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A new Florida law aims to make the procedure safer, but some experts think it needs to go further to curb the risk from this surgery.

A Brazilian Butt Lift involves a surgeon boosting the size and shape of the buttocks by injecting fat removed from somewhere else on the body via liposuction. The death rate from BBLs is the highest among any plastic surgery, mostly because some doctors inadvertently have injected fat graphs into the vessels in the gluteal muscle. That can cause a “fat emboli,” which is when particles of fat enter the bloodstream, travel to the heart or lungs, block circulation and can cause fatal results.

South Florida is the capital of high-volume, low-cost, strip-mall clinics that do BBLs. It also is the area of the state where most of the deaths from the surgery occurs.

Twenty-five women in South Florida have died from BBL complications and two nearly died between 2010 and 2022. All but one of the surgeries were done at high-volume, low-budget clinics, according to a study published in February in The Aesthetic Surgery Journal. The study found 2021 was the deadliest year for BBLs in South Florida.

Yet even reports of deaths haven’t cooled demand. Brazilian Butt Lift is the most Googled cosmetic surgery in Florida, with more than 20,000 searches a month. In 2021, there was a 37% yearly increase in BBLs performed in the U.S. or a total of 61,387 surgeries, according to The Aesthetic Plastic Surgery National Databank.

Florida lawmakers want to make BBLs safer.

A law effective July 1, 2023, requires Florida physicians to follow two new rules. First, they must conduct an in-person examination of the patient the day before the procedure. Second, they must use ultrasound guidance to clearly see that fat is injected only in the upper layers under the skin and never into the muscle.

Some plastic surgeons believe simply requiring professionals to use ultrasound guidance doesn’t go far enough.

“I don’t think an ultrasound done by a physician who does not specialize in it is enough to improve the safety factor significantly,” said Boca Raton plastic surgeon Gregory Albert of the Optimization Centre. “I also think the fat doesn’t need to be directly injected into the muscle for complications to happen. It could be the pressure of the fat injected near the vessel that creates the risk.”

Albert wants even stricter laws to improve the safety of the procedure.

“What is going on is too many cases done in too short a time by too many unqualified operators” he said. “Florida needs to limit the number of BBLs by the same surgeon in one day. To do those procedures quickly you need multiple assistants, and multiple assistants leads to multiple problems.”

Patients arrive at Albert’s Boca Raton office with misshapen arms or other body parts as a result of the liposuction some surgeons do to relocate fat to the buttocks. “Sometimes they take it from areas of the body the patient didn’t consent to take it from,” Albert said.

While the new Florida law is a start, he said, further research needs to be done on how the state can reduce the number of deaths and complications from this cosmetic procedure.

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