The $5,000 quest for the perfect
butt
How the Brazilian butt lift, one of the world’s most
dangerous plastic surgery procedures, went
mainstream.
Rebecca Jennings Aug 2, 2021, 8:30am EDT
The quest for the perfect peach can be costly in more ways than one.
Getty Imagesnone
When she woke up from surgery, Kayla Malveaux found herself alone in
the clinic recovery room, slumped over in a wheelchair. She felt sharp
pain around her face and swollen eyes, but she wasn’t sure why. The
operation she’d just had involved fat taken from her abdomen and
transplanted into her bottom, an increasingly common procedure called
the Brazilian butt lift. Though she can’t say for sure what really
happened between the time the surgery was over and the time she
woke up, she has a guess. “It’s like they threw me in the wheelchair and
then I must have hit my head,” she says.
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As the 22-year-old was wheeled out of the Miami cosmetic surgery
clinic, she understood. In the waiting room was “a herd of girls,” she
says, all waiting for their own procedures with a single surgeon. “I
couldn’t see how a doctor can do that many patients a day without
overworking themselves, you know?” she says.
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Kayla is one of thousands of women who’ve flown to South Florida — or
Turkey or Mexico or Thailand — for questionably cheap operations,
where a complex, multi-hour surgery not covered by health insurance
can run as low as $3,000, although most clinics advertise BBL
packages for around $5,500 (not including aftercare, which can double
the cost). These procedures often take place in small clinics, where
doctors who might have been trained as dermatologists or
pediatricians are legally allowed to advertise themselves as “board
certified” physicians even though the extent of their plastic surgery
training might have consisted of a single weekend course. To make up
for the high cost of running an operating room, they squeeze in as
many as eight patients every day.
You can see where the Brazilian butt lift — a physically taxing surgery
for the doctor as well as the patient — might start to get dangerous. But
this hasn’t stopped the thousands of women who’ve undergone it over
the past few years; the number of BBLs globally since 2015 has risen
77.6 percent, according to a survey by the International Society of
Aesthetic Plastic Surgery, and it is now the fastest-growing cosmetic
procedure in the world.
As Kayla arrived at the airport after her surgery, she was told the
terminal didn’t have any wheelchairs left. On her flight back to
California, she realized she was one of several BBL patients on the
plane.
You spend enough time on TikTok and Instagram, and it can start to feel
like you’re the only person in the world who hasn’t had their butt done.
The BBL silhouette is omnipresent and unmissable, an impossibly tiny
middle resting atop a plump bottom and thick thighs; at its most
extreme it presents a cartoonish version of a fertile woman, a cross
between the Venus of Willendorf and Jessica Rabbit. At its most subtle,
a BBL just looks like good genes, the kind of golden ratio associated
with the most iconic sex symbols of the last 100 years.
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The BBL aesthetic of the 2010s and the present day, however, is most
often associated with the Instagram influencer, whose body exists to be
consumed by the most people possible (whether or not it has been
photoshopped is almost beside the point). After Kim Kardashian, one of
the ur-examples of the modern influencer, proved with an X-ray that
she hadn’t had butt implants, the next logical question was, “Well,
how?” The answer, many have speculated, is that she and some of her
sisters had gotten Brazilian butt lifts, which wouldn’t have shown up on
an X-ray because the procedure involves the removal and retransplant
of one’s own fat.
The platforms that provided the foundation for the rise of influencers
are also the reason why the BBL has penetrated the mainstream.
Consider “Instagram face,” the button-nosed, cat-eyed, pouty-lipped
look popularized by professionally sexy models like Emily Ratajkowski
and Bella Hadid, that for the vast majority of the population is only
achievable through skillful makeup or, more often than not, a click of a
button. Apps like Facetune bring that same kind of one-touch wizardry
to bodies, which can be stretched, slimmed, and smoothed to infinity —
and can do it convincingly. The BBL, just like any of the fastest-growing
cosmetic surgery procedures, attempts to recreate the way we look
when our bodies are filtered through the internet.
Until the last decade or so, the BBL was not common practice in the
US. Its origins, as its name suggests, are in Brazil, where cosmetic
surgery has a storied background, largely due to the country’s history
of eugenics. In 1918, Dr. Renato Kehl founded the Eugenics Society of
São Paulo, which aimed to erase all signs of Black and Indigenous
physical appearance in Brazil. In 1960, a surgeon named Ivo Pitanguy
founded the world’s first plastic surgery training center in Brazil, where
he pioneered what became known as the Brazilian butt lift and taught
surgeons all over the globe how to perform his techniques.
