BBL Risks: Is a Brazilian Butt Lift Safe?

The main BBL risks are seroma, infection, blood clots (DVT and pulmonary embolism), fat necrosis and oil cysts, asymmetry and dents, fat reabsorption, skin necrosis, sciatic nerve irritation, anaesthetic complications, scarring, dissatisfaction with the result and, rarely, fat embolism. Most are uncommon and treatable when a Brazilian butt lift is performed to current UK standards, with fat placed only above the muscle under real-time ultrasound guidance. The rare but serious risk of fat embolism is what gave the BBL its reputation, and it is almost entirely linked to fat injected into or beneath the gluteal muscle.

This guide covers every BBL complication in turn, with published incidence, warning signs, prevention and treatment, plus how BAAPS guidance has changed since 2018 and when to seek urgent help. For the death rate figures in detail, see our BBL death rate and safety statistics.

What Are the Risks of a BBL?

A BBL is two procedures in one: liposuction to remove fat from areas such as the abdomen, flanks and back, then fat transfer to the buttocks. Grouped by type, BBL risks and complications are:

• Life-threatening but rare: pulmonary fat embolism, a blood clot reaching the lungs, and sepsis.
• Common and usually minor: seroma, bruising, swelling and temporary numbness.
• Problems with the result: asymmetry, dents, fat necrosis, oil cysts and more fat reabsorption than expected.
• Less common: skin necrosis, sciatic nerve irritation, poor scarring, anaesthetic complications and dissatisfaction.

The UK safety review by the British Association of Aesthetic Plastic Surgeons (BAAPS) makes the same point: fat embolism is the most publicised risk, but hypothermia, sepsis, skin necrosis and poor aesthetic results must be considered too, and all are better controlled in strictly regulated healthcare settings^[1].

Can You Die From a BBL? The Death Rate in Brief

Yes, but the risk has fallen sharply as technique changed. A 2017 task force survey covering 198,857 gluteal fat grafts reported 32 deaths from pulmonary fat embolism, a mortality rate of around 1 in 3,448, and found the risk was significantly higher when surgeons injected into the deep muscle^[2]. In a 2020 follow-up survey published in the Aesthetic Surgery Journal ↗, the estimated mortality rate had fallen to around 1 in 14,952 after only 0.8% of surgeons still reported injecting into deep muscle, compared with 13.1% before^[3]. The BAAPS review describes a risk of around 1 in 15,000 as similar to the mortality risk of a tummy tuck^[1].

These are averages across all settings, including unregulated ones; our BBL death rate statistics guide explains the figures in full.

Why Are BBLs Dangerous? Fat Embolism Explained

The buttock has a layer of fat under the skin and, beneath it, the gluteal muscles, which contain large veins. Fat placed in the subcutaneous layer above the muscle is well away from those veins. Fat injected into or under the muscle can enter a torn vein, travel to the heart and block the blood vessels of the lungs. This is a macroscopic pulmonary fat embolism, and it usually happens on the operating table or within hours of surgery.

A second, different condition, fat embolism syndrome, can appear 24 to 72 hours after surgery, with breathlessness, confusion and sometimes a pinpoint rash. Both are emergencies. Prevention is about technique: the 2017 task force advised against deep muscle injection, cannulas smaller than 4 mm and pointing the cannula downwards^[2], and BAAPS guidance adds continuous ultrasound to confirm the cannula tip stays in the fat layer^[1]. Our guide to ultrasound-guided BBL explains how this works in theatre.

How Common Are BBL Complications?

Far more common than fat embolism, and far less dangerous, are the everyday complications of fat transfer. A 2025 systematic review and meta-analysis in the Aesthetic Surgery Journal ↗ of 6,235 patients who had ultrasound-guided gluteal fat grafting found no deaths and no fat embolisms. Minor complications occurred in 6.32 per 100 patients, with seroma at 2.94, infection at 0.23 and fat necrosis at 0.09 per 100^[4].

Looking more widely, a 2026 systematic review of non-embolic complications in Plastic and Reconstructive Surgery ↗ pooled 18 studies and 12,032 patients and found an overall non-embolic complication rate of 2.67%. Of those complications, contour irregularities made up 32.4%, asymmetry 25.6%, fat necrosis 14.3%, infection 13.1%, cysts 10.6% and abscesses 2.2%^[5]. An earlier review of 1,788 fat transfer procedures reported a 13% complication rate, against 25% for buttock implants^[6]. Rates vary with how complications are defined, but the pattern is consistent: most BBL problems are minor and affect the look of the result rather than your health.

