Brazilian butt lift: Behind the world’s most dangerous cosmetic surgery

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Made famous by Kim Kardashian West, the Brazilian butt lift is, according to a recent survey by the International Society of Aesthetic Plastic Surgery, the fastest-growing cosmetic surgery in the world, writes Sophie Elmhirst in The Guardian. It is also the most dangerous.

The quest was simple: Melissa wanted the perfect bottom. In her mind, it resembled a plump, ripe peach, like the emoji. She was already halfway there. In 2018, she’d had a Brazilian butt lift, known as a BBL, a surgical procedure in which fat is removed from various parts of the body and then injected back into the buttocks.

On a recent afternoon, Melissa visited the British aesthetic surgeon Dr Lucy Glancey for a consultation. Glancey had performed Melissa’s first BBL. Like anyone inspecting their own body, Melissa could see things no one else could see. She wasn’t seeing just its current form in the mirror, but multiple versions: her former body, her desired body, her digital body.

Explaining why she got her first BBL, Melissa, who is white, said she “ felt attracted to black men and mixed-race men and they liked curvier women”.

The surgery, costing up to £8,000, also helps her earning potential. Melissa works in a gym but also makes money modelling clothes on Instagram. “When you’re looking at what gets the most likes, they’re always girls of this shape,” she said.

A decade ago, Glancey rarely performed BBLs. Now, she does two or three a week and receives about 30 inquiries. Since 2015, the number of butt lifts performed globally has grown by 77.6%, according to a recent survey by ISAPS. It is the fastest-growing cosmetic surgery in the world.

The popularity of the BBL, Glancey told me, is down to one woman: “Her impact,” she said of Kim Kardashian West, “really is her body.”

Dr Mark Mofid, a leading American BBL surgeon, also noted the influence of Jennifer Lopez and Nicki Minaj, alongside a glut of imagery on social media that “had really popularised the beauty of feminine curves”.

But achieving such beauty can be risky. In 2017, Mofid published a paper in the Aesthetic Surgery Journal which revealed that 3% of the 692 surgeons surveyed had experienced the death of a patient after performing the surgery. Overall, one in 3,000 BBLs resulted in death, making it the world’s most dangerous cosmetic procedure.

Melissa knew the risks. When she had her first BBL, in 2018, it happened to be the week of British woman Leah Cambridge’s death in Turkey, the most popular destination for UK patients seeking cheaper aesthetic surgery. That same year, the British Association of Aesthetic and Plastic Surgery recommended that British surgeons refrain from performing the surgery altogether. Not being a regulatory body, it couldn’t enforce a ban, though some surgeons voluntarily stopped.

While the fashion holds, the perfect bottom is a taut orb. Working in concert with the perfect breasts, the perfect bottom turns the body into the shape of an S. “It’s the classic hourglass figure,” said Melissa.

The perfect bottom is also an angle: 45 degrees from the base of the spine to the top of the buttocks. In that sense, the perfect bottom is really the result of having the perfect spine, the kind that naturally protrudes at its base. According to a paper by a group of evolutionary psychologists published in the journal Evolution and Human Behaviour in 2015, “lumbar curvature” apparently signified a woman’s ability to bear children, and so made her attractive as a mate.

There are options. In the 18th century, you’d have been yanked into a corset; a little later, a bustle. Now, you can buy padded knickers or create homemade inserts. You can have implants or inject filler. Or you can have a BBL, which fulfils two briefs in one mission, removing fat from places where you don’t want it and putting it where you do. The BBL, like Robin Hood, takes from the rich – the wobbly belly – and gives to the poor: the flat, bony bum.

The BBL began in Brazil, birthplace of aesthetic surgery and the myth of the naturally “sticky-outy” bottom, the kind seen in countless tourist board images of bikini-clad women on Copacabana beach. “In the global imagination, we think Brazilians are obsessed with butts,” said the anthropologist Alvaro Jarrin, author of The Biopolitics of Beauty, which examines the culture of cosmetic surgery in Brazil. In reality, needless to say, not every Brazilian woman has the idealised Brazilian bottom.