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From there, the practice traveled north and exploded once pop culture
began to shed its preference for the “tits on a stick” silhouette and
started to revere stars like Jennifer Lopez and Nicki Minaj. As the
mainstream media began to incorporate the beauty standards that
have long been held by Black and Latinx cultures — e.g., that big butts
are hot — it continued to idealize the white women who conformed to
these standards and, furthermore, allowed them to profit over Black
and Latina women whose bodies the fashion establishment had
previously critiqued. The idea that certain body types can be
considered trendy at all, of course, has a history that has always been
laden with classism, racism, and sexism, and it’s easy to argue that the
media only began to celebrate big butts when it became financially
beneficial to do so.
South Florida quickly emerged as the plastic surgery capital of
America, in part because of its huge Latinx population and the fact that
Floridians can comfortably wear bikinis year round. By 1999, more than
one in 10 plastic surgery procedures performed by board-certified
plastic surgeons took place in Florida, and the history of malpractice
goes back just as far. Florida, just like every other state in the country,
allows medical doctors to practice and treat patients in any field, as
long as they obtain consent from the patient.
“You can set up your own clinic and you could be doing liposuction
tomorrow with no training in liposuction whatsoever, and it’s perfectly
legal,” explains Adam Rubinstein, a board-certified plastic surgeon in
Miami. Though these doctors wouldn’t be able to perform plastic
surgery in a hospital or legitimate surgery center, where regulations are
stricter and have far more oversight, there’s nothing stopping them
from opening a clinic of their own, and no higher board they must
answer to.
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The field of medicine largely relies on the industry policing itself, which
makes it difficult for legislators to address the issues. “We have the
expertise to do that, but we don’t have the legal authority,” explains
Arthur Perry, a plastic surgeon who spent 10 years on the New Jersey
State Board of Medical Examiners and who refuses to perform BBLs.
“So yeah, I could call myself a cardiac surgeon today, set up an
operating room, and do cardiac surgery in my office. You can sue me
for malpractice, but that’s a civil penalty as opposed to criminal.”
Helly Larson, a 26-year-old podcaster in Georgia, got her BBL in 2019
at a Miami clinic. Though she’d known plenty of women who’d had
BBLs through her work as a stripper, she was making enough money
with the body she already had. “Then literally, one day I just was like,
‘Okay, I’m doing it,’” she says. “I scheduled a consultation with a doctor
who had done a YouTuber that I was watching, they approved me and I
paid my deposit, all within a week.” She’d done further research on the
website RealSelf, which acts almost like a Yelp for cosmetic surgeons,
where former patients can post reviews and photos.
Like Kayla, she didn’t get the sense that something was off until she
was in the bed waiting to start the surgery. Four hours after she was
supposed to be anesthetized, she says the doctor came in and
complained about the lack of professionalism by the anesthesiologist.
“As I’m sitting in the gown, all of the red flags start to come through and
I was just like, ‘You’re gonna be okay, it’s gonna be okay,’” she says. “I
didn’t even know about the death rates.”
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The death rates for BBLs have been, historically, not good. One 2017
study placed the worldwide mortality rate at a whopping one in 3,000;
25 of those deaths occurred in the US in the five years prior. Thanks to
more widespread education and better safety techniques, that ratio is
widening: In 2019, one survey estimated the mortality risk at one in
14,921, and as of 2020 it is one in 20,117. That’s still higher than the
mortality rate from liposuction (1.3 in 50,000) or for outpatient surgery
(0.25-0.5 in 100,000). (All figures via the International Open Access
Journal of the American Society of Plastic Surgeons.)
BBL deaths have, for the most part, occurred because of improper
technique. The problem with inserting fat into the buttock is that your
butt contains a lot of very large blood vessels — “as big as drinking
straws,” one doctor put it — which, if accidentally injected with fat, can
result in that fat traveling to your lungs and cause a deadly pulmonary
embolism. That’s part of the reason why most reputable surgeons have
a limit to the amount of fat they’ll insert — there’s less likelihood of
dead fat, which creates lumps and lopsidedness. (In popular BBL
destinations like Turkey, doctors are willing to insert much more fat.)
These issues are compounded when doctors are pumping out clients
as fast as they can. At a single plastic surgery clinic, eight women died
over the course of six years, seven of them working-class Black and
Latina women who reportedly were targets of the clinic’s advertising
campaigns. In 2018, a patient died three days after getting a BBL at
New Life Cosmetic Surgery; the cause of death was determined to be
from liposuction and fat transfer procedure complications. “Miami is
the chop shop of plastic surgery,” Helly says. “I think the doctor had,
like, five BBLs the day I had mine.” In the lead-up to her surgery, the
clinic had been emailing and checking in regularly, but once it was over,
she says, “It’s crickets.”
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One aspect that many clinics don’t always fully explain is what happens
after you get a new butt. Many aren’t upfront about the fact that there
are limits to how much fat surgeons can remove and implant, and
therefore what a single BBL procedure can accomplish. For many
women to achieve their desired look, they must come back for two or
three procedures. What’s more, not all of the fat inserted into the butt
will stay alive — it’s a common complaint among BBL patients to fall in
love with their post-surgery butt, only to watch it shrink over the next
few months.
Aftercare guidance depends on the patient’s existing body type, but all
of them must wear a faja, a corset-like garment that keeps the body
shape in place, for about three months as the new fat learns to connect
with the existing fat. Sleeping must be done face-down for at least six
weeks, and sitting requires a special pillow. To help with circulation,
patients must schedule regular post-op massages, which are often
painful. Peeing, by the way, is its own hurdle. “I’ve seen people where
they’ll keep [the garment] on while they go to the bathroom, they’ll
literally just pee all over themselves and live like that,” Helly says.
Outside of the network of cheap clinics, Miami has also seen a spate of
surgery recovery centers that offer pickup and dropoff, massages, and
other post-op assistance, with names like Prima Dollhouse, Barbie Dolls
Recovery House, and Sassy Queen, though it’s also typical to rent an
Airbnb and use trusted loved ones as temporary nurses. Sites like
YouTube are filled with women’s experiences with their own postoperative care, some decent, some awful; vlogger Latausha Denn
chronicled her terrible recovery process in a video titled “THE WORST
EXPERIENCE OF MY LIFE.” For Helly, the first week was “absolute hell;”
she described walking around a coffee table like running a mile. Longterm effects are common as well; both Kayla, who got her procedure
last fall, and Helly, who got hers in 2019, still experience abdominal
numbness. Helly also has lingering circulation issues when sitting
down, back pain, and trouble sleeping.
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These aftereffects are rarely present in the many Instagram and TikTok
accounts run by doctors advertising their prowess in creating sculpted
hourglass figures. Some have built huge audiences with cheeky
sketches on how a BBL means freedom from the gym or how all their
patients are having hot girl summers. They field dozens of DMs a day
from women hoping to recreate the bodies they’ve seen online.
Edward Chamata, a doctor who works under popular TikToker Dr. Jung
at Premiere Surgical Arts in Houston, Texas, sees this as a boon to
prospective patients, who enter the consultation room with far more
knowledge about different procedures than they would have access to
otherwise. “Every kind of plastic surgeon is on Instagram, and it’s a
massive reach on those platforms,” he says. “It’s a big part of
empowering the patients and informing them on their care, so they
almost have a lot of education already at hand.”
Other doctors see it differently. Perry believes that “as doctors, we’re
not supposed to be salesmen.” On the rash of self-described BBL
experts, Perry quotes Willie Sutton, a famous robber from the 1950s
who was asked why he robbed banks and replied, “Because that’s
where the money is.”
“Why do these doctors do these procedures? Because that’s where the
money is,” Perry says. “But that doesn’t mean it’s right.”
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The best — and only, really — way a patient can make an educated
choice about where to get any kind of cosmetic surgery is to research
as much as they possibly can. Resources like certificationmatters.org
and the American Board of Plastic Surgery allow people to look up
doctors’ certifications in particular areas. Rubinstein also warns against
any surgery that sounds too good to be true: $5,000 isn’t enough to
cover the costs of running an operating room, he says, without cutting
some serious corners. “I’d say you probably shouldn’t pay much less
than $8,000 for a BBL in Miami,” he says. Often, he’ll operate on
women who’ve had a botched operation from a less educated doctor.
Ethical guidelines state that doctors should use rigorous screening
processes that weed out people who aren’t optimal patients for a BBL
— people who are severely under- or overweight, people with a history
of eating disorders or body dysmorphia, people who maybe haven’t
thought through the enormous decision they’re about to make. “I
always ask my patients to bring in wish pics, and many times, they’ll
bring in pics from Instagram,” says Chamata. “And a lot of times those
photos are photoshopped, with obviously unnatural proportions that
just aren’t achievable in the real world.” He says around 30 percent of
the patients he sees aren’t appropriate candidates.
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Yet looking “unnatural” has often been one of the goals for many
people who’ve undergone plastic surgery. “It’s an interesting
sociological phenomenon,” says Perry. “It started with breast implants
in the 1960s, where there were so many bad breast implants — too big,
too high — that women began to think that that was normal. I’ve
actually had people request me to put implants up a little high, so that
the bulge is visible under the collarbone. I try to explain to people, this
is not normal. It’s the same thing with brows.” (He mentions a certain
powerful politician as a particularly bad example of a brow lift done
wrong.) “My goal as a plastic surgeon is to help people look normal,
and sometimes we forget about that as plastic surgeons who are very
interested in just getting everyone and their sister operated on. My job
is not to do whatever you ask me to do. It’s to use my aesthetic and
ethical judgment, and do what’s right.”
Unsurprisingly, Perry believes the BBL boom will fade out, and perhaps
is already starting to. “The people coming in are no longer saying, ‘I
want it as big as possible.’ Now they’re saying, ‘I just want it to be
round,’” says Rubinstein.
That specific bodies can be “trendy” is, again, an ugly concept with an
uglier history. The BBL, however, has an even more complex one. As
Sophie Elmhirst put it in her thorough investigation on BBLs at the
Guardian:
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Following the chain of cultural appropriation that has led to this
point is bewildering. The notion of the idealised Brazilian bottom,
which some rich white Brazilian women disdain because of its
stereotypical associations with biracial women, has become the
desired shape among certain white women in the US and Europe,
who are in turn emulating a body shape artificially constructed and
popularised by an Armenian-American woman, who is often
accused of appropriating a Black aesthetic, which some Black
women then feel compelled to copy, not having the idealised body
shape they believe they’re supposed to have naturally. “You steal a
version of what a Black woman’s body should be, repackage it, sell it
to the masses, and then if I’m Black and I don’t look like that? That’s
a mindfuck,” summarised [Alisha] Gaines, [professor of English at
Florida State University].
The stereotype of the Instagram-faced, BBL-bodied influencer is now
almost bigger than a person’s physical appearance. On TikTok, where
advertisements for and real-life stories about BBLs proliferate, so too
does a meme known as “the BBL effect.” Twenty-three-year-old Antoni
Bumba came up with the idea for the character, which they call “Miss
BBL,” after idolizing a certain type of influencer who weaved seamlessly
between the ranks of Hollywood and Instagram baddies — Amber Rose,
Kylie Jenner, the Real Kyle Sisters.
“We have 20-something seasons of Keeping Up With the Kardashians,
where you see these girls taking 45, 60 seconds just to get out of the
car and into the restaurant because they have to serve every single
angle for the paparazzi,” says Antoni. Miss BBL is recognizable not with
the way she looks but in the little motions that let others know she’s a
bad bitch — taking ample time to flick her hair behind her shoulders,
eating slowly and carefully, and wearing a constant camera-ready
smize. “People who get work done essentially have no problem holding
up people’s time to be able to cater to their needs,” they explain. “And
it’s so fire because it gives all of these people, especially women, this
sort of edge, invoking confidence and self-sufficiency into their day-today lives.”
While Kayla and Helly ultimately ended up happy with their results, both
wish they’d done more research before going under the knife. “If I were
to do anything else again, it would probably be in California,” Kayla
says. “Most places in Miami, after they take your money, they don’t
really care.”
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Helly described how her body dysmorphia got worse after she had the
surgery; for about a year, she could barely look at herself in the mirror.
“I would say to anybody looking into getting procedures, you’re not just
going to magically be a brand new person that has this work ethic and
great motivation. You need to find that before you go in and change
your whole body.” she says. “If I had seen a girl on TikTok or YouTube
talking about the reality behind it, I don’t even know if I would have
gone through with it.”
It’s certainly possible that within a decade, the BBL will continue to fade
out, just as body types have risen and fallen in popularity throughout
history. “Think about the way that nobody has these huge watermelon
titties anymore,” Helly says. “Working in the dancer industry, I had a lot
of clubs that wouldn’t hire me because I had thick thighs and their
mindset was still stuck in the ’90s. All these women are going to start
getting their hips and butt reduced because it’s going to go out of
fashion.”
Whatever the next most desirable silhouette looks like, what will remain
is the cosmetic surgery industry’s willingness to follow aesthetic trends
at any cost, offering “pioneering” procedures that haven’t been
properly vetted, or doctors who’ve decided they could make more
money jumping from podiatry to plastic surgery. Until lawmakers catch
up with the reality of the field, over time the BBL could just be one of
any number of dangerous operations that promises to build the perfect
body.
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