Let's Address the Elephant in the Room
The BBL had the highest mortality rate of any cosmetic procedure. That's a fact. Headlines about deaths—particularly in Florida and overseas—have made many women question whether this procedure is worth the risk. Here's what you need to know to make an informed decision.
The Brazilian Butt Lift has a complicated history. Between 2011-2017, it had a mortality rate of approximately 1 in 3,000—making it the deadliest cosmetic procedure in the world. That number sent shockwaves through the plastic surgery community and led to major protocol changes.
Today, the data tells a different story. When performed correctly by qualified surgeons following updated guidelines, the BBL is statistically safer than a tummy tuck. Here's what changed—and how to ensure you're getting a safe procedure.
What This Guide Covers
What Caused the Deaths
Understanding what went wrong is essential to understanding why the procedure is safer today. The primary cause of BBL deaths was fat embolism—fat entering the bloodstream through gluteal blood vessels and traveling to the lungs or heart.
The Mechanism
Large gluteal veins run through the muscle layer of the buttocks. When surgeons injected fat into or below the muscle (intramuscular injection), they risked puncturing these vessels. Fat would then enter the bloodstream, travel to the lungs, and cause a pulmonary fat embolism—often fatal.
The danger wasn't the procedure itself—it was where the fat was being placed.
❌ Dangerous (Old) Technique
- • Fat injected into muscle
- • Fat injected below muscle
- • Downward angle toward vessels
- • No awareness of cannula depth
- • No imaging guidance
✓ Safe (Current) Technique
- • Fat ONLY in subcutaneous layer
- • Large, inflexible cannulas
- • 3D awareness of cannula position
- • Ultrasound guidance available
- • Strict depth protocols
Current Mortality Data
The numbers have changed dramatically since the industry adopted new safety protocols:
| Time Period / Location | Mortality Rate |
|---|---|
| Global (pre-2017) | 1 in 3,000 |
| USA (post-2019 guidelines) | 1 in 14,921 – 1 in 20,117 |
| Properly performed BBL (2024) | Safer than tummy tuck (1 in 13,147) |
Key Study: Colombian Medical Tourism
A 2025 peer-reviewed study of 2,324 international patients at Premium Care Plastic Surgery (Medellín) found a 6.2% overall complication rate and 98.2% satisfaction rate. All surgeries were performed in accredited hospitals with full monitoring—comparable to U.S. benchmarks.
Safety Protocols That Changed Everything
In response to the mortality data, major plastic surgery organizations released updated guidelines in 2018-2019. Here's what qualified surgeons now follow:
Subcutaneous-Only Injection
Fat is injected ONLY into the subcutaneous layer (fat layer under the skin)—never into or below the muscle. This is the single most important safety change.
Large, Inflexible Cannulas
Surgeons use larger-diameter cannulas that are easier to control and track. This provides maximum awareness of where the tip is located at all times.
Angle Awareness
Surgeons avoid injecting at downward angles that could penetrate toward the gluteal vessels. 3D awareness of cannula tip location is maintained throughout.
Ultrasound Guidance
Increasingly recommended: real-time ultrasound visualization of cannula depth. Not universally used yet, but a growing standard among top surgeons.
Volume Limits
Reasonable limits on the amount of fat transferred in a single session. Responsible surgeons don't promise extreme results that would require dangerous volumes.
Colombian Surgeon Awareness
A 2019 survey found that 94% of Colombian surgeons were aware of the updated safety recommendations, and 86% now only graft fat in the subcutaneous plane. The adoption rate is high—but verification still matters.
Questions to Ask Your Surgeon
These aren't optional. Ask every one of these questions and pay attention to how your surgeon responds:
"Do you inject fat only in the subcutaneous layer?"
The only acceptable answer is an emphatic yes. If they can't clearly explain their technique, walk away.
"Do you use ultrasound guidance?"
Not mandatory, but a sign of a surgeon who takes safety seriously. Ask what they do instead if they don't use it.
"How many BBLs do you perform per week?"
High volume can mean expertise—but watch for surgeons doing too many per day. Fatigue increases risk.
"What is your complication rate?"
Any surgeon who claims zero complications is lying or hasn't done enough procedures. Look for transparency.
"Are you SCCP-certified?"
SCCP (Colombian Society of Plastic Surgery) certification is non-negotiable. Verify on their website.
"What hospital/facility will you operate in?"
Should be JCI-accredited or ICONTEC-certified. Avoid "garage clinics" at all costs.
Red Flags to Walk Away From
If you encounter any of these warning signs, find another surgeon immediately:
Surgeon cannot explain injection depth technique
If they're vague about where fat goes, they're either hiding something or don't know what they're doing.
Operating room not in accredited facility
BBLs require proper emergency equipment and monitoring. Non-accredited clinics often lack these.
Price significantly below market ($2,000-2,500 range)
Proper BBL requires quality equipment, facility fees, and surgeon expertise. Rock-bottom prices mean corners are being cut.
Scheduling multiple complex procedures same day
High-volume "factory" surgery increases risk. Quality surgeons limit their daily caseload.
Promising extreme results
Massive buttock augmentation requires dangerous fat volumes. Realistic results are safer results.
Not listed in SCCP directory
If they're not SCCP-certified, they haven't completed proper plastic surgery residency training.
Setting Realistic Expectations
Even with perfect technique, BBL results have limitations:
- • 20-30% of transferred fat will be reabsorbed over 3-6 months
- • Final results stabilize at 4-6 months
- • You need enough body fat for liposuction (very thin patients may not be candidates)
- • Results depend on your body's individual healing response
- • You cannot sit directly on your buttocks for 6-8 weeks
The Bottom Line
The BBL is no longer the most dangerous cosmetic procedure—when performed correctly. The deaths that made headlines were caused by outdated techniques that are now considered malpractice. Today's safety protocols have made the procedure dramatically safer. Your job is verification: choose an SCCP-certified surgeon, operating in an accredited facility, who can clearly explain their subcutaneous-only technique. Do that verification, and the data supports that BBL is a safe procedure.