You can exercise your way to bigger glutes—or for those wanting immediate or more dramatic results—there’s the option of a Brazilian butt lift (BBL). The aesthetic procedure continues to grow in popularity, despite the health risks. According to the American Society of Plastic Surgeons, more than 20,000 people had a BBL done by board-certified surgeons in 2017, rising steadily from the 8,500 people who did it in 2012.

A BBL uses a combination of liposuction and fat-grafting, resulting in added volume, defined curves, and a lift. There are serious concern about whether this surgery is safe at all after reports surfaced that the death rate following a BLL is a terrifying 1 in 3,000. We spoke with plastic surgeons Dr. Lara Devgan and Dr. David Shafer to walk us through all the controversy.

The Procedure

A BBL starts with liposuction, where a surgeon will suck fat out of areas in the body then process and re-inject it into the buttocks and hips. The areas of planned liposuction (Shafer says fat is usually taken from the abdomen or the lower back) and the outline of planned fat grafting are marked before surgery. Once the patient is positioned on the operating room table face-down and under anesthesia, the liposuction is performed in the desired areas and the fat is collected in a specialized system that separates live fat cells from liposuction fluid. That fat is then injected in the marked areas of the butt. Shafer says surgeons will sometimes graft fat into the thighs or hips, depending on what body shape the patient wants. The procedure requires a few very small incisions that sutured closed at the end.

How Much Do BBLs Cost?

Devgan says the cost of BBLs can vary depending on the provider performing the surgery and where you live, but it can range anywhere from $3,000 to $30,000.

Shafer says some patients just don’t have enough excess body fat for a BBL. “[Curvy patients] have fat available for harvesting through liposuction and enhancing their buttocks and thighs fits their body type,” he says. Devgan recommends patients be healthy adults within 15 pounds of their goal weight.

Before surgery, you’ll also need to have a medical clearance from your general practitioner. Shafer explains that doctors will make sure you’re healthy for surgery and screen for risk factors associated with surgical complications such as blood clotting disorders or any cardiovascular issues.

What Is BBL Recovery Like?

Shafer says recovery happens in three stages: first few days, first several weeks, and first several months. During the first few days, you can generally go back to work. During the first several weeks, most of the swelling reduces and the bruising starts to heal. This is when you can go back to the gym and are approved for travel. The last stage is where any remaining swelling will resolve and the transferred fat has pretty much settled.

Devgan says you’ll want to avoid pressure on areas where there is grafted fat. If you’re a back or side sleeper, this means you’ll need to sleep on your stomach and avoid strenuous exercise for several weeks.

Expectations also need to be managed: the results are only semi-permanent. Shafer and Devgan note that only up to 80 percent of the grafted fat survives, so many patients may need to revise some aspect of the surgery in the future.

“In most cases 70 to 80 percent of the grafted fat survives while some of it absorbs,” Shafer says. “The fat is living tissue and will change with weight fluctuations in the body so if you lose weight, the fat can shrink just like anywhere else on your body. Likewise, if you gain weight, the fat can expand just like anywhere else on your body when you gain weight.”

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