Are BBLs Safe?

Brazilian Butt Lift (BBL) safety is a topic surrounding one of the most popular aesthetic surgeries in the United States. BBLs are so popular because of the combination of the liposculpting of the waist and the volumizing fat transfer to the buttocks and hips. This combination often creates an incredible transformation and an hourglass figure. However, the Brazilian Butt Lift has also become an infamous topic from a safety standpoint because of previous limitations within the procedure. However, the BBL is now safer than ever, thanks to modern ultrasound technology and other advanced techniques.

At Austin Plastic Surgeon, our team is skilled, knowledgeable, and eager to share with you the ways that BBLs are designed to be both safe and effective. If you are interested in a BBL procedure, schedule a personal consultation at the location that is most convenient for you:

You may also fill out our contact form with any inquiries and we will reach out to you shortly.

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About BBL Safety

At one point, the BBL was considered the most dangerous aesthetic procedure in the United States due to fat emboli, or fat in the bloodstream. ⁽¹⁾ However, this is not true anymore, as our knowledge of the procedure, the anatomy, and the techniques has improved. The risk of fat emboli increases significantly when fat is injected into the muscle. ⁽¹⁾ This increased risk is thought to be due to damaged blood vessels in the muscles after a significant pressure gradient between the veins and fat in the muscles, which can pull the fat into the blood vessels. ⁽¹⁾

There are multiple techniques we can use to decrease the risk of intramuscular injection. Nowadays, we can employ the use of ultrasound for visual guidance of fat grafting, amongst other advanced techniques.

What is an Ultrasound?

Ultrasound, also known as sonography, is a type of imaging that uses sound waves to create a two-dimensional image. The ultrasound probe transmits sound waves that echo off the tissues of the body and return to the transducer probe to create an image. Since it only uses sound waves, it is considered one of the safest imaging techniques as no radiation is used in the treatment. It has been used in medicine for over 60 years to provide images of the human body. As technology has improved, the probes and computers necessary for sound wave analysis have become smaller and easier to use. ⁽²⁾

Ultrasounds and BBLs

The use of ultrasound for BBL safety has continued to improve over time, and the evolution of our understanding of the gluteal anatomy and the techniques of fat grafting to the buttock has made the BBL much safer than it was before.

The utilization of ultrasound visualization during a BBL gives patients and surgeons an extra level of security that ensures that the procedure is being done as safely as possible. This is because an ultrasound allows the plastic surgeon to more accurately visualize the various compartments of fat and the muscles below the skin. The benefits manifest in terms of both safety and aesthetic appearance; the ability to directly visualize the muscle in real-time allows the plastic surgeon to watch the fat being injected and ensure the correct placement of the fat above the muscle. ⁽³⁾

In this way, the plastic surgeon can also target specific fat compartments, allowing for better control over the shape of the buttock and increased projection capabilities. ⁽³⁾ There is both a superficial plane and a deep fat plane–the plastic surgeon can fill both of these fat compartments using direct visualization. Without the use of ultrasound guidance, most plastic surgeons will avoid these deeper fat layers, as it can be difficult to avoid intramuscular injections while filling these layers without this tool. ⁽³⁾

Other Improved Safety Techniques

In addition to ultrasound technology, increased safety has also resulted from an improved understanding of gluteal anatomy and from the improved techniques for fat grafting. In the plastic surgery community, we now understand that fat must only be injected into fat tissue when augmenting the buttocks–not muscle. Early BBL procedures that included intramuscular injections often led to an increased risk of adverse outcomes for patients. ⁽²⁾ The new techniques that focus on injecting above the muscle to allow the plastic surgeon to shape the body safely are much more common now.

