Procedure guide
What a Brazilian butt lift involves, why technique determines its safety, and what to expect.
Written by Orr Shauly, MD, plastic surgery resident. Updated .
For information and education only, not medical advice.
The short answer.
A Brazilian butt lift, or BBL, uses liposuction to remove fat from areas such as the waist and back and injects it into the buttocks to enlarge and reshape them.1,2 In 2017 it had the highest reported death rate of any cosmetic operation, about 1 in 3,448, mostly from fat injected into the deep muscle entering large veins and traveling to the lungs.3,4 Injecting fat only into the layer beneath the skin, above the muscle, is now the central safety rule, and reported deaths fell to about 1 in 14,952 after these recommendations were adopted.4,5
- 1 / 3,448
- deaths in 2017
- Reported mortality from gluteal fat grafting in a 2017 international survey of surgeons.4
- 1 / 14,952
- deaths by 2019
- Reported mortality after surgeons adopted the 2017 safety recommendations, a trend toward improvement.4
- 22,151 Patients
- complication meta-analysis
- Patients in 38 studies, with minor complications in 3.58% and the lowest rates with subcutaneous-only injection.5
- 6 Weeks
- limited sitting
- Typical period of avoiding pressure on the buttocks after surgery, with sitting limited for the first 2 weeks.1
What a Brazilian butt lift is.
A BBL combines liposuction of the waist, flanks, back and thighs with fat grafting to the buttocks, which both enlarges the buttocks and sharpens the contrast with a smaller waist.1,2
The choice between fat and an implant depends mainly on how much fat a person has. With enough fat, grafting is used, and with too little, a silicone buttock implant may be considered.1
Why technique determines safety.
Large veins run beneath and within the gluteal muscle. When fat is injected into or under the muscle, it can enter these veins and travel to the lungs, a pulmonary fat embolism that can be fatal.1,3 In a 2017 survey of 692 surgeons covering 198,857 procedures, 32 deaths and 103 nonfatal fat emboli were reported, and injecting into the deep muscle significantly increased the risk.3
- Subcutaneous Only: Fat is placed only in the fat layer beneath the skin and above the muscle, never into the muscle.3,4
- Cannula Size: Larger, stiffer cannulas of more than 4 mm are recommended over small ones.3,4
- Cannula Angle: The cannula is kept parallel to the muscle and never pointed downward toward the deep vessels.1,3
- Ultrasound Guidance: Real-time ultrasound lets the surgeon see that the cannula stays in the subcutaneous layer.6,7
These measures have made a difference. After the 2017 recommendations, the rate of fat embolism fell from 1 in 1,030 to 1 in 2,492, and deep muscle injection dropped from 13.1% to 0.8% of surgeons.4 In a 2026 meta-analysis of 22,151 patients, pulmonary embolism occurred in 0.04%, and subcutaneous-only injection and ultrasound guidance had the lowest complication rates.5
Setting matters too. A review of 25 BBL deaths in South Florida between 2010 and 2022 found that all involved fat in the muscle and that 92% occurred at high-volume, low-cost clinics with very short operations, including 14 deaths after subcutaneous-only rules were introduced.8 Complications after cosmetic surgery abroad are often infections that need prolonged treatment, hospitalization or surgery after returning home.9
Who is a candidate.
Candidates are in good health with enough fat to harvest. People who are slightly overweight are often excellent candidates, and thin patients can have dramatic results when enough fat is available.1 Pregnancy, cancer and severe medical conditions are contraindications.1
The thickness of the fat beneath the skin determines how much space there is to inject safely. It increases with body mass index, and formulas can estimate it when ultrasound is not available.10
Fat grafting compared with implants.
| Method | Approach | Evidence |
|---|---|---|
| Fat Grafting5,11 | Liposuction with fat injected beneath the skin | Overall complications 9.9% in 3,567 patients, lower than implants |
| Silicone Implant11,12 | Solid implant placed in or under the gluteal muscle | Overall complications 21.6% - 25%, most often wound separation and seroma |
Fat grafting also allows contouring of the hips, waist and lower back at the same time.1,12
How a BBL is performed.
