfer process, the fat is removed from its existing blood supply and then relocated. While awaiting injection, the fat struggles to survive, making it highly vulnerable to infection.
Receiving an IV drip of antibiotics during your procedure, prior to the actual incision, can significantly help prevent infection, as can adhering to strict sterility protocols during the surgery. However, if you do develop an infection, it's crucial to visit your provider promptly—because if the infection remains untreated, it could lead to tissue necrosis. The risk of experiencing this complication increases when undergoing liposuction, an essential part of a BBL. With tissue necrosis, bacteria can cause not only skin but also fat and muscle to die (it can also be caused by poor blood flow to the area).
Fortunately, it's relatively easy to determine if you have an infection: "The area becomes red, hot, firm, and painful," describes Dr. Nykiel. "If it's near an incision site, you might have a small amount of drainage." To treat it, your provider will make a small incision over the area to remove the infected fat and fluid, clean the area, and prescribe antibiotics. Some providers also use hyperbaric oxygen therapy as a preventive measure, pushing oxygen back into the blood and skin for better healing.
BBL Complication #3: Skin Numbness or Sensitivity
As the cannula moves beneath your skin during liposuction, it disrupts the nerve endings that travel through your fat to the skin's surface. This can cause alterations in skin sensation. "Initially, it's numbness—people describe it as feeling like a bowl of jelly," says Dr. Nykiel. "Then you'll experience a slight tingling, with prickly sensations as the nerves regain consciousness, which they typically do." Don't be surprised if these sensations persist for up to a year after the procedure.
BBL Complication #4: Contouring Irregularities
This is a risk associated with any liposuction procedure and can occur during the fat removal itself (resulting in small bumps) or when it is reintroduced to the body. "[With fat transfer,] you're depositing small droplets of fat in a widespread area, attempting to create a perfectly shaped outcome," explains Dr. Tutela. "The truth is, as you pass the cannula back and forth, you could create small areas where there is a slightly higher deposit next to an area with a slightly lower deposit."
To correct the appearance of contouring irregularities, your surgeon can intervene again, anywhere from six months to a year after the procedure, and smooth out the texture. If the contouring irregularity is caused by lipofibrosis, where those lumps and bumps are actually hardened scar tissue, your provider may recommend lymphatic drainage massage and self-massage to help break up the scar tissue until a year has passed, when they will smooth out any remaining bumps.
BBL Complication #5: Volume Loss
"Fat loss is not just a risk—it's an inevitability," states Dr. Tutela, who notes that the average resorption rate of transferred fat is approximately 50% nationwide in 2024. "You're going to experience it to some extent, but it's difficult to determine the amount and location." It's largely a matter of chance, but how your provider processes the liposuction fat can make a difference.
"Human beings are 60% water—when we perform liposuction, anywhere from 30% to 50% of what we extract could be swelling, fluid, or not even fat," explains Dr. Nykiel. If a provider separates the fat from the rest of that liquid, you'll have a more accurate representation of your results after the procedure, although you may still notice a volume change. "Fat cells decrease slightly after surgery because they are in shock," says Dr. Nykiel. "Typically around a year later, you'll observe a sort of recovery and regrowth." However, if a provider fails to separate the fat from the other liquid, your body will quickly absorb all those fluids, resulting in a much smaller-looking outcome.
You'll also notice changes in the shape and size of your butt as your weight fluctuates. "When people gain weight, they will notice that their entire body increases in volume," says Dr. Nykiel. "Even though the butt becomes larger, the loss of definition from the waist to the back to the butt can significantly alter the appearance of the results." However, if you lose the weight you've gained, your results will be restored.
In the case of significant fat resorption, aside from undergoing multiple BBL sessions, a great way to maintain the appearance of a shapely butt is to follow a consistent fitness routine. Says Dr. Nykiel, "The perkiness and toned look of the butt mainly come from your butt muscle—that constitutes the majority of your butt's volume."
