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29 Apr 2023
By Pamela Appea

NextImg:Why BBLs are one of the riskiest cosmetic surgeries

On Oct. 20, 2021, 26-year-old Jaynisha Williams, a mother of two, walked into a cosmetic surgery clinic called Best U Now in Plantation, Florida. Williams, who was known as "Jayla" among friends, had two procedures scheduled: a breast augmentation and a Brazilian butt lift, or BBL. One of many patients who went through plastic surgery at the Best U Now medical facility that day, Williams tragically died on the operating table, according to news reports. The Broward County's Office of the Medical Examiner in Florida later found "the BBL procedure was completed, but she (Williams) never awoke from the anesthesia."

Sources estimate as many as 25 BBL deaths occurred in south Florida between 2010 and 2022 alone.

Williams is not alone. There have been many other instances of fatal BBL surgeries in Florida in recent years, including in 2022 when Tanesha Walker, a 47-year-old Indiana grandmother of 11 passed away; or, in 2016, when Heather Meadows, 29, a West Virginia woman, and mom of two, died during her surgery. In fact, the increasingly popular BBL is statistically one of the most deadly elective plastic procedures. Various sources estimate as many as 25 BBL deaths occurred in south Florida between 2010 and 2022 alone — and this number represents only the recorded gluteal deaths among licensed medical professionals practicing in south Florida. 

The popularity of different cosmetic surgeries is a reflection of what kinds of bodies are "in" at any given cultural moment. In the 1990s and 2000s, it was breast augmentation; currently, the tastemakers in the beauty and fashion world have decreed that the fixation is on women's butts. Our cultural obsession with buttocks has resulted in an exponential rise in the number of cosmetic gluteal surgeries in the past two decades. According to the American Society of Plastic Surgeons, there were a mere 5,735 buttocks lifts and implant procedures performed in 2005; in 2021, 61,387 individuals went to a licensed medical professional for butt surgery (fat grafting and implants combined) — an increase of over 1000%. And 2021's numbers were a 37% increase on 2020's.

Brazilian butt lifts and other gluteal surgeries may be increasingly popular in the United States, but many American medical tourists seeking BBLs routinely travel to destinations like Mexico, the Dominican Republic, Turkey, Colombia, Brazil and elsewhere for affordable gluteal surgeries. The numbers cited by the American Society of Plastic Surgeons do not include these procedures abroad.

The rise in the popularity of the procedure is accompanied by a concomitant rise in deaths. An academic survey found as many as 1 in 3,000 of BBLs nationwide resulted in death, earning the surgery the title of the world's "most dangerous cosmetic procedure," according to researchers.

If the initial out-of-country surgery was botched, follow-up medical care, procedures and surgeries will typically not be covered by US health insurance companies.

Of course, the vast majority of BBLs don't end catastrophically. Yet the risk may be greater abroad. Alarmingly, there is not accurate compiled data on the number of deaths from botched BBLs performed on Americans abroad. There are, however, numerous news stories of people who died abroad while having the procedure, including a New York mom, an Indiana daycare owner, and the death in 2020 of Californian Joselyn Cano, an Instagram influencer

Dr. David Kahn, M.D. is a plastic and cosmetic surgeon in California, and a clinical associate professor of surgery and plastic & reconstructive surgery at Stanford University. Kahn warned of a host of medical safety, ethical and aftercare concerns for gluteal surgery outside of the United States. If the initial out-of-country surgery was botched, follow-up medical care, procedures and surgeries will typically not be covered by US health insurance companies, Kahn says. And when it comes to gel butt injections, another procedure that Kahn does not perform, many out-of-country medical tourists often have no idea what was injected in them.

The evolution of BBL surgery — and why BBLs are more deadly 

The procedure that is colloquially known as a BBL is technically called a "buttock augmentation with fat grafting" or a "safe subcutaneous buttock augmentation." The point of a BBL is to add volume and shape to one's butt; plastic surgeons warn that it won't affect sagging or excess skin. Surgically speaking, a BBL is basically fat grafting, in which fat is moved from one location to your body to your buttock area. 

Unlike other cosmetic procedures such as Botox, BBLs are not quick and easy, despite a host of online sources that falsely claim you can easily go back to work a day or two after a BBL. The majority of plastic surgeons state that BBL post-surgical recovery time can be four to six weeks or more.

In many BBLs, surgeons make two separate surgical incisions into the body— often the stomach and buttocks — to facilitate fat transfer. After surgery, it can be extremely challenging to comfortably do basic tasks for weeks, like sitting, going to the bathroom, exercising or showering. This is true even in the case of a "successful" BBL surgery.