Other BBL techniques that have improved the safety of the procedure include large-bore cannulas, auto-injectors, and patient positioning. The large-bore cannulas, or suction tubes, give the surgeon much more control of the position of the cannula and make it less likely to enter the muscle. The fat auto-injectors have become popular as the surgeon can concentrate on the placement of the cannula tip while the auto-injector delivers the fat into the buttock. Meanwhile, patient positioning can help protect the veins from being injured by the cannulas, as well as prevent unintentionally reaching the muscles during the BBL treatment. ⁽⁴⁾

Benefits

BBLs, especially with today’s modern safety precautions and techniques, can have the following benefits for patients:

Ultrasound-guided procedures are not new to medicine. They have been used for procedures in the hospital for many years. However, in the past, ultrasound devices were large and difficult to use without specialized personnel. As technology continues to improve, so does our ability to safely and effectively treat patients. Ultrasound devices have become much smaller and more portable, which allows the surgeon to have the ultrasound device during surgery with the images connected to a monitor or iPad so that the entire fat transfer procedure can be visualized.

Candidates

An important component of patient safety during a BBL is the initial step of ensuring that the patient is a good candidate for this kind of procedure. Candidates should be in good overall health, as well as have realistic expectations relating to BBL results. They should also have sufficient fat for the liposculpting phase of the procedure–which is when fat is taken from another area of the body. Patients should weigh close to their ideal weight and be at this weight consistently, as subsequent fluctuations could affect the appearance of the BBL results.

It is also very important that candidates are either non-smokers or are willing to stop smoking for some time before their appointment. Smoking cigarettes and consuming other nicotine products can negatively impact how one’s body reacts to a surgical procedure like a BBL.

Candidates should be willing to follow all of their plastic surgeon’s preparation instructions in order to ensure that the procedure is both safe and successful. Patient candidacy is carefully evaluated during a personal consultation, so patients do not need to worry about making this decision about whether or not they are a good candidate on their own.

Personal Consultation

During a personal consultation at Austin Plastic Surgeon, our staff takes great care to ensure that patients are fully informed about what they can expect with a BBL procedure. Personal consultations are also important in ensuring patient safety, as this is when we ask the patient to share facts about their medical history that are crucial to procedural planning. We can also help patients understand what kind of lab testing they will need to complete prior to their surgery, as we will need ample time to review this material.

To set up a personal consultation with our helpful staff, fill out our contact form or call the Austin Plastic Surgeon office location of your choosing:

Ultrasound Procedure

During a BBL procedure that involves ultrasound, the plastic surgeon will place the ultrasound probe in the area of the buttocks or hips, or wherever they are planning to inject the fat later on in the procedure. After this, the plastic surgeon will be able to visualize the large-bore fat cannula in real-time, so that they can watch and ensure that fat grafting is taking place precisely, efficiently, and above the layers of muscle. The ultrasound will also help the plastic surgeon visualize the superficial and deep fat compartments so that they can fill these layers directly, with much less risk of injury to the surrounding structures.

Cost of a BBL in Austin

The cost of BBLs varies from patient to patient, as many different factors must be taken into account. For example, some people may request or require more extensive liposuction and fat grafting procedures in order to achieve their desired appearance. Our knowledgeable staff will discuss all of these factors with you during your personal consultation at Austin Plastic Surgeon. To find out exactly what your BBL would cost, you will need to attend this appointment at one of our offices. Call the location closest to you, or fill out our contact form and we will reach out to you with more information as soon as possible.

For procedure cost estimations, visit our pricing page.

References

1. Pazmiño P, Garcia O. Brazilian Butt Lift–Associated Mortality: The South Florida Experience. Aesthetic Surgery Journal. 2022;43(2). doi:https://doi.org/10.1093/asj/sjac224
2. National Institute of Biomedical Imaging and Bioengineering. Ultrasound. Nih.gov. Published December 2023. https://www.nibib.nih.gov/science-education/science-topics/ultrasound
3. Pazmino P, Daniel Del Vecchio. Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better. Published online May 9, 2023. doi:https://doi.org/10.1093/asj/sjad142
4. Turin SY, Fracol M, Keller E, et al. Gluteal Vein Anatomy: Location, Caliber, Impact of Patient Positioning, and Implications for Fat Grafting. Aesthetic Surgery Journal. 2019;40(6):642-649. doi:https://doi.org/10.1093/asj/sjz260