But it can be difficult for doctors to know exactly where they are injecting; they sometimes accidentally injected fat into the gluteal muscle, or just below it. Fat can then travel directly to the heart and into the lungs, impeding blood flow and causing immediate death.
Concerned about the death rate, the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery, and the International Society of Aesthetic Plastic Surgery, among others, established the Task Force for Safety in Gluteal Fat Grafting in 2018 to provide safety guidelines around the procedure.
One of their recommendations: that doctors stop injecting into the muscle and use larger instruments. “Those cannulas bend, and if they bend when you put them in the buttock, you have no idea where the tip of the cannula is,” said Dr. Luis Rios, a board-certified plastic surgeon in McAllen, Texas, and past president of The Aesthetic Surgery Education and Research Foundation, the research, education, and philanthropic arm of the Aesthetic Society. A 2020 follow-up survey found that 94 percent of physicians are aware of the recommendations.
“If done right, if done carefully, it’s safe,” says Dr. Steven Teitelbaum, a board-certified plastic surgeon in Santa Monica who was involved in drawing up the guidelines but is not performing the surgery. “We know exactly the mechanism that can lead to death, and we know how to avoid it. The surgeon just needs to stay intensely focused and concentrated.”
Yet people still die, especially in “chocolate shops”: low-cost, high-volume centers usually found in Las Vegas, Los Angeles, and Miami — with doctors who may not be certified or even surgeons. In the past eight years, one such physician, Ismael Labrador, has let eight patients die in clinics he has headed, four of failed BBLs, USA Today and Naples Daily News reported. The clinics’ names have been changed twice as of 2016, making it nearly impossible for new clients to research him. (Dr. Labrador did not call back.)
“The problem is not just that these doctors are not adequately trained, but that, as rogue actors, there is no way to collect their data or send them a warning about the dangers of a procedure,” said Dr. Teitelbaum. “When we started recognizing that there was a problem with BBL, we were faced with the problem of figuring out how to find these people to notify them, and unfortunately there was no way to do it.”