Brazilian butt lift (BBL): safety, complications and evidence-based practice (2023–2025)

How the evidence was selected: Criteria for the latest reviews

A targeted literature search was conducted using PubMed and PubMed Central to identify English-language publications between 2023 and 2025 addressing gluteal fat grafting safety, outcomes, and technique evolution. Inclusion criteria comprised systematic reviews, large cohort studies and clinical evaluations focusing on fat embolism prevention, ultrasound-guided injection, infection complications, or informed-consent processes. Narrative commentaries or small case reports were excluded. The final selection reflects methodologically robust evidence directly applicable to the safety and efficacy of BBL procedures.

Incidence and nature of complications in recent studies

Recent evidence shows that BBL is widely performed, but serious complications increase when safety standards are not respected. The most severe adverse event, pulmonary fat embolism, is consistently associated with intramuscular injection. Recent publications emphasize that complication severity is strongly technique-dependent, while preventable infection remains an important secondary driver of morbidity.

Anatomical and structural risk factors in BBL

The gluteal region contains a complex vascular network, most notably the superior and inferior gluteal veins which can act as entry points for fat emboli if injection depth extends below the subcutaneous layer. Evidence demonstrates that deep or intramuscular fat injection substantially increases embolism risk, while strictly subcutaneous delivery mitigates it. Key structural factors associated with elevated risk include:

• Deep cannula angulation during injection.
• Excessive pressure or large-volume boluses.
• Lack of visualization or tactile feedback of cannula tip.
• Absence of ultrasound confirmation of the plane.

These findings establish that plane control and cannula orientation are the most critical anatomical variables influencing BBL safety.

Technical and procedural advances improving safety

Recent evidence focuses on how image-guided plane verification and structured training reduce technical errors during fat transfer.

Ultrasound-guided fat grafting

Recent studies describe ultrasound guidance as the most transformative advance in BBL safety. Structured hands-on training models, such as simulation-based programs developed in leading centers, allow surgeons to visualize cannula trajectories and confirm subcutaneous placement in real time. Evidence shows that surgeons trained under ultrasound-guided protocols achieve higher accuracy in injection depth and report fewer intraoperative plane violations.

Combined procedural approaches

Clinical outcome analyses of combined procedures, such as ultrasonic liposuction with submuscular implants and ultrasound-verified fat grafting demonstrate low complication rates and stable long-term results. These findings suggest that multi-modal techniques, when performed under controlled, image-guided conditions, can maintain both safety and aesthetic predictability without increasing risk.

nfectious and post-operative complications

Beyond embolic events, infection represents another major category of risk in BBL surgery. Recent clinical studies document nontuberculous mycobacterial (NTM) infections following fat transfer, often linked to breaches in sterilization or re-use of contaminated instruments. 

Such infections can lead to prolonged recovery, scarring, and in rare cases, hospitalization. These reports consistently link infection risk to lapses in instrument processing, closed-system handling and operating-room asepsis.

Patient education and informed-consent quality

A 2025 systematic evaluation of how BBL is presented on social media platforms revealed that most online content highlights aesthetic outcomes while minimizing procedural risk. This distortion contributes to unrealistic expectations and incomplete informed consent. Experts emphasize that transparent communication, including discussion of potential complications, recovery time and the necessity of surgical expertise is fundamental to ethical practice and patient safety.

Key protective factors and safety determinants identified

Across the reviewed evidence, the following factors are most consistently linked to lower complication rates:

• Subcutaneous-only injection verified by ultrasound.
• Continuous cannula movement with low-pressure fat delivery.
• Strict aseptic technique and disposable instruments.
• Comprehensive surgeon training and adherence to safety guidelines.

Clinical implications: What the evidence means for practice

• Depth discipline is non-negotiable: Avoid deep-plane injection to reduce embolic risk.
• Image guidance: Reduces plane errors and improves reproducibility across surgeons.
• Sterility matters as much as technique: Infection can undo a technically perfect result.
• Quality consent: Reduces misinformation-driven expectations.

Current evidence reinforces that BBL safety depends on technique discipline, imaging guidance, and systemic prevention, not on patient selection alone.

Final conclusions about the safety of a BBL procedure

The 2023–2025 PubMed evidence clearly indicates that the Brazilian Butt Lift can be performed safely when modern standards are rigorously applied. The procedure’s historical risks, once among the highest in aesthetic surgery, are now demonstrably reducible through ultrasound-guided technique, strict aseptic practice, structured training, and transparent patient communication. In contemporary practice, BBL risk is no longer an inherent property of the procedure itself but a reflection of the surgeon’s adherence to evidence-based safety principles.

Bibliography: Recent PubMed-indexed articles considered

• Bies JJ. Brazilian Butt Lift Gone Wrong: A Case Series of Non-Tuberculous Mycobacterial Gluteal Infection After Brazilian Butt Lifts. Cureus. 2023. PMID: 38174196.
• Taritsa IC. Is the Public Adequately Informed about #BBL? A Content Analysis of Instagram Posts Regarding the Brazilian Butt Lift Procedure. Aesthetic Plast Surg. 2025. PMID: 40603774.
• Chacur R. Gluteal Augmentation: A Historical Perspective on Aesthetic Practice. Aesthet Surg J Open Forum. 2024. PMID: 39886297.
• Elsaftawy A. Enhancing Buttock Contours: A Safer Approach to Gluteal Augmentation with Ultrasonic Liposuction, Submuscular Implants, and Ultrasound-Guided Fat Grafting. J Clin Med. 2024. PMID: 38792398.
• Finkelstein ER. A Clinically Relevant Model for Hands-on Training in Ultrasound-Guided Gluteal Fat Grafting: The Miami Butt Model. Aesthet Surg J. 2025. PMID: 40337909.