2015: The Pattern Is Named
Surgeons in Mexico and Colombia reviewed deaths after fat injection into the buttocks. The common thread was fat injected into the muscle.³
The BBL Death Rate, Explained
The Brazilian butt lift was called the deadliest cosmetic operation. The reason was never the fat. It was where the fat went. Here are the real numbers, where they come from, and what changed once surgeons kept the fat under the skin.
Every figure on this page is sourced
In short
What Is the BBL Death Rate?
About 1 death in 3,448 operations in a 2017 survey of surgeons worldwide.¹ About 1 in 14,952 by 2019 among surgeons who placed the fat under the skin only.² The difference is where the fat goes. Fat injected into the buttock muscle can reach the lungs. Fat under the skin cannot.
The numbers
Three Numbers That Tell the Story
1 in 3,448
Deaths per Brazilian butt lift in the 2017 international surgeon survey that set off the alarm¹
1 in 14,952
Deaths per BBL by 2019 among surgeons who kept the fat under the skin²
4,150
BBLs in one 2023 series where ultrasound confirmed the fat stayed under the skin, every time⁶
The mechanism
Why a BBL Can Be Fatal
Fat is taken from the waist and placed in the buttocks. If it goes into or under the gluteal muscle, it can enter the large veins there and travel to the lungs. Doctors call that a pulmonary fat embolism. It is sudden, and it is often fatal.³ Fat placed under the skin cannot reach those veins. That is the whole story of BBL safety, in two sentences.
2015 to 2023
How the Death Rate Fell
2017: The Survey
An international survey of surgeons put the death rate at about 1 in 3,448 operations. A multi-society task force was formed.¹
2018: The Rule
The task force warned every surgeon: fat goes into the layer under the skin only, never into the muscle.⁴
2019 Onward: The Drop
Among surgeons following the rule, the rate fell to about 1 in 14,952.² A British review put the true risk nearer 1 in 15,000, similar to a tummy tuck.⁵ Ultrasound now lets a surgeon watch the fat stay under the skin.⁶
Risk factors
What Changes the Odds
| Raises the risk | Goals | |
|---|---|---|
| Where the fat goes | Into or under the muscle. | Under the skin only, as the task force requires.⁴ |
| Who operates | Staff finish the case while the surgeon moves rooms. | The surgeon you met, start to finish. |
| Anesthesia | General. Hours asleep. | Awake, under tumescent local anesthesia. |
| Volume | As much as possible in one day. | Only what one session can safely carry. |
| Cases per day | Fifteen to twenty. | What one surgeon can do well. |
| Facility | An office no one inspects. | AAAHC-accredited, surveyed on site. |
Goals’ own summary of the evidence cited on this page. No practice is named.
Florida, 2019 to 2023
Florida Wrote It Into Law
After ten verified deaths in 36 months, Florida turned the task-force rule into regulation, then statute.¹⁰
2019: Under the Skin Only
The Board of Medicine’s emergency rule, now Rule 64B8-9.009. Fat must never cross into the gluteal muscle.⁷ ⁸
2022: Ultrasound, and Three a Day
Ultrasound guidance while the fat goes in, the recording kept in the chart, and no more than three BBLs per surgeon in a day.⁹ ¹⁰
2023: The Surgeon, Present
Statute 458.328. The surgeon may not delegate fat removal or injection, and treats one patient at a time.¹¹
Why Goals Left Miami
Our statement on the market these rules were written for. Reporting has kept counting deaths since, most recently in October 2026.¹² ¹³
How we do it
The Awake BBL at Goals
Fat Under the Skin Only
Never into the muscle, at a volume one session can safely carry. It has been our rule from the start.⁴
Awake, Under Local Anesthesia
No general anesthetic. In a national survey of 15,336 awake tumescent cases there were no deaths and no lung emboli.¹⁴
One Surgeon, Start to Finish
The surgeon you met does the whole operation and sees you at follow-up.
Awake Brazilian Butt Lift
How the procedure works, who it suits, and what to expect.
