Brazilian Butt Lifts Are Trending Again, Here’s How the Procedure Has Changed

If you’ve ever heard of a Brazilian butt lift (BBL), a procedure that involves transferring fat from areas of the body to the buttocks, then you know it’s a touchy subject because it was pinned as the “most-dangerous” cosmetic surgery procedure in 2019. While this title might suggest a decline of the procedure, Palo Alto, CA plastic surgeon David Boudreault, MD says he’s been doing more of them than ever before, and it’s because he performs a safer version of the original BBL that follows American Board of Plastic Surgery suggested guidelines. It’s called a subcutaneous-only gluteal augmentation and it helps him create a beautiful, contoured shape to the butt and body, too.

How long do BBLs last?
That’s actually a really common question because there’s this idea that fat transfers are temporary—I don’t know how this idea started—but the reality is that only a percentage of the fat that’s transferred in a BBL survives. If you gain or lose weight after the procedure, you can see an increase or decrease in the size of your fat cells, but data shows that an average of 40 percent of fat survives after fat transfers. A goal with my BBLs is to over-transfer by about 30 to 40 percent so that we end with a result that is nearly what we expected. This will make up for the fat loss that happens in the recovery period, but once the fat is transferred and situated, it will be permanent.  

Do you prefer BBLs or butt implants?
I don’t perform butt implants in my practice, I only remove them due to the high amount of complications that they present. Plus, gluteal implants really only work to address volume loss in the upper central part of the buttocks. For my patients who don’t have much fat on their bodies at all, we can get a really nice shape change that fits their body without being overly done with a BBL. If somebody is looking for a very dramatic result, they probably will need a combination of implants and a fat transfer. In my clinic, I decided not to offer them because they can get infected, malpositioned, vulnerable, and they can make for a buttocks that appears too high. My goal is to offer a nice, natural look that is reliable.

Is there a certain body type that works best for BBL?
We require a detailed body evaluation with photos before we commit to surgery. The biggest thing I look for when a patient comes in requesting a BBL is where I can take fat from their body to transfer to the buttocks. Sometimes, this could be in the back or the waist—this is the most ideal because taking fat from the waist makes for a nice shape change—but as long as they have fat anywhere, we can typically perform a BBL. If a patient has a BMI that is below 18, they don’t have enough fat stores to use and it can become hard to perform the surgery.

Since you’re removing fat from the central area of the body, does the procedure re-shape that area, too?
Yes. The goal with removing fat in this area is to create a toned-looking abdomen. We want to strategically remove the fat so that the contours are in areas that you would expect to see. In order to accomplish this, we perform hi-def liposuction along with a fat transfer to create a more contoured and toned body. 

Why is the BBL pinned as a dangerous procedure?
Fat transfer to the buttocks received a lot of attention a few years back because patients were dying from it. After research, all board-certified doctors have a new way of performing the procedure if they want to remain compliant, called the subcutaneous-only gluteal augmentation. Traditionally, doctors were injecting into the muscle, which would travel into the blood vessels and then the lungs, which caused a pulmonary imbulum and people would die. I’ve been performing the updated version of the procedure for almost six years now and I have never had a complication, but it’s really important to ask your surgeon what technique they’re using.

Are there any non-surgical options available to patients who aren’t ready for a fat transfer?
The first question we always ask ourselves is ‘can we achieve what the patient is looking for without surgery?’ Because surgery always has an inherent risk, I always do what I think is best for the patient. Sometimes, I’ll tell them they need a better diet and more exercise to get the results they’re chasing. On the other hand, there are certain people who have stubborn bodies and have a hard time losing weight in the places they want to. I often perform a fat removal with liposuction where I remove fat from places like the love handles or the hips, which offers a long-lasting change without the transfer. This is not going to be as dramatic as a BBL, but it will offer a nice result. We also have SculpSure, which permanently removes fat, and Sculptra, a type of filler that, when used in large volumes, can achieve fullness in people with a lower BMI. There are definitely non-surgical options but they’re better for people who don’t want too dramatic of a change.