- Liposuction: Fat is harvested from the abdomen, flanks, back and thighs, which also shapes the waist.1
- Grafting: Fat is injected into the subcutaneous layer of the buttocks, aiming for balanced volume across each area, with volumes that can range from about 450 to more than 1,800 cc per side.1
- Drains: Drains are optional and did not consistently lower complications in a meta-analysis.1,5
Recovery.
Recovery protocols vary between surgeons, and the course below comes from a surgical textbook.1
| Time | What Usually Happens |
|---|---|
| Weeks 1 - 21 | Sitting is limited to the bathroom, and normal activity resumes at about 2 weeks |
| Weeks 2 - 61 | Pressure on the buttocks is still avoided |
| Week 41 | A compression garment is worn for about a month |
| Months 3 - 61 | Exercise resumes at about 3 months, and cycling or horseback riding at 3 - 6 months |
Risks and complications.
| Complication | Reported Rate | Context |
|---|---|---|
| Minor Complications5 | 3.58% | 38 studies, 22,151 patients |
| Seroma5,6 | 2.03% - 2.94% | Fluid collection, the most common minor complication |
| Contour Irregularity5 | 2.29% | Uneven or asymmetric results |
| Non-Embolic Complications13 | 2.67% | Irregularities, asymmetry, fat necrosis, infection, cysts |
| Pulmonary Embolism5 | 0.04% | Pooled across 38 studies |
Other risks include infection, fat necrosis, oil cysts, pain along the sciatic nerve and loss of some grafted fat.1,13 Warning signs of fat embolism include confusion, small skin hemorrhages, fever and breathing difficulty, which require urgent evaluation.1
Results and how long they last.
Subcutaneous-only grafting is effective. In a prospective study of 50 women, the fat layer of the buttocks was 56.51% thicker right after surgery and lost an average of 18.16% of that gain by 12 months, comparable to studies of deeper injection.14 In a series of 7,000 subcutaneous-only BBLs, estimated graft survival was about 70%, with no fat embolism or blood clots.15
Grafted fat behaves like the patient's own fat, so results change with weight gain or loss.2
Alternatives.
What we don't know yet.
- True Mortality: Death rates come from surveys and autopsy reviews, not complete registries.3,4
- Ultrasound Benefit: Ultrasound-guided studies show low complication rates, but few compare it directly with standard technique.5,6
- Long-Term Retention: How much grafted fat lasts beyond a year is not well measured.14
Common questions.
Is a Brazilian butt lift safe?
Safety depends on technique and setting. Deaths have occurred mainly when fat was injected into the muscle, and safety improved after surgeons adopted subcutaneous-only injection and other recommendations. Most complications in modern series are minor, such as seroma or irregularities.
Why is subcutaneous injection safer?
Large veins lie beneath and within the gluteal muscle. Keeping fat in the layer above the muscle avoids these veins, which lowers the risk of fat traveling to the lungs.
How much fat survives after a BBL?
Some grafted fat is lost. In one prospective study of subcutaneous grafting, about 18% of the initial gain in fat thickness was lost by 12 months, and a large series estimated about 70% graft survival.
When can I sit after a BBL?
Textbooks describe limiting sitting to the bathroom for about 2 weeks and avoiding pressure on the buttocks for about 6 weeks, though protocols vary between surgeons.
Is a BBL better than buttock implants?
Fat grafting has lower overall complication rates than implants and allows contouring of the waist and hips, but it carries the risk of fat embolism if technique is not followed. Implants may be considered when there is too little fat.
When can I return to work after a BBL?
Normal activity resumes at about 2 weeks in textbook protocols, but sitting restrictions affect desk work. Your surgeon can give a personal estimate.
Is a Brazilian butt lift right for me?
Only an in-person evaluation can answer that. This guide is educational and cannot assess an individual case. A qualified plastic surgeon can review your goals, anatomy, health history and the safety measures they use with you.
Key terms.
- Brazilian Butt Lift
- Buttock augmentation using liposuction and fat grafting.
- Gluteal Fat Grafting
- Injection of a person's own fat into the buttocks.
- Pulmonary Fat Embolism
- Fat entering the veins and blocking blood flow in the lungs, the main cause of death after BBL.
- Subcutaneous Plane
- The fat layer beneath the skin and above the muscle, the safe layer for gluteal fat grafting.
- Intramuscular Injection
- Injection into the muscle, which is avoided in gluteal fat grafting because of nearby large veins.
