Why We Don’t Do BBLs

As a plastic surgery practice, many patients have asked why we don’t offer the Brazilian Butt Lift (BBL). After all, it is one of the most popular surgical procedures discussed across social media and popular culture.

The simple answer: the traditional BBL — as it has come to be known over the years — doesn’t adhere to our safety standards. It is an unpredictable procedure, and the most exaggerated outcomes often require unnecessary risk.

What Is A BBL – & What It Has Become to Mean Over Time

In the most basic terms, the BBL is a surgical procedure that involves a trained surgeon performing liposuction to collect existing fat from one area of the body (often the stomach, back, thighs and/or hips) and then placing it into the buttocks in an effort to improve shape, projection and all-around appearance.

This exchange is often seen as desirable because it can, in theory, remove fat from a problematic area and place it in a new area. It feels like a win-win situation for many patients.

However, over the years, the BBL has become less about conservative fat grafting and more synonymous with exaggerated proportions and unrealistic body ideals.

The Greatest Risks of BBL Surgery

There is an inherent risk in any surgery, but it is drastically increased with traditional BBLs — especially when it comes to pulmonary embolism. The American Society of Plastic Surgeons issued a public statement in 2018 warning against the “alarming” rise in deaths and complications as a result of BBL surgeries.

“The fat that’s being grafted gets into the venous system around the buttock muscles. That fat can travel to the heart — & it kills people instantly.”

-Dr. Michelle Sieffert

At the time of the 2018 announcement, the death rate for the procedure was about 1 in every 3,000, a substantially higher rate than any other elective aesthetic surgery.

To Be Clear: Fat Grafting Can Be Safe

But only when performed by a board-certified plastic surgeon trained in this technique. Fat injections must be mainly limited to the subcutaneous area right underneath the skin. Without this level of precision and expertise, deep intramuscular migration can occur, significantly increasing the risk of pulmonary embolism.

The real problem is the modern pursuit of surgical extremes, most often an exaggerated, unnatural level of projection and volume in the buttocks and hips. Surgeons chasing exaggerated volume or projection may inject at high pressure or near dangerous anatomical zones and submuscular space.

That’s where risks compound.

“There are not veins in the subcutaneous layer. The veins are deep into the muscle. It’s very hard, when you’re operating with a cannula under the skin, to know exactly where the cannula lies — whether it’s in the subcutaneous fat or it’s deeper within the muscle.”

-Dr. Michelle Sieffert

“You will never see a case where 100% of a fat graft survives. Some surgeons over-graft to try & compensate for reabsorption, which can lead to oil cysts or fat necrosis because there is too much fat in a place where there’s no blood supply to sustain it. When the fat dies, the immune system tries to break it down & take it away, which can calcify it, turning it into nodules”

-Dr. Michelle Sieffert

The S Curve: Dr. Sieffert’s Safer, More Sculpted Alternative

What we offer instead is a more measured, artful technique — one that reflects the natural curves of the body rather than exaggerating them. Sometimes referred to as the “S Curve,” this method of contouring the waist, flanks and hip dips through strategic, low-volume fat grafting was popularized by Dr. Ashkan Ghavami in Beverly Hills.

Dr. Sieffert has adopted and refined this approach to align with her own aesthetic principles and surgical philosophy. She uses the technique as a way to subtly enhance existing curves, not to artificially alter the body’s proportions.

“The ideal candidate for the S Curve method is someone who’s already at their goal weight & has a stubborn fat deposit. We’re not trying to drastically change anatomy, just fill in areas where it’s hard to build muscle.”

-Dr. Michelle Sieffert

Another More Predictable Approach: Multiple Rounds of Low-Volume Fat Grafting

Rather than over-grafting and risking complications, some surgeons take a more conservative, safety-minded approach. This method involves grafting only as much fat as the tissue can reasonably support, understanding that a portion will naturally be lost and planning for additional rounds if necessary.

While it can be used in the context of a buttock enhancement, this technique is especially valuable in areas like the face and breasts, where over-filling can lead to aesthetic imbalances or post-operation complications. These areas are more prone to rejecting excess fat because they have thinner tissue and more limited blood supply.

Body Goals vs. Anatomical Realities

The rise of the BBL shifted expectations for what body contouring could achieve. And not always in a healthy way. Many women began to believe that any body could be reshaped into the “snatched waist, big booty” silhouette.

But the reality is: your bone structure, fat distribution and muscular anatomy all influence your shape. Those things aren’t easily changed, no matter how much liposuction is involved.

“I can’t make hip bones wider. Yes, surgery can make your rib cage smaller, but I’m personally not going do that. I’m a plastic surgeon, but I would love to see the focus shift to solidifying fitness in patients’ lives. Lifting weights. Zone 2 cardio. Looking ahead to build a stable base of athleticism.” 

-Dr. Michelle Sieffert

We Prioritize Your Confidence – & Your Safety

At Donaldson Plastic Surgery, we refrain from performing surgeries that require unnecessary risk or chase fleeting trends. Our focus is helping you feel more confident in your natural body, with methods that honor your anatomy and preserve your long-term wellbeing. While we do perform fat grafting to enhance shape, we avoid the extreme volume and exaggerated results often associated with the traditional BBL.

Your Health Deserves Care That Extends Far Beyond the Procedure

Patient safety, natural results and post-op support are our highest priorities. We often begin by connecting patients with our functional medicine team to ensure they are in optimal health before surgery. From there, we guide every step of the recovery process with 24/7 access to our team.

That level of post-operative access is vital and should be the expectation for any patient seeking any plastic surgery procedure.