FAQ
Questions About BBL Safety
It was called that after a 2017 survey found about 1 death in 3,448 operations. Among surgeons who keep the fat under the skin, the rate has fallen to roughly 1 in 15,000, close to a tummy tuck.
About 1 in 14,952 by 2019 among surgeons following the task-force rule, and a 2023 British review put it near 1 in 15,000. The risk is far higher when fat is injected into the muscle.
Fat embolism. Fat injected into or under the gluteal muscle enters large veins and travels to the lungs. Fat placed under the skin cannot do that.
Being awake removes the general anesthetic and its risks, and you walk out the same day. The fat placement rule matters just as much, and we follow both.
Ask the surgeon directly: under the skin only, or into the muscle? And how do they confirm it during the procedure? A good surgeon answers without hesitation.
Florida’s rules are far stricter than in 2019. The safest BBL anywhere has the same marks: one named surgeon, fat under the skin, a volume one session can carry, and an accredited room.
Yes. Awake, under tumescent local anesthesia, fat under the skin only, by the surgeon you met, in an AAAHC-accredited facility.
Related guides
Keep Reading
How to Verify a Plastic Surgeon
Four free checks in ten minutes, with the links.
Liposuction Rules by State
What seven states require, Florida for comparison, and every license lookup.
Why Goals Left Miami
Our statement on the market we walked away from.
Get started
Ask Us About the Awake BBL
Free consultation, no obligation. Ask where the fat goes, who operates, and what one session can safely carry. You will get straight answers.
Prefer to talk now? (833) 462-5769
References
Sources
The numbered references for the figures and rules cited on this page, checked October 17, 2026.
- Mofid MM, Teitelbaum S, Suissa D, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthet Surg J. 2017;37(7):796-806.
- Rios L, Gupta V. Improvement in Brazilian butt lift (BBL) safety with the current recommendations from ASERF, ASAPS, and ISAPS. Aesthet Surg J. 2020;40(8):864-870.
- Cárdenas-Camarena L, Bayter JE, Aguirre-Serrano H, Cuenca-Pardo J. Deaths caused by gluteal lipoinjection: what are we doing wrong? Plast Reconstr Surg. 2015;136(1):58-66.
- Multi-Society Task Force for Safety in Gluteal Fat Grafting. Urgent warning to surgeons performing fat grafting to the buttocks (July 2018).
- 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.
- Pazmiño P, Del Vecchio D. Static injection, migration, and equalization (SIME): a new paradigm for safe ultrasound-guided Brazilian butt lift. Aesthet Surg J. 2023;43(11):1295-1306.
- Florida Department of Health, Board of Medicine. Annual Regulatory Plan 2019: emergency rule 64B8ER19-1 on gluteal fat transfer, incorporated into Rule 64B8-9.009 effective September 3, 2019.
- Florida Administrative Code, Rule 64B8-9.009, Standard of Care for Office Surgery.
- Florida Administrative Code, Emergency Rule 64B8ER22-3, Standard of Care for Office Surgery (effective June 14, 2022).
- WUSF Public Media. Surgeons are challenging state restrictions on Brazilian butt lifts (June 22, 2022), reporting the Board of Medicine’s stated reasons for the 2022 emergency rule.
- Florida Statutes §458.328 (2023), Office surgeries, as amended by CS/CS/HB 1471, effective July 1, 2023.
- NBC 6 South Florida. Woman died of pulmonary fat embolism after plastic surgery in Miami: autopsy (2022).
- NBC6 Investigates (Viteri A, Fossi C). Family demands answers as NBC6 uncovers six patient deaths linked to Miami clinic. October 16, 2026.
- Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients: national survey results. Dermatol Surg. 1995;21(5):459-462.
This page is general patient education published by Goals Aesthetics & Plastic Surgery. It is not medical advice and does not replace a consultation with a licensed surgeon. Every operation carries risk, and results vary from person to person. Rates describe large groups of patients, not any one person’s risk. Figures come from the sources above as of the date shown.