Kahn has observed what he calls a "significant increase in buttock surgeries" in the past twenty years. Still, Kahn had high confidence in American plastic surgeons that were "licensed and board-certified."

"People think what they are paying for is a three-hour surgery. They are also paying for aftercare and professional knowledge," Kahn noted.

He notes that the conversation around BBL safety is multilayered. While Kahn concedes that surgical risk is never zero, licensed board certified plastic surgeons are rightly held to an incredibly high standard; thus, data for gluteal surgical deaths among licensed board-certified plastic surgeons performing gluteal surgeries in the United States is considerably lower than what has been reported in the media, he claims. 

"The buttock has gluteal veins that can be injured . . . [and] during the procedure, the fat that is meant to be injected to the soft tissue can be inadvertently taken into the veins," Kim said.

When it comes to BBLs surgeries and the rash of patient deaths over the past decade, Dr. John Kim, professor of surgery and of dermatology at Northwestern University Feinberg School of Medicine, said most licensed and board certified plastic surgeons have honed their surgical procedures over the years. Now, board certified licensed plastic surgeons make sure fat is injected subcutaneously, above the muscle, in order to avoid injury to the gluteal vein. The risk is fat clots that could travel up to the heart and lungs and become a deadly embolism.

Another important innovation, Kim said, is the use of a type of ultrasound imaging, called "intraoperative ultrasound technology," during gluteal surgeries. Such imaging is incredibly helpful for plastic surgeons to visualize what's happening internally during gluteal and other plastic surgery operations.

"The buttock has gluteal veins that can be injured . . . [and] during the procedure, the fat that is meant to be injected to the soft tissue can be inadvertently taken into the veins," Kim said. As a result, "you can get clots that can travel from your calves to other parts of your body. The fat can create problems with the heart and the lungs." This is what has historically caused higher fatality rates and catastrophic consequences, he said.

"We are advocating for all of our surgeon members to utilize ultrasound technology during surgery . . .  I use a handheld ultrasound device and I can visualize where I am injecting fat. I sleep better knowing that I use ultrasound technology," added Dr. C. Bob  Basu of Houston, Texas, who currently serves as the Board Vice President of the American Society of Plastic Surgeons. Basu, a board-certified licensed plastic surgeon, said he started using intraoperative ultrasound technology for gluteal operations in the last year and a half. 

Fly-by-night BBL surgeons

An area of shared concern among many within the plastic surgeon community, Kahn said, is when American medical professionals who are not plastic surgeons take a "weekend or short-term course" and start offering plastic surgery in their practice. Kahn said that in his opinion, an OB-GYN should not be doing a rhinoplasty, to give one example. Patients may not know that their plastic surgeons is only a part-timer — yet the demand for plastic surgery and procedures is so high that many don't necessarily do the research.

Indeed, there is evidence to support that Williams' doctor may have suffered from a lack of experience. (Kahn has no connection to the Jaynisha "Jayla" Williams case or any of the cases mentioned in this article.) Yahoo News reported that Dr. John Edward Nees, the designated physician at Best U Now where Williams was a patient, "claimed they allowed another inexperienced doctor (not named in that report) who was not a qualified anesthesia provider to sedate Jayla [Williams]." Meanwhile, the Florida Health Department filed an administrative complaint against the surgery center.

BBL regrets 

The story of Tiffany, a 23-year-old self-employed hair braider in New York, exemplifies the negative experiences of dissatisfied BBL surgery patients. Tiffany thought she was scheduled for a Brazilian butt lift and a tummy tuck with a licensed Bronx-based plastic surgeon last year in 2022. But on the day of the surgery, it was clear when she arrived that not only did Tiffany have a misunderstanding about the procedures happening that day, but surprisingly, was unsure whether she was even medically cleared to have both gluteal surgery, a tummy tuck and liposuction.

"I hated it when I got there [on the day of my surgery.] They weighed me and told me I was overweight and I was supposed to have lost weight before I came," Tiffany said. "I'm pretty sure I told them I was 200 pounds [on a previous visit.] but they had it down [that] I was supposed to be 164 pounds on the day of the surgery."

Tiffany told Salon she did not have any pre-surgical health issues, such as high blood pressure or preexisting conditions that would have made surgery a no-go.

"They only gave me lipo in my stomach and my love handles and transferred it to my butt. I had to choose between a BBL or a tummy tuck," she recalled.