- Cannula
- A thin tube used to remove or inject fat.
- Gluteal Implant
- A solid silicone implant placed in or under the buttock muscle.
- Seroma
- A collection of fluid under the skin, the most common minor complication after BBL.
Research by Dr. Shauly on this topic.
References.
- 1.Sinno S, Mendieta CG. Buttock augmentation. In: Janis JE, editor. Essentials of aesthetic surgery. New York: Thieme; 2018. p. 828-36.
- 2.Shauly O, Gould DJ, Ghavami A. Fat Grafting: Basic Science, Techniques, and Patient Management. Plast Reconstr Surg Glob Open. 2022;10(3):e3987. PubMed
- 3.Mofid MM, Teitelbaum S, Suissa D, Ramirez-Montañana A, Astarita DC, Mendieta C, et al. Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthet Surg J. 2017;37(7):796-806. PubMed
- 4.Rios L, Gupta V. Improvement in Brazilian Butt Lift (BBL) Safety With the Current Recommendations from ASERF, ASAPS, and ISAPS. Aesthet Surg J. 2020;40(8):864-70. PubMed
- 5.Elsaftawy A, Bonczar M, Jagosz M, Bonczar T, Stajniak P, Główka T, et al. Gluteal Augmentation with Fat Grafting: A Systematic Review and Meta-Analysis of Complications and Procedural Factors. Plast Reconstr Surg. 2026;157(3):381e-393e. PubMed
- 6.Milani Reis A, Roca Mora MM, Bicudo Bregion P, Kreutz-Rodrigues L, Camp S, Sharaf BA. Ultrasound-Guided Gluteal Fat Grafting: What is the Evidence? A Systematic Review and Meta-Analysis. Aesthet Surg J. 2025;46(1):57-62. PubMed
- 7.Vidal-Laureano N, Huerta CT, Perez EA, Earle SA. Augmented Safety Profile of Ultrasound-Guided Gluteal Fat Transfer: Retrospective Study With 1815 Patients. Aesthet Surg J. 2024;44(4):NP263-NP270. PubMed
- 8.Pazmiño P, Garcia O. Brazilian Butt Lift-Associated Mortality: The South Florida Experience. Aesthet Surg J. 2023;43(2):162-78. PubMed
- 9.McAuliffe PB, Muss TEL, Desai AA, Talwar AA, Broach RB, Fischer JP. Complications of Aesthetic Surgical Tourism Treated in the USA: A Systematic Review. Aesthetic Plast Surg. 2023;47(1):455-64. PubMed
- 10.Frank K, Casabona G, Gotkin RH, Kaye KO, Lorenc PZ, Schenck TL, et al. Influence of Age, Sex, and Body Mass Index on the Thickness of the Gluteal Subcutaneous Fat: Implications for Safe Buttock Augmentation Procedures. Plast Reconstr Surg. 2019;144(1):83-92. PubMed
- 11.Sinno S, Chang JB, Brownstone ND, Saadeh PB, Wall S. Determining the Safety and Efficacy of Gluteal Augmentation: A Systematic Review of Outcomes and Complications. Plast Reconstr Surg. 2016;137(4):1151-6. PubMed
- 12.Oregi P, Khatib M, Cavale N, Rahman SM. Comparing the safety profiles of implants and autologous fat grafting in gluteal augmentation: A systematic review. J Plast Reconstr Aesthet Surg. 2023;83:463-74. PubMed
- 13.Domínguez-Millán R, Hoyos A, Cárdenas-Camarena L, Green AC, Cuenca-Pardo J, Gutiérrez Valle FA, et al. Non-embolic complications of gluteal fat transfer: A systematic review of the literature. Plast Reconstr Surg. 2026. doi:10.1097/PRS.0000000000013408. PubMed
- 14.Cansancao AL, Condé-Green A, David JA, Vidigal RA. Subcutaneous-Only Gluteal Fat Grafting: A Prospective Study of the Long-Term Results with Ultrasound Analysis. Plast Reconstr Surg. 2019;143(2):447-51. PubMed
- 15.Güzey S, Ergan Şahin A. Brazilian Butt Lift: What We Learned Over 7000 Patients? Aesthetic Plast Surg. 2026;50(14):5864-72. PubMed