The surgery itself was pioneered by the Brazilian doctor Ivo Pitanguy. He performed a variety of procedures, and was rumoured to have prettified celebrities from Frank Sinatra to Sophia Loren while offering poorer patients subsidised treatment. Beauty, Pitanguy believed, was a human right, though he recognised that its pursuit could be a troubling process. “The most important thing is to have a good ego,” Pitanguy was often quoted as saying, “and then you don’t need an operation.”

In 1960, Pitanguy founded the world’s first plastic surgery academy, teaching his techniques to a new generation of surgeons. As surgeons learned the art of the BBL, the practice gradually travelled north.

Brazil remains the global centre of cosmetic surgery, in part because of Pitanguy’s legacy: free or low-cost cosmetic procedures are still available in the public health system. Not being a luxury commodity, the practice of cosmetic surgery saturates society at every level. Such accessibility has a darker side – Brazilian surgeons are “known worldwide for producing new techniques,” Jarrin told me, because “they have these low-income bodies to practise on”.

In the UK, by contrast, purely cosmetic surgery is only practised privately. Glancey’s clinic occupies a floor above an NHS GP surgery. There, are two very different sets of patients: those who pay and those who don’t. Glancey’s patients are making a consumer’s choice: they want something, and provided it’s possible and safe, she sells it to them.

Glancey needs to see what she’s dealing with before she even agrees to a consultation. She also requires vital statistics: age, weight, height, body mass index (BMI). “If it’s above 30 [which indicates clinical obesity], I don’t operate, I just tell them to lose weight,” she said, bluntly. “It’s liposuction, it’s not a cure for obesity.”

Aesthetic surgery has always been inseparable from the politics of race. Alisha Gaines, professor of English at Florida State University, and the author of Black for a Day: White Fantasies of Race and Empathy, traces the fetishisation of black women’s bottoms back to the toxic legacy of slavery and colonialism, and more specifically to the case of Saartjie Baartman, a South African woman brought to London in 1810 by a British doctor and exhibited around the country, as the “Hottentot Venus”.

In Brazil, meanwhile, the culture of cosmetic surgery emerged from the country’s history of eugenics. Dr Renato Kehl, who founded the Eugenics Society of São Paulo in 1918, expressed his support for surgery in his book The Cure of Ugliness. His aim was simple: to “perfect” Brazil’s population through “the extinction of the black and the rainforest-dwelling races”.

In its imitation of a perceived feature of blackness, rather than whiteness, the BBL might appear to go in the other direction. But the aspiration, suggested Gaines, is for a kind of cherrypicked, tokenistic black aesthetic, while retaining the societal privilege of being white. Glancey told me that around half of the inquiries she receives about BBLs are from black women.

Just before Melissa’s second appointment with Glancey, she told me she had a new plan for her surgery. As well as fat removed from her stomach, she also wanted Glancey to take fat from beneath her chin and her upper arms before inserting it into her bottom.

Glancey said she would remove the fat manually, with a syringe, and probably wouldn’t get more than 20 cubic cm. She reminded Melissa that she would have to wear a compression bandage beneath her chin, as well as a garment around her stomach and bottom, to aid healing. Recovering from a BBL is painful.

For the operation itself, scheduled for a few weeks’ time, Glancey would follow her usual process. First, she marks up the patient with a pen – black ink for where she’s removing fat, red for where it’s going back in. She does this with the patient and takes photos, so there’s no post-operative dispute about what was planned. Then the patient is anaesthetised, and a saline solution including local anaesthetic and adrenaline is pumped through their body to help shrink the blood vessels, control the bleeding, and to create a “wetting” effect so the fat can be removed more easily.

Glancey then makes another small incision and inserts a blunt cannula under the skin to “harvest” the fat. As the fat is sucked out, it travels down a tube to a canister where it is washed of blood and local anaesthetic. Once removed, the fat only survives for an hour or two. It’s still “alive” – fat is often described as an “endocrine organ” because of its ability to secrete hormones.

For the fat to stand the greatest chance of survival in the body, it has to be quickly inserted back into the buttocks, once again using a blunt cannula and aided by a foot-controlled pump. Here, the surgeon becomes a kind of combination of a blind sculptor and one of those musicians who can play multiple instruments simultaneously by strapping them to different parts of their body. While the foot controls the pace of the fat coming back up into the body, Glancey’s right hand guides the cannula, and her left hand – which she calls the “seeing hand” – strokes the surface of the skin to feel where the fat should be placed.

