Is BBL Still Risky? What Really Causes Complications and How We Prevent Them

About a decade ago, the Brazilian Butt Lift became one of the most requested procedures in plastic surgery, largely thanks to the Kardashian effect and the hourglass silhouette it put on every magazine cover. Then the headlines changed. Reports of complications, and in some tragic cases, started surfacing, many linked to patients traveling overseas to Mexico and elsewhere for the procedure. The popularity of BBL took a real hit.

I still get asked about this constantly: is BBL safe? And if a patient wants the results (the curves, the proportion, the natural augmentation only your own fat can give you), how do we get there without the risk that made the news? Here’s what actually causes BBL complications, and how the procedure has evolved to prevent them.

Why BBL Earned a Dangerous Reputation

BBL surgery has evolved tremendously over the last ten years, not just aesthetically, but technically. The concern that built up over that time came from a specific, well-documented cause: fat being injected into areas where it could enter the vascular system. When that happens, a fat globule can travel through the veins to the heart and lungs and cause a pulmonary embolism, which typically results in a fatality on the operating table.

These isolated cases understandably drew national media attention, and rightly so; they were and are life-threatening. In response, plastic surgeons across the country came together and formed a task force specifically focused on BBL safety, developing procedures and protocols that surgeons could follow to keep this from happening.

What Actually Causes a Fat Embolism During BBL

One of the biggest misconceptions patients have is that a blood clot or fat embolism only happens when fat is injected under the muscle, directly into a blood vessel. That’s not the case. All it takes is piercing the fascia (the connective tissue layer that sits above the muscle). Once that layer has been violated, fat injected over the following hours can actually creep down into the muscle fibers. Combined with the swelling and added volume, that migration causes small veins to rip, and the negative pressure created pulls fat into the vascular system and up toward the lungs.

A colleague of mine ran a striking experiment that illustrates exactly this. Using cadavers, they injected green applesauce in place of fat into the buttock, then deliberately pierced the fascia. The applesauce made its way all the way down to where the deep veins were, proof that you don’t have to inject under the muscle to end up with material in the vascular system. Even injections placed above the muscle can lead to complications if the fascia is violated in the process.

How Ultrasound-Guided BBL Injection Changes the Equation

That’s exactly why ultrasound guidance has become such an essential part of how I perform BBL today. All fat has to be injected above the muscle, in the superficial layer of the subcutaneous space. The obvious question is: how do you know exactly where you are during the procedure? The answer is a combination of experience, training, and, critically, having a real-time image that shows you precisely where your instrument is.

With ultrasound, I can see the cannula in real time and confirm we’re staying above the muscle, in the deep layer of the subcutaneous space, without ever crossing into or piercing the fascia. The fat is placed above the muscle and spread carefully with the cannula under direct visualization. This technique is gaining traction across the specialty precisely because of the safety concerns we’ve discussed, and it’s a core part of the protocols our national task force has been promoting for BBL surgeons.

Is BBL Safe in 2026? What This Means If You’re Considering the Procedure

BBL is still a great procedure. For the right candidate, performed the right way, it delivers results that implants alone can’t replicate. The complications that made headlines a decade ago weren’t a reason to abandon the procedure; they were a reason for the specialty to get more precise about it. Ultrasound-guided injection, staying strictly above the muscle, and following the safety protocols developed by the plastic surgery task force are what separate a modern, well-executed BBL from the cases that made the news.

If you’re considering a BBL, the single most important decision you’ll make is who performs it. Look for a board-certified plastic surgeon who uses real-time imaging during fat transfer, who can speak specifically to how they avoid the fascia and stay above the muscle, and who operates in an accredited surgical facility, not a discount clinic overseas.

Schedule a Consultation with Dr. Ali Tehrani

Dr. Ali Tehrani performs ultrasound-guided Brazilian Butt Lift procedures at his Newport Beach, CA practice, following the safety protocols developed by the national BBL task force. If you’d like to talk through whether BBL is right for you and see the ultrasound-guided technique explained in more detail, schedule a consultation with our team today.

Note: Adapted from Dr. Tehrani’s interview segment. Source video: