What Is BBL?
BBL (Brazilian Butt Lift) is a body-contouring procedure in which the patient's own fat tissue is used. Fat harvested by liposuction from the abdomen, waist, back or thighs is purified and injected into the buttocks in multiple layers.
In which cases is it preferred?
- To increase hip volume and projection
- Balancing body contours (hourglass silhouette)
- To aim at balancing the body's proportions
- To offer a natural alternative to implants
Who is BBL suitable for?
- People who want to increase buttock volume and projection by natural means
- People who want to balance the waist-to-hip ratio (hourglass silhouette)
- People with enough fat reserve for transfer
- People in suitable general health, who do not smoke and have realistic expectations
In very thin people the fat that can be harvested may be limited, so reaching the targeted volume may not always be possible; suitability is assessed during the examination.
How is safety ensured?
The basis of safety in BBL is delivering the fat to the correct anatomical layer — under the skin, without entering the muscle. In the modern safe technique the injection is done in a superficial plane, in a controlled way and, when needed, under ultrasound guidance. Therefore it is very important that the procedure is performed by an experienced surgeon in a properly equipped centre. Your suitability and safety assessment are determined by a detailed examination.
The surgical process
- Planning: the areas from which fat will be taken and the target volume are decided.
- Surgery: under general anaesthesia, liposuction + purification + layered injection are carried out in about 3–4 hours.
- Recovery: sitting directly on the buttocks is avoided for the first 8 weeks (a special BBL cushion); a compression garment is worn for 4–8 weeks.
Safety: what do the numbers say?
BBL is no longer as risky an operation as it once was. When the procedure was becoming widespread, the risk of fatal fat embolism was reported as 1 in 2,500, and that raised a legitimate concern. The safety review published by the British Association of Aesthetic Plastic Surgeons in the Aesthetic Surgery Journal in 2023 reports that the real risk was later estimated to be closer to 1 in 15,000 — a level comparable to abdominoplasty.
What brought about this improvement was clarity about the layer the fat is placed in: when fat is delivered only into the subcutaneous plane rather than into muscle, the risk falls markedly. The same review highlights the value of using ultrasound during surgery so that the surgeon can see that work is proceeding in the correct layer.
A study published in 2024 puts a number on this: in 1,815 patients in whom fat was transferred under ultrasound guidance and only into the subcutaneous plane, the complication rate was 4%; the commonest were seroma (1.2%) and local skin circulation problems (1.2%).
The practical conclusion is this: what determines safety in a BBL is not the name of the procedure but the layer the fat is placed in. So the question to ask is not "is BBL safe?" but "is the fat being placed into the muscle or under the skin?"
How much of the transferred fat stays?
Part of the transferred fat is absorbed by the body in the first months; the part that lasts consists of the cells that establish their own blood supply. That is why the volume immediately after surgery is not the final volume.
How much remains has been measured: in a study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery in 2024, three-dimensional imaging in 35 patients who received fat only in the subcutaneous plane found a retention rate of 77.9% at 3 months and 64.7% at 6 months. In a longer study of 50 patients, thickness at 12 months had decreased by an average of 18% compared with the measurement taken immediately after surgery.
Roughly put: there is some absorption in the first months, and most of what remains is permanent. The result settles over 3–6 months and from that point on is maintained according to weight stability.
Smoking and hookah upset this balance. Whether the transferred fat takes hold depends on those cells establishing a new blood supply; tobacco narrows the vessels and reduces the blood reaching the tissue. A meta-analysis of 53 studies on tobacco use in aesthetic surgery shows that post-operative complications increase significantly in tobacco users — surgical site infection, delayed wound healing and skin necrosis being the prominent ones.
To be honest: there is no measured answer in humans to the question of what percentage of the fat remains in a smoker. But the impairment of healing has been clearly shown; that is why stopping tobacco before and after surgery is asked for.
When weight is lost the transferred fat shrinks too — because those cells are now part of the body's own fat tissue. This is the most important difference between BBL and an implant.
What changes during recovery?
- Sitting restriction and the BBL cushion: in the first weeks you do not sit directly on the buttocks. When sitting is necessary, a special BBL cushion is used that shifts the weight from the buttocks to the back of the thighs. This restriction is not about comfort but about the transferred fat taking hold; your doctor decides how long and in what way.
- A special BBL garment: BBL has its own compression garment — it wraps the waist, abdomen and back from which the fat was taken while leaving the buttock area open, putting no pressure on it. An ordinary liposuction garment does not do this job.
- Movement: walking is recommended early on to reduce the risk of clots; strenuous exercise is postponed.
- Result timeline: the volume decreases in the first weeks and settles over 3–6 months.
BBL is no longer as risky an operation as it once was. As the procedure spread, the risk of fatal fat embolism was reported as 1 in 2,500; the real risk was later estimated to be closer to 1 in 15,000 — a level comparable to abdominoplasty. What brought about this improvement was placing the fat only in the subcutaneous plane rather than into muscle.
In the safe technique, no. The fat is placed only in the subcutaneous plane; injection into the muscle is avoided. Using ultrasound during surgery makes it possible to work while seeing that the fat stays in the correct layer.
In a study of 1,815 patients in whom fat was transferred under ultrasound guidance and only under the skin, the complication rate was 4%; the commonest were seroma (1.2%) and local skin circulation problems (1.2%).
Part is absorbed in the first months; the part that lasts consists of the cells that establish their own blood supply. Measured data show a retention rate of 77.9% at 3 months and 64.7% at 6 months in patients given fat only in the subcutaneous plane; in a longer study, thickness at 12 months had decreased by an average of 18% compared with the measurement taken immediately after surgery. So there is some absorption in the first months and most of what remains is permanent. The volume immediately after surgery is not the final volume; the result settles over 3–6 months.
Yes. The transferred fat cells are now part of the body's own fat tissue; when weight is lost they shrink too. This is the most important difference between BBL and an implant.
In the first weeks you do not sit directly on the buttocks. When sitting is necessary, a special BBL cushion is used that shifts the weight from the buttocks to the back of the thighs. Your doctor decides how long and in what way; this restriction is not about comfort but about the transferred fat taking hold.
In very slim people the amount of fat that can be harvested may be limited and the target volume may not be reachable. Suitability is assessed at the examination.
References
- Tillo O, Nassab R, Pacifico MD. The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review and Recommendations. Aesthet Surg J. 2023;43(6):675–682. PMID 36495200
- Vidal-Laureano N, Huerta CT, Perez EA, Earle SA. Augmented Safety Profile of Ultrasound-Guided Gluteal Fat Transfer: Retrospective Study With 1815 Patients. Aesthet Surg J. 2024;44(4):NP263–NP270. PMID 38124368
- Wang B, He P, Zhao R. B-ultrasound-assisted gluteal fat grafting in Asians: A prospective study of quantitative results from three-dimensional imaging and B-ultrasound analysis. J Plast Reconstr Aesthet Surg. 2024;94:12–19. PMID 38729047
- Cansancao AL, Condé-Green A, David JA, Vidigal RA. Subcutaneous-Only Gluteal Fat Grafting: A Prospective Study of the Long-Term Results with Ultrasound Analysis. Plast Reconstr Surg. 2019;143(2):447–451. PMID 30688886
- Theocharidis V, Katsaros I, Sgouromallis E, Serifis N, Boikou V, Tasigiorgos S, Kokosis G, Economopoulos KP. Current evidence on the role of smoking in plastic surgery elective procedures: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2018;71(5):624–636. PMID 29426809