Mirror, mirror on the wall, who's the thiccest of them all? Brazilian butt lifts are the new beauty craze – even though they are as popular as they are deadly. But(t) why?
„Damn, she thicc!” Phrases like this can be heard every day in times when Kim Kardashian and co. dominate social media. And what influencers exemplify will eventually reach society at large. The dream of the perfect Instagram body is expensive: thick lips, big breasts, thin waists and big butts. Of course, these body shapes are often unattainable and that is when the beauty doc steps in. However, one beauty procedure is more dangerous than many others: the Brazilian butt lift (BBL).
Misleadingly, the Brazilian butt lift is neither Brazilian nor is it a butt lift. It is an autologous fat transplant from other areas of the body – such as the abdomen, back or arms – to the buttocks and hips. In and of itself, the procedure is not particularly dangerous. But when large amounts of fat are transported – which is often the case with today's procedures – the situation is quite different. “Fat embolism is a recognized risk associated with fat injections, particularly as used in gluteal augmentation,” researchers wrote in a recent review on deaths of US patients who underwent cosmetic treatment abroad.
The review, which appeared in the Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report, shows how dangerous cosmetic procedures abroad can be. Many cosmetic surgeries are very expensive, a factor that is often not relevant abroad. Cosmetic tourism is therefore growing in popularity: “The Dominican Republic is popular for medical tourism because it is close to the United States, has an existing tourism infrastructure, and some doctors from the Dominican Republic advertise in the United States,” the authors of the study state. Patients often undergo several operations far away from home in a very short period of time and then travel home freshly operated on. Post-operative complications then have to be treated in their home country, often without the doctors or patients themselves knowing exactly what was done.
Researchers therefore looked at how many deaths there were between 2009–2022 among US citizens who underwent cosmetic surgery in the Dominican Republic – and found a significant increase in recent years. While there was a median of 4.1 deaths per year between 2009–2018, there were already 13.0 cases in 2019–2022 with a peak of 17 cases in 2020. A total of 93 deaths related to cosmetic surgeries were reported in the years between 2009–2022. All but one patient was female with an average age of 40.
The review examined the 29 deaths from 2019-2022 in more detail. Medical data was available for 24 of these cases. All 24 deaths were women, 92 % of whom had comorbid conditions with increased risk for venous thromboembolism. 96 % of the women were overweight, two suffered from diabetes. Autopsy reports are available for 20 cases. All deaths confirmed by autopsy could be attributed to intra- and postoperative complications. “Most deaths were the result of embolism – fat embolism (55 %) or venous thromboembolism (35 %) – for which a high proportion of patients who died had risk factors, including obesity and multiple procedures during the same operation,” the study authors said.
“Among deaths due to fat emboli, all patients had undergone liposuction and gluteal fat transfer.” All deaths confirmed by autopsy had therefore undergone BBL – although some patients had also undergone other operations. But why is autologous fat transplantation in particular so deadly, even though it involves the body's own substances?
As the volume of transported fat increases, the subcutaneous recipient site can become overwhelmed. For this reason, surgeons began to transplant the fat deeper and deeper into the gluteal muscles, which are well supplied with blood – and this can lead to fatal complications. “Intramuscular gluteal lipoinjection is associated with mortality caused by gluteal blood vessel damage allowing macroscopic and microscopic fat embolism; therefore, buttocks lipoinjection should be performed very carefully, avoiding injections into deep muscle planes,” reads another study on the mortality of BBLs.
Many patients try to save money by having supposedly inexpensive cosmetic procedures carried out in other countries where prices are low and waiting times are short. However, some beauty tourists pay a much higher price for their beauty trip. The complications and dangers of cosmetic surgery should not be underestimated. Procedures such as a BBL are not a simple beauty correction that you can just have done on vacation. It is an invasive surgical procedure that involves exactly the same risks as conventional surgery.
Image source: Alex Shuper, Unsplash
