Are There Any Potential Brazilian Butt Lift Risks?
By Dr. Michael Baumholtz, MD, FACS — Double Board-Certified Plastic Surgeon · Published October 10, 2026
Yes, and they are worth understanding properly. The Brazilian butt lift once carried the highest death rate of any cosmetic procedure, caused by fat entering the bloodstream when it was injected into the gluteal muscle. After surgeons changed where they place fat, the reported mortality rate among board-certified plastic surgeons fell from roughly 1 in 3,000 to about 1 in 15,000 a safety profile comparable to a tummy tuck.
📌 Key takeaways
- The danger was specific, not general: fat injected into or beneath the gluteal muscle.
- Fat should go in the subcutaneous layer only, above the gluteal fascia.
- Reported deaths fell sharply as surgeons abandoned intramuscular injection.
- Those figures come from board-certified plastic surgeons they do not describe every provider offering BBLs.
- Who operates, and where, matters more here than for almost any other cosmetic procedure.
Why the BBL Developed Its Reputation
The headlines were not exaggerated. For a period, the Brazilian butt lift was the most dangerous cosmetic operation performed.
In 2017, a task force convened by the Aesthetic Surgery Education and Research Foundation surveyed surgeons and estimated a death rate of roughly 1 in 3,000. In 2018, a multi-society task force issued an urgent safety advisory describing that rate as higher than any other cosmetic surgery.
That advisory is unusually blunt for a professional body, and its findings explain everything that followed.
What Actually Caused the Deaths
The cause was a pulmonary fat embolism. Large veins run through the gluteal muscle. If a cannula injures one of those veins while fat is being injected under pressure, fat can enter the bloodstream and travel to the lungs. It can happen quickly and it can be fatal.
The 2018 task force examined autopsy findings and reported a striking pattern:
- Every death involved fat found within the gluteal muscle.
- No death involved fat placed only in the subcutaneous layer.
- Subcutaneous fat cannot migrate across the gluteal fascia into muscle on its own so intramuscular fat at autopsy meant it was injected there.
This is the single most important fact about BBL safety: the risk was not inherent to transferring fat to the buttocks. It came from where in the buttock the fat was placed.
A 2019 Brazilian study put a number on it, finding the risk of death roughly 16 times greater with intramuscular injection than with subcutaneous placement.
How the Procedure Changed
Surgical practice shifted quickly once the evidence was clear.
| Year | What changed |
|---|---|
| 2017 | ASERF task force survey estimates mortality at roughly 1 in 3,000. Surveyed surgeons report intramuscular injection in 13.1% of cases. |
| 2018 | Multi-society advisory urges surgeons to inject into subcutaneous tissue only, never into muscle. |
| 2019 | Published study finds intramuscular injection carries roughly 16 times the risk of death. |
| 2020 | Follow-up ASERF survey estimates mortality at about 1 in 14,952. Reported intramuscular injection has fallen to 0.8%. |
| 2022 | ASPS, The Plastic Surgery Foundation, The Aesthetic Society and ASERF issue a joint statement supporting subcutaneous-only placement and real-time ultrasound guidance. |
| 2024 | Florida becomes the first state to require ultrasound guidance by law during gluteal fat grafting. |
By 2020, the reported mortality figure of about 1 in 14,952 compared favourably with abdominoplasty at roughly 1 in 13,147. The procedure did not become safe by chance. It became safer because surgeons stopped doing the thing that was killing patients.
An important caveat about those numbers
The improved figures come from surveys of board-certified plastic surgeons. They do not describe outcomes across every clinic and every provider advertising a BBL.
That distinction matters more for this procedure than almost any other. The safety improvement came from a specific change in surgical technique, adopted by surgeons who follow their specialty’s guidance. A provider outside that group may not have adopted it.
Where the Fat Goes: Subcutaneous Only
The current standard is straightforward. Fat is placed in the subcutaneous layer the fatty tissue between the skin and the gluteal fascia and never into or beneath the muscle.
The 2022 joint statement from the major plastic surgery societies supports exactly this standard, alongside the use of real-time imaging to confirm where the cannula tip is during injection.
Techniques that support staying in the safe plane include keeping the cannula angled away from deep structures, tracking the cannula tip by feel through the skin throughout each pass, and using instruments rigid enough not to bend mid-injection.
Ultrasound guidance
Real-time ultrasound lets a surgeon see the cannula tip and confirm it is above the fascia while injecting. The major societies have called this a common-sense measure and supported mandating it.
Florida passed a law requiring it in 2024. Texas has no equivalent requirement, so in San Antonio this remains a question to ask rather than something you can assume. [DR B TO CONFIRM: whether ultrasound guidance is used in this practice. Do not state that it is unless confirmed.]
The Other Risks Worth Knowing
Fat embolism dominates the conversation, and it is not the only consideration.
- Fat reabsorption. Not all transferred fat survives. A portion is reabsorbed over the first months, which is why results are assessed at around six months and why some patients consider a second session.
- Asymmetry and contour irregularities. Fat does not always take evenly, and lumps or dents can develop.
- Infection at either the liposuction sites or the injection sites.
- Seroma — fluid collecting at the donor site.
- Fat necrosis, where transferred fat does not survive and forms firm nodules.
- Donor site changes. Liposuction leaves its own contour considerations wherever fat was harvested.
- Blood clots, a risk common to body contouring surgery generally.
- Weight change afterwards alters the result, since transferred fat behaves like the fat it came from.
Recovery Restrictions Exist for a Reason
BBL recovery has unusual rules, and they are not arbitrary. Pressure on freshly transferred fat affects how much of it survives.