What Are the Side Effects of a BBL? Every Complication Explained

Swelling, bruising, soreness and temporary numbness are normal BBL side effects, not complications. Swelling peaks at 3 to 5 days, and the skin usually softens or “fluffs” at around 6 to 8 weeks.

Blood clots: DVT and pulmonary embolism after a BBL

• How common: in a prospective study of 129,007 cosmetic surgery patients, a confirmed blood clot (venous thromboembolism) occurred in 0.09% overall, rising to 0.21% after body procedures. Combining operations, higher BMI and older age all raised the risk^[7].
• Signs: a deep vein thrombosis (DVT) causes pain, swelling, warmth or redness in one calf or leg. If a clot reaches the lungs, it causes sudden breathlessness, chest pain or coughing up blood.
• Prevention: walking from the day of surgery, plenty of fluids, a clot risk assessment, pausing an oestrogen-containing pill or HRT for 4 weeks before surgery where advised, and avoiding long journeys early on. At Centre for Surgery a tummy tuck and BBL are never combined in one operation; they are staged 3 to 6 months apart.
• Treatment: blood-thinning medication, started as soon as a clot is confirmed on a scan. A pulmonary embolism is treated in hospital.

Seroma after BBL

• How common: the commonest BBL complication, at 2.94 per 100 with ultrasound guidance and up to 6.9% in older series^[4][6].
• Signs: a soft, sometimes sloshing swelling, usually over a liposuction area such as the lower back or flanks, appearing in the first few weeks.
• Prevention: wearing your compression garment day and night for 6 weeks, as instructed.
• Treatment: small seromas are reabsorbed by the body; larger ones are drained with a needle in clinic, sometimes more than once.

Infection after a BBL

• How common: 0.23 per 100 with ultrasound-guided technique, and around 3% in wider reviews^[4][6]. The 2026 review also examined atypical mycobacterial infections, a slow-growing type of infection that has been reported after cosmetic surgery^[5].
• Signs: fever, increasing rather than settling pain, a red, hot or swollen incision, cloudy or smelly discharge, or feeling generally unwell.
• Prevention: surgery in a sterile operating theatre, careful wound care, stopping smoking and vaping for 4 weeks before and after surgery, and attending your wound check at 7 to 14 days.
• Treatment: antibiotics, and drainage of any abscess. Severe infection can lead to sepsis and needs hospital care, and infected fat may be lost from the result.

Fat necrosis and oil cysts

• How common: 0.09 per 100 with ultrasound guidance^[4], although fat necrosis and cysts together made up a quarter of non-embolic complications in the 2026 review^[5].
• Signs: firm lumps under the skin, sometimes tender, appearing weeks or months after surgery. An oil cyst is a smooth, fluid-filled lump of liquefied fat.
• Prevention: placing fat in small threads rather than large pools, avoiding overfilling and keeping pressure off the buttocks for 2 weeks.
• Treatment: many small lumps soften over months. An ultrasound scan confirms the diagnosis, and larger cysts can be drained or removed. Our guide to fat necrosis after BBL covers this in detail.

Asymmetry, dents and contour irregularities

• How common: the most frequent non-embolic problems, making up 32.4% (irregularities) and 25.6% (asymmetry) of complications in the 2026 review^[5].
• Signs: one buttock fuller than the other, or dents and ripples at the liposuction areas once swelling settles.
• Prevention: careful planning and marking, even liposuction, and wearing your garment as advised. If your surgeon recommends lymphatic drainage massage, you are referred to a qualified therapist and pay them directly, as it is not provided in-house. Our guide on how to prevent dents after a BBL has practical steps.
• Treatment: wait at least 6 months for the final result, then correct with further fat grafting or targeted liposuction, as explained in our revision BBL guide.

Fat reabsorption: will my BBL shrink?

• How common: expected in every BBL. Around 50% to 70% of transferred fat survives, so 30% to 50% is reabsorbed, mostly in the first 3 months.
• Signs: the buttocks gradually look smaller as swelling settles and some grafted fat is lost.
• Prevention: your surgeon slightly overfills to allow for it. On your side, no sitting directly on the buttocks for 2 weeks (have a BBL cushion ready before surgery for unavoidable sitting), no smoking or vaping, and a stable weight.
• Treatment: surviving fat is permanent from about 6 months; if too much has been lost, a top-up can be discussed at your 6-month review. See BBL shrinking: what is normal.

Skin necrosis

• How common: rare, but listed by BAAPS among the serious BBL risks^[1].
• