In April, we reported on the dangers of Brazil buttock lifts (BBLs) and what makes South Florida a hotspot for BBL-related deaths. In this report, we track what’s happened since plastic surgeons began raising concerns about the procedure’s safety and the Florida medical board stepped in.
After a series of deaths linked to buttock fat grafting procedures — known as BBLs — in Miami, plastic surgeons, physician groups and the Florida medical board have struggled with how to make the procedure safer. Now, Florida has one codifying law standards of care for the risky procedure, where fat is suctioned from the patient’s midsection and re-injected into the upper buttock.
“Our community feels very strongly about this,” said Pat Pazmiño, MD, plastic surgeon and owner of Miami Aesthetic. MedPage Today. Pazmino wrote a paper showing that BBL deaths were concentrated in South Florida and is director of the Florida Society of Plastic Surgeons, which helped propose elements of the bill. “The last thing we want is plastic surgery to blacken the eye and more importantly, [we want] for the protection of all patients undergoing these operations.”
In recent years, patients undergoing BBLs have died of pulmonary fat embolism (PFE) — where particles of fat enter a blood vessel and block it — at alarmingly high rates.
Concerned surgeons and other experts found that these PFEs mostly occurred when a surgeon deposited fat in the deeper gluteal muscle instead of subcutaneous fat on its surface, injuring blood vessels or injecting directly into them. The procedure is often performed “blind,” meaning the surgeon can’t see exactly where under the skin the tip of his cannula ends.
Florida Board of Medicine approved two emergency rules in 2019 and 2022. Both were temporary measures, requiring injection only into the subcutaneous fat layer, the use of ultrasound guidance, and a limit of three buttock fat grafting procedures per day. The Board had planned to implement permanent rules, but he did not adopt them the bill, HB 1471, was just passed unanimously.
In a first for plastic surgery, Pazmiño said, the bill mandates certain precautions when performing buttock fat grafting. It came into effect on July 1. New clinics must be inspected by the health department before being registered. Surgeons must meet patients in person at least one day before the scheduled surgery and cannot perform BBLs on more than one patient at a time. Doctors must also use ultrasound to guide their cannula during fat grafting and cannot delegate fat extraction or grafting to other staff.
A state law simply packs more punch than a medical board rule, Pazmiño said. “I think it makes everyone aware that it’s not OK … if you’re a receptionist and the surgeon gives you the cannula. Now, you know very well that you’re both breaking the law.”
The new law targets practices favored by clinics that one surgeon refers to as “shops.” These operations, many of which were clustered on a stretch of a main road in Miami, benefited from speed and volume, scheduling many procedures per day and charging far less than average.
Mark Mofid, MD, who has his own plastic and reconstructive surgery practice in San Diego, wrote one of the first quantification studies BBL mortality rates. He said MedPage Today once spoke to a colleague who worked at such a clinic, who told Mofid that he was doing 10 to 12 BBLs a day, for about $3,000 to $3,500 each (the average cost for a BBL in 2020 was $4,807).
“There’s only a certain number of hours in the day where you can do the procedure. So realistically, [the new law] it probably limits surgeons to some extent,” Mofid said.
According to medical board disciplinary hearings and other reports, doctors at these clinics may not meet a patient until the day of the procedure and had uncertified assistants or staff perform liposuction or other parts of the procedure without supervision, maximizing the number of procedures performed moved between rooms.
Now, patients and doctors can develop the kind of relationship that Pazmiño said is critical to patient safety. “Surgery is not the 2 hours you spend in the operating room,” he said. “It’s all about creating a relationship and a bond between the surgeon and the patient beforehand. Then, once that’s established, the surgeon understands what the goals are for performing the surgery and more importantly, caring for the patient subsequently.”
But while the legislation is an important step forward, Mofid said, it may just push the problem elsewhere.
“It certainly makes things safer in Florida, but it’s not a national law,” Moffidt said MedPage Today. “I think it’s likely that now that Florida is becoming a more heavily regulated state, people will just take business elsewhere.”
Nowhere else in the US, however, were there as many complications or deaths. “South Florida, until now, has been the most dangerous place to get a BBL,” Pazmiño said. “And hopefully by passing this law that educates surgeons and patients, we will now have raised the standard of care and hopefully be one of the safest places to have surgery.”
