Race for the bottom

The Brazilian Butt Lift does a pivot

Photo by charlesdeluvio on Unsplash

Each decade has its cultural trends. Long ago shifts in clothing would indicate fashionability—corsetry, miniskirts, flares, or shoulder pads. Modern times have brought modish bodily changes to breasts, lips and bums. Arguably the last decade has been the era of the Brazilian Butt Lift, or BBL. Growing numbers of women have been lured by the appeal of a perfectly round backside—along with a narrowed waist. (The procedure removes fat from the abdomen and appends some of it to one’s rear end.)

The news that one of the world’s most fashionable and famous backsides—that of Kim Kardashian—is no longer being “topped up” with fat cells has excited many cultural commentators. As Kim’s famous BBL goes into a slow decline, such is her influence on women that many are now predicting the end of the BBL era. That sort of change, though, isn’t yet clear from the data. The procedure is thought to be procedure within cosmetic surgery that has the largest worldwide rate of growth.

Dying trend

Setting aside the broader debate philosophical debate about the desire to make such extreme body modifications, one of the primary concerns about the BBL is its safety. Here, big changes are needed. So much so that the BBL may even be renamed by cosmetic surgeons.

As it happens, the BBL is a misnomer. Contrary to popular opinion, it is neither Brazilian nor a lift. It is a reshaping of the lower back, the hip, the posterior thigh, and the gluteal region. As Del Vecchio, of Massachusetts General Hospital, and colleagues write in Plastic and Reconstructive Surgery in 2019, its origins can be traced to a procedure featured on the Learning Channel in 1996. In the film, a Brooklyn plastic surgeon liposuctioned fat from a Brazilian patient and injected it into her gluteal region. The segment was called “Building the Brazilian Butt.” Thus the BBL was born. (The authors say it is an urban legend that the lift was invented by Brazilian cosmetic surgeon Ivo Pitanguy.)

Alongside the emergence of the BBL was a fallacy that injecting fat into muscle was better for the long-term survival of the fat cells. (This idea can be traced to an experimental study in rats in 1995.) In fact, wherever fat is injected a lot of of it will die. This loss is why those with new transplants have to be so careful with their rear ends. It is also why, after the procedure, you cannot sit down for at least two weeks, and are told to sleep on your front or side.

Death rates for the BBL were terrible. At one point 1 in 3,000 women were dying. The highest rate of any aesthetic procedure. This made surgeons move to injecting fat into a safer subcutaneous fat layer. Yet this new approach was not always successful and women continued to die. Post-mortems were conducted. Turned out that surgeons injected more deeply than they intended and this slip ended up killing their patients. (BBLs risk creating a “fat embolism”.) By 2018 the British Association of Aesthetic Plastic Surgeons (BAAPS) were advising its members not to perform BBL surgery at all. That year, the American Society of Plastic Surgeons offered advice on how to conduct these procedures more safely.

Only last month the more cautious BAAPS revised its position. It has now issued guidelines for a procedure it calls Superficial Gluteal Lipofilling. Fat must only be injected into the subcutaneous plane and intraoperative ultrasound must be used during the placement of fat into the gluteal area so that surgeons don’t make mistakes. I’m not an expert but the use of ultrasound to guide the cannula seems a much safer approach. And it is a low-cost technology.

Yet for this new idea about how to do a BBL more safely, women need to know to ask for this to be done—even if they have chosen, unwisely, to have the work done in a clinic overseas to save money. Safer still would be to keep that tush at home. There would also be no risk of one’s enlarged bottom falling out of fashion, like the hemlines of yesterday.