Her surgery went well, she thought: "After I woke up, I felt little to no pain at all," Tiffany said. "At first I was happy about my results."

But later, Tiffany was unhappy with the aftermath. Near her surgery scars, she "started getting keloids." "I have a lot of back fat which makes it look like I didn't get the full results I needed," she says. "I would never go back there." 

Still, many repeat gluteal surgery patients like Tiffany ultimately elect to become medical tourists to save money. 

"I'm planning my second surgery out of the country, and I'm planning on getting [another] BBL and a tummy tuck as well," Tiffany said. She is in the process of saving up for surgery abroad. 

Social media's role in the BBL's popularity

The BBL "glow-up" is a popular video form for influencers on Tik-Tok, Instagram and Youtube; in it, users showcase their gluteal surgeries and procedures. It has its corollary in the "BBL regret" post. A celebrity example of "BBL regret" comes from model and reality star Blac Chyna. Chyna announced in 2023 announcement that she went through a series of butt reductions and other plastic surgery fixes. The previous procedures that Chyna most regretted were "butt injections" — a nebulously-defined procedure that is often performed by unlicensed operators on a medical black market. In some cases, butt injections have been deadly; in other cases, they can be disfiguring.

Rapper Cardi B has also been open about her risky butt injection procedures. In interviews, Cardi B says that before being famous she received her first illegal butt injections in her early 20s, for $800, from an unlicensed practitioner in New York, and subsequently went back for follow-up injections.

Cardi B has spoken openly about how serious medical complications were, and she states was extremely unwell in the days following these injections. Cardi B says she had virtually no aftercare following the procedure; she notes that the procedure was performed by an unlicensed woman who was not a medical professional. Later, reporters identified the unlicensed practitioner as Donna Francis, who was later indicted, arrested, extradited and arraigned for criminally negligent homicide after a television producer died from one of Francis' botched cosmetic procedures. Francis ended up serving a year in jail.

"Surgeons want to avoid having unhappy, dissatisfied patients, which they see as bad for future business." At the same time, their business "depends on granting patients' requests for procedures."

In a 2023 Instagram post, Cardi B spoke about "removing" 95% of her butt injections. (Silicone and other gluteal injectables cannot typically be fully removed.) Cardi B notes that while still supports an individual's right to plastic surgery, she is very candid about the importance of taking care of one's health, listening to one's plastic surgeon and avoiding "butt shots" at all costs.

Other reality stars, influencers, and celebrities have shared their tales of so-called BBL "reversals" and revision surgeries. Yet as is the case with all gluteal surgeries or procedures, you cannot truly "reverse" a BBL surgery, but you can revise it — or have additional procedures in order to get closer to one's desired look. Simply put, once you have a gluteal surgery (or two, three or more) you're never going to go back 100% to your pre-surgery self.

Is the bubble butt bubble bound to burst?

Alka Menon, Ph.D. is a Yale University assistant professor in sociology, and the author of a new University of California Press book "Refashioning Race: How Global Cosmetic Surgery Crafts New Beauty Standards." Her research focuses on the influence and role plastic surgeons have when it comes to certain procedures. 

"Generally, plastic surgeons do try to make sure they are on the same page with patients about the risks and benefits of procedures and the narrative of change possible with surgery. They fear lawsuits, and they emphasize the importance of 'educating' patients about procedures," Menon said. 

But Menon noted that it is "challenging"to fully explain how risky a procedure might be. "Surgeons want to avoid having unhappy, dissatisfied patients, which they see as bad for future business." At the same time, their business "depends on granting patients' requests for procedures," she noted. 

And medical jargon is not always easy to grok: "For patients, it is tough to fully absorb the list of potential complications and risks in medical lingo, especially the less frequent but more serious ones. Most people do not anticipate that the worst case scenario could happen to them," she notes.

Social media's role in popularizing certain practitioners — as well as BBLs themselves — cannot be understated. Many customers pick a plastic surgeon based on social media testimonies or online reviews. There are countless websites and support groups where patients can "rank" plastic surgeons and share their personal experiences. The internet has contributed to the rise of medical tourism including for gluteal procedures, said Menon, who has done extensive research on plastic surgeons and race and ethnicity in the United States, Malaysia and elsewhere. 

With viral trends like the "BBL regret" post, social media may eventually contribute to the decline of the BBL — perhaps. We won't know for sure until the data is in for 2022 and 2023. At the least, the confluence of stories about botched surgeries and even deaths may, hopefully, introduce more risk-awareness to those considering such surgeries.

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