Expect guidance on how long to avoid sitting directly on the buttocks, how to sit when you must, and when normal sitting resumes. Patients who ignore these instructions tend to lose more volume than those who follow them.
Questions to Ask Any Surgeon Before a BBL
These are the questions that separate a safe practice from a risky one. Ask them directly.
- Are you certified by the American Board of Plastic Surgery? (Verify it yourself at abplasticsurgery.org.)
- In which layer do you place the fat? The answer should be subcutaneous only, never intramuscular.
- Do you use ultrasound guidance during the injection?
- How many BBLs do you perform in a day? The Aesthetic Society’s working group recommended a limit of three, to reduce fatigue-related error.
- Where will my surgery take place, and is that facility accredited?
- Who administers anaesthesia, and what is the plan if a complication occurs?
- How much fat do you plan to transfer, and might I need a second session?
A surgeon who cannot answer the fat placement question clearly, or who becomes defensive when asked, has told you what you need to know. Read more on how to choose a plastic surgeon.
Travelling Abroad for a BBL
San Antonio patients are within easy reach of lower-priced options across the border, and cost is a legitimate factor in any decision. The trade-offs are worth weighing before booking.
- You cannot verify training against the American Board of Plastic Surgery, because that certification applies to US-trained surgeons.
- Technique standards vary. The subcutaneous-only guidance came from US and Brazilian professional bodies; adherence elsewhere is not something you can confirm from a website.
- Complications develop after you fly home, and will be managed by a surgeon who did not perform your operation.
- Flying soon after body contouring surgery carries its own clot risk.
- Your recourse differs substantially from having surgery in Texas.
Who Is and Isn’t a Candidate
A BBL is not right for everyone, and the honest assessment happens at consultation.
Generally good candidates are in good health, do not smoke, are at a stable weight, have enough donor fat elsewhere on the body, and have realistic expectations about how much volume a single session can achieve.
Patients who may be better served by something else include those with very little donor fat, those still losing weight, and those whose real concern is loose skin rather than volume which is a body contouring question, not a fat transfer one.
The Bottom Line
The Brazilian butt lift carries real risks, including a rare but serious one that has killed patients. It is also a procedure that became substantially safer once the profession identified the cause and changed how it is performed.
What that means in practice: the risk you take on depends heavily on who operates on you and how they do it. That is why the questions above matter more than the price.
Considering a BBL in San Antonio? Dr. Baumholtz is double board-certified in Plastic Surgery and General Surgery and will walk you through his technique, your candidacy, and the realistic result before you commit to anything.
Book a consultation or call +1 210-880-3708. Learn more about the Brazilian butt lift procedure.
Frequently Asked Questions
Is a Brazilian butt lift safe?
It is considerably safer than it was a decade ago. After surgeons stopped injecting fat into the gluteal muscle, the reported death rate among board-certified plastic surgeons fell from roughly 1 in 3,000 to about 1 in 15,000, comparable to a tummy tuck. Safety depends heavily on surgeon technique.
What made BBLs dangerous?
Fat injected into or beneath the gluteal muscle could enter large veins and travel to the lungs as a fat embolism. Autopsy reviews found that every reported death involved fat within the muscle, and none involved fat placed only in the subcutaneous layer.
Where should fat be injected during a BBL?
In the subcutaneous layer only the fatty tissue between the skin and the gluteal fascia and never into or beneath the muscle. This is the standard supported by the major plastic surgery societies and written into Florida law.
What is the current BBL death rate?
A 2020 survey of board-certified plastic surgeons estimated roughly 1 in 14,952. Earlier estimates were around 1 in 3,000. These figures reflect board-certified plastic surgeons and do not describe every provider offering the procedure.
Should my surgeon use ultrasound during a BBL?
The major plastic surgery societies support real-time ultrasound guidance to confirm the cannula stays in the safe plane, and Florida requires it by law. Texas has no such requirement, so ask your surgeon directly whether they use it.
How much fat survives after a BBL?
Not all of it. A portion of transferred fat is reabsorbed over the first few months, which is why results are assessed at around six months and why some patients consider a second session to reach their goal.
Why can’t I sit after a BBL?
Pressure on freshly transferred fat reduces how much of it survives. Your surgeon will give specific guidance on how long to avoid sitting directly on the buttocks, how to sit when necessary, and when normal sitting can resume.
Is it safe to get a BBL abroad?
It is a choice some patients make, with real trade-offs. You cannot verify American Board of Plastic Surgery certification, technique standards vary, complications are managed after you return home by a different surgeon, and flying soon after surgery carries clot risk.
How do I choose a safe BBL surgeon?
Verify board certification with the American Board of Plastic Surgery, ask directly which tissue layer they inject into, ask whether they use ultrasound guidance, confirm the facility is accredited, and ask how many BBLs they perform in a day.
Am I a good candidate for a BBL?
Good candidates are in good health, do not smoke, are at a stable weight, and have enough donor fat elsewhere on the body. Patients with very little donor fat, or whose concern is loose skin rather than volume, are usually better served by a different procedure.
Sources
- Multi-Society Gluteal Fat Grafting Task Force, Urgent Safety Advisory (2018)
- Reporting on ASERF task force surveys and the Aesthetic Society Working Group on BBL Patient Safety
- ASPS, The Plastic Surgery Foundation, The Aesthetic Society and ASERF, Gluteal Fat Grafting Safety Advisory (2022)
This article was last reviewed in October 2026. Safety guidance in this area continues to evolve; discuss your individual risk with your surgeon.
About the author. Dr. Michael Baumholtz is a double board-certified plastic surgeon in San Antonio, Texas, certified in both Plastic Surgery and General Surgery, with more than two decades of surgical experience. He has served as a guest examiner for the plastic surgery board examination. Read his full profile.
