As the Brazilian butt lift (BBL) craze took hold in recent years, Miami became the go-to destination for the procedure, which tries to mirror the voluptuous backsides of Kim Kardashian or Nicki Minaj by taking fat from other parts of the body and injecting it into the buttocks. Low-cost, high-volume BBL clinics popped up across the region, coinciding with a spike in serious, sometimes deadly medical complications from the surgery.
A new Florida law is now aiming to make the operation safer and address the rise in Brazilian butt lift deaths.
HB 1471, which went into effect July 1, aims to prevent one of the most dreaded complications of the surgery: a fat embolism. The bill mandates the use of ultrasound machine guidance during the procedure to ensure fat is being inserted into the skin rather than the gluteal muscle, where the fat can enter the bloodstream, travel to the heart, lungs, or brain, and cause a fatal embolism.
The law also requires surgeons who perform Brazilian butt lifts to remain at the operating table during the procedure, prohibiting them from delegating critical surgical tasks to other medical staff.
Michael Salzhauer — a popular Bal Harbour-based plastic surgeon known as Dr. Miami on TikTok and other social media — tells New Times that Miami's aesthetics industry is dependent on Brazilian butt lifts, a billion-dollar business globally.
"If you go to Miami International Airport, you will see wheelchairs lined up heading to other parts of the country with people that are leaving Miami after having a BBL. You can notice them because they are all sitting on the same kind of pillow. Some of them don't want to sit down at all in the wheelchair. Some get on the plane and they're like sitting on their knees backward."
From 2011 to 2021, the number of Brazilian butt lifts performed nationwide rose from roughly 3,700 to more than 61,000, according to the Aesthetic Plastic Surgery National Databank.
To keep up with the demand for BBLs, which began their meteoric rise in popularity in the mid-2000s, a wave of new clinics opened around South Florida. Some clinics were completing massive volumes of BBLs to rake in the cash without proper experience, risking patient death on the operating table or during recovery.
As these clinics kept opening, Dr. Miami notes, they were bringing in surgeons from all over the country to run high-volume facilities at low-cost rates where some surgeries were bound to turn tragic.
"With the explosion of social media, people started finding out that this operation existed, and whenever a new procedure comes out, it takes a while for the actual surgeons to spread it among their trainees to fill the demand," Dr. Miami says. "Because of that, there's way more demand for the operation than there were surgeons to do it safely. Over the last ten years, there were many surgeons trying the operation without really understanding the anatomy and safety, and that's why it became a little dangerous."
Dr. Miami calls the BBL craze a "perfect storm" of increased demand, poorly trained surgeons, and a high volume of operations.
He calls it a "perfect storm" of increased demand, poorly trained surgeons, and a high volume of operations facilitated by South Florida's dense concentration of post-operation recovery houses.
While the BBL industry boomed, safety regulations lagged behind. In response to the increase in patient deaths from the procedure, the Florida Board of Medicine issued a 90-day emergency rule in 2019 dictating that fat can be injected only into the skin, not the muscle. The rule was made permanent the following year.
Still, patient deaths continued to occur and the Brazilian butt lift retained the label of "the deadliest of plastic surgeries." In 2022, the Board of Medicine issued another emergency rule, which mandated the use of an ultrasound machine when injecting fat and instituted a three-BBL limit per day per surgeon.
The new Florida law, HB 1471, reinforces the ultrasound requirement and mandates that doctors examine patients in person before performing Brazilian butt lifts. As a general regulation, the law also requires the Department of Health to inspect medical offices before allowing them to register to complete complicated surgeries.
A study from the Aesthetic Surgery Journal found there were 25 BBL-related deaths in South Florida from 2010 to 2022 and 92 percent of the operations were done at high-volume, low-cost clinics whose patients often find them on social media. Fourteen of those deaths occurred after the board instituted the 2019 rule, according to the study.
Although Dr. Miami says he is a fan of the new law, he wishes it went a step further.
He says he hopes to see a national organization or the medical board come out with a mandatory BBL training period in addition to guidelines for nurses when patients are at a recovery center. He suggests that a physician new to the surgery should have to perform a few dozen Brazilian butt lifts under the supervision of an experienced BBL doctor before they're allowed to do it on their own.
"Younger surgeons or any surgeons that are starting to operate and do BBLs need to be guided on how to do it safely, even using the ultrasound," the doctor says. "I don't think it would be terribly onerous to implement something like that, and I think it would go a long way towards making sure everyone is doing this operation safely."