In a series of videos Glancey sent me of her performing the procedure, the sheer vigour required was striking. She pumped the cannula forwards and backwards repeatedly, like a particularly involved handheld vacuum cleaning session. An operation can last anywhere between three to six hours, and the thrusting motion is necessary for fat removal and insertion. By the end, Glancey is often exhausted. The patient’s body, meanwhile, like any anaesthetised body undergoing a serious operation, resembled a lifeless slab of flesh, which Glancey handled with that odd surgical balance of delicacy and force.

A patient has to wait weeks before they know what their bottom will ultimately look like. The fat takes time to settle, and Glancey has to remind her patients that at best, only about 50% of the fat “takes”. The rest is absorbed by the body and ejected through the lymphatic system. To optimise the amount of fat that survives in the body requires a surgeon’s skill. Glancey sticks to the UK guidelines and limits how much she will insert – 300cc per buttock. She tells her patients to complete the BBL over more than one operation, adding a little at a time.

In Turkey, the most popular destination for cosmetic surgery patients travelling abroad in Europe – and the third most popular in the world, after Thailand and Mexico – the limits are less conservative. Some surgeons openly advertise that they will insert more than 1,000cc into a patient’s buttocks. Glancey says that she regularly sees patients who have returned unhappy with the results, often because a significant quantity of fat has died and left them lopsided or misshapen.

The risk involved in performing a BBL is not only about the quantity of fat, but how it is inserted. During the operation, the danger occurs at a very precise moment: the insertion of the cannula into the buttock. As it goes under the skin, the cannula has to remain above the gluteal muscle. If it goes below, and fat enters the bloodstream, fat droplets can coalesce, travel through the blood and cause a pulmonary embolism.

One of the most popular Turkish clinics, which advertises its £3,000 BBL package heavily on Instagram, is called Comfort Zone. Comfort Zone offers everything – rhinoplasty, BBL, breast implants, contouring and the “mommy makeover”, a surgery that aims to correct the aesthetic ruin of reproduction. British-Turkish businessman Engin Yesilirmak suggested that women were drawn to Comfort Zone not just by their cheap BBL package but because of the freedom a Turkish surgeon enjoys. “The doctors are braver here than in Europe,” said Yesilirmak. “Here we will take four litres of fat.”

Its marketing mostly takes place through Instagram personalities. Occasionally they’ll throw in the odd gimmick. Recently, to celebrate reaching 100,000 Instagram followers, Comfort Zone invited its fans to leave a comment on a post and tag five friends. It would then select a winner and give them a free surgery of their choice. (“The irresponsible marketing, the glamorisation, the trivialisation, the incentivisation,” said Mary O’Brien, president of the British Association of Aesthetic Plastic Surgeons. “These are all things that our organisation is trying to highlight as areas of concern.”)

Beauty has always been a matter of cruel chance: you’re born that way. We all perform appearance-enhancing tricks that we’d haughtily never place in the same category as cosmetic surgery – teeth-straightening, eyebrow-threading, Spanx. Wrestling nature can be a life’s expensive work, and so perhaps the cheapening and therefore democratising of cosmetic surgery is a middle finger up to evolution. We can all be beautiful now, and reap the associated aesthetic and financial rewards.

After her second BBL, and all the benefits it would bring, Melissa liked to think she’d be content. But once you start having surgery, she told me, it can be hard to stop. She finds herself on surgery websites, browsing. “I’m in love with the ski-slope nose now,” she said. “Like, where did that come from?”

Melissa was mystified by her own desire, but it came to her the way desires usually do: you see something you like, and you want it for yourself. Surgery can change the way you see your body. No longer is it a gradually decaying biological event, but a project that can be constantly improved, like a kitchen. The problem is, what happens when you’ve built the perfect kitchen, which is blue, and then everyone decides that the perfect kitchen should actually be red?

In any case, no matter how much work you do to it, the body remains alive, organic, unpredictable. Even the Kardashian West bottom might not for ever look as it does today, swathed as it was recently in a dress printed with an image of Kardashian West’s own face (2.1m likes). However hard we try, no one can inhibit nature entirely. Gravity and time will have their way with an ageing BBL, as they do with everything else. Even the perfect bottom will sag; even the perfect body will die.

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