Fixing a Brazilian Butt Lift (BBL) Gone Wrong

By: James Nachbar, MD, FACS


The video below shows popping and draining a fat transfer to the buttocks ("Brazilian Butt Lift", or "BBL") that another surgeon performed.

BBL Gone Wrong

Two large buttock bulges caused by fat transfer to the buttocks, sometimes called Brazilian Butt Lift or BBL

This patient had surgery by another surgeon who did what they called a “360 Lipo” along with what is called a “Brazilian Butt Lift,” or "BBL," which is fat transfer into the buttock area.  

Unfortunately, that was probably the wrong operation for this patient, who needed a real Butt Lift.  

After surgery, she was left with two bulges in her buttock area, so she had surgery to fix that by removing these bulges and converting her to a real Butt Lift by removing some of the skin and tissue above the buttock area.

In the video, the patient’s head is to the left, and the feet to the right.  We are working on the left buttock cheek.  I have made the lower incision for the butt lift – you can see the line to the left, toward the head, which marks the skin and fat I will ultimately remove to lift the butt cheek.  

When the pseudo-capsule (or "pocket") is opened, we can see it is filled with bloody fluid and fat globules.  Ultimately, I will remove this pseudo capsule, but that can be done more precisely if we get it emptied first.

While this patient shows an extreme problem, there are other problems with the BBL procedure, especially when it is carried out poorly.  

The most severe potential problem is death, which can occur on the operating table, and has been reported to occur in one out of 3,000 BBL procedures.  It appears that death occurs with BBL due to fat injection into the muscle of the butt.  While injection into the muscle lets the surgeon get better blood supply to keep more fat alive, the fat can get into the veins and go to the heart, which is not designed to pump fat, and the fat prevents the heart from pumping blood.  That is why it is essential that the fat injected with BBL be kept in the subcutaneous space.  

However, only injecting into the smaller subcutaneous space limits the amount of fat that can get blood supply from each procedure.  If more fat is injected than can be supported by the tissue, large chunks of the fat will die, which is called fat necrosis.  You will see photos online after BBL while the patient is still in the OR, but that is before the fat necrosis has set in.

Once these pseudo-capsules are drained, they will be removed, and the butt lift will be done by removing the skin and fat marked above the incision, to the left.

Pseudo-capsule just before rem

This is the pseudo-capsule, the scar tissue that formed around the large collection of fluid and fat globules. The pseudo-capsule has been almost com

Space in the buttock after rem

This shows the space where the pseudo-capsule had been in the left buttock cheek, after that scar tissue had been removed.

Fluid and pseudo-capusles afte

The fluid that had been recovered is shown, along with the empty pseudo-capsules, after Dr. Nachbar had removed them.

Skin and fat removed for the B

After the pseudo-capsules had been removed, Dr. Nachbar performed the Butt Lift by removing and tightening the tissue above the buttock, pulling it up

She just had her surgery, so she is still healing.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.