The Ups and Downs of the Brazilian Butt Lift

Through the 1990s and early aughts, the most "desirable" booty de jour was taut and teeny. But trends change and evolve, especially those related to women's bodies. Thus, it wasn't long before this one did a complete 180-degree turn. By the time Kim Kardashian broke the internet with her cover for Paper magazine in 2014, "the big booty era," as Vogue magazine coined it, was here in full display.

Fitness influencers with cinched waists and pronounced bums took over Instagram. At the same time, celebs such as Nicki Minaj, Jennifer Lopez and the rest of the Kardashian clan were hailed as the epitome of femininity. Some people with big booties were undoubtedly fit from hardcore workout regimens. Others were genetically blessed. But more than a few had plastic surgeons to thank.

There are a few ways to enhance the butt's size, but one procedure is by far the most popular: the Brazilian butt lift, colloquially known as the BBL. The number of BBLs increased by more than 90 percent between 2015 and 2019, according to the American Society for Aesthetic Plastic Surgery. In 2021, surgeons performed more than 61,000 butt augmentation procedures in the United States.

"If in the '60s and '70s flat-chested and small-framed Twiggy was the pinup in every teenager's room, nowadays we see more shapelier and curvaceous models on the runways," said Olga Bachilo, M.D., a board-certified plastic surgeon who practices at Glamour Plastic Surgery and Med Spa in Bellaire, Texas.

"The wider acceptance of Latin American and African American actors, [some of whom]...have curvier bodies, has also triggered a heightened response," she continued. "Reality TV stars, like the Kardashians, that have promoted the trend are probably the biggest drivers of this fad. And when entertainment, fashion and beauty industries endorse it, it becomes a norm to the average person."

Despite its popularity, the BBL does have drawbacks, including potential life-threatening complications. Here's what to know about the rise—and fall—of the Brazilian butt lift.

What is a BBL?

As the name suggests, the Brazilian butt lift was born in Brazil, invented in 1960 by surgeon Ivo Pitanguy, who then trained doctors around the world to perform the procedure.

Traditionally, the surgery involves suctioning or "harvesting" fat from one or more areas of the body—think the tummy, legs or love handles—and transferring it into the butt. Ideally, this procedure creates an hourglass shape with a thin waist and a pronounced butt.

Today, though, there are variations on the procedure, some of which are nonsurgical and involve dermal fillers rather than fat transfers. These noninvasive techniques tend to be much safer and less expensive.

Why the BBL boom?

A bigger bottom came back into fashion in the mid-2000s, along with a general emphasis on body positivity and inclusiveness. But the procedure truly rose to fame after 2011, when an episode of "Keeping Up With the Kardashians" featured Kim proving with an X-ray that implants were not responsible for her world-famous bum. Within the next few years, thanks largely to Instagram, having a bigger butt became aspirational.

"With the ever-growing pervasiveness of social media, BBLs and all aesthetic surgical and nonsurgical procedures, for that matter, have become more accepted in the community at large," said Glenn Vallecillos, M.D., a board-certified plastic surgeon at Glenn Vallecillos Plastic Surgery in Beverly Hills, California. "As people become more willing to speak about their procedures through social media outlets publicly, the negative stigma of getting plastic surgery is slowly fading.

"The shift from the negative perception of plastic surgery to plastic surgery being acceptable and even desired has been additionally propelled by the willingness of celebrities, such as the Kardashians, to share their aesthetic treatment experiences online," Vallecillos continued. "Indeed, to many, getting plastic surgery in the United States carries a status symbol, much as it does in countries like South Korea and Colombia."

As the demand for Brazilian butt lifts increased, the average price decreased, making it more accessible and affordable. The cost in the United States went from an average of $5,507 in 2018 to $3,329 in 2020, according to the Aesthetic Plastic Surgery National Databank.

The BBL and other aesthetic procedures became more prevalent during the "COVID cosmetic boom." Experts say multiple factors contributed to this phenomenon, including people's inability to spend money on other luxuries, such as going out or traveling. Many people began working from home, making surgery recovery logistics more manageable. Some folks sought cosmetic enhancements to appeal to audiences on sites such as OnlyFans, with the goal of increasing revenue or replacing lost revenue.

The downsides of BBLs

All surgical procedures carry some risks, including infection, bleeding and complications from anesthesia. A 2017 study estimated the worldwide mortality rate from a BBL to be about 1 in 6,200, while other estimates average about 1 in 3,000, both far higher than other cosmetic procedures. Over the past five years, the risk has decreased with improved knowledge, techniques and regulations, but the risk still shouldn't be ignored.

"The added risk seen in BBLs is attributed to the process of transferring fat into the buttock region, which is a highly vascular area containing a lot of large blood vessels," Vallecillos explained. "If fat is unintentionally injected into the blood vessels and, notably, the veins, it may be carried through the veins, eventually ending up in the blood supply of the lungs, creating a fat embolus, which is often catastrophic, irreversible and fatal."

The risk of pulmonary embolism is greater if the surgeon injects fat directly into the buttock muscle because that's where most large blood vessels reside, he said. Some surgeons inject the fat there because it creates more pronounced results, but in his opinion, "these risks far outweigh the benefits."

Vallecillos said the American Society of Plastic Surgeons dissuades surgeons from performing high-risk injections and encourages them to inject fat just under the skin instead.

The complex procedure can be taxing for both doctor and patient, and requires advanced training and expertise. But as demand increased, the number of procedures naturally increased, potentially leading to more reports of complications. Celebrities such as Minaj and Cardi B have openly discussed receiving butt enhancements under unsafe circumstances. Many media influencers, too, have stepped forward to discuss their own adverse experiences.

Is the bubble bursting?

As with any trend, the BBL's social and financial value depreciated as it became more ubiquitous. Some experts are predicting the procedure's popularity may take a nosedive.

Requests for BBL reversals—which involve a combination of liposuction, fat graft removal and a sculpting filler—are on the rise. Even the Kardashians have reportedly ditched their trademark derrieres, with recent photos showing less exaggerated proportions.

However, that doesn't mean the Brazilian butt lift will disappear anytime soon. Less dramatic booty transformations, sometimes called "skinny BBLs" or "country club BBLs," which involve less augmentation in the hips and bum but with the same flat tummy, are growing in popularity.

Nearly all trends fade with time, and mainstream fashion is now fully entrenched in the 1990s and Y2K nostalgia. But the BBL's fall from favor may not be wholly benign. People with privilege can slip from one trend to another without consequence. Changing beauty standards—especially those concerning body type—have historically disproportionately affected people of color.

The takeaway

The popularity of the Brazilian butt lift is a hallmark example of how social media can alter and define perceptions of beauty and body image, Vallecillos explained. Over time, after seeing thousands of pronounced BBLs or other enhancements, people start striving to get the procedure.

"This ultimately creates a disservice not only to the patient but to the perception of the aesthetic plastic surgery specialty," he added.

Regardless of coming trends, experts say it's important for people to consider their health and best interests above all else. If aesthetic procedures are on the table, vet your surgeon carefully and choose a board-certified professional experienced in the procedures you desire.

"Make sure you're comfortable with your surgeon and feel good about your decision," Bachilo said. "Do not do it because you are going through a rough patch in your life and you think it will make you feel better. Most importantly, have realistic expectations. Surgeons are not magicians, and 99.9 percent of the photos you see on social media have been touched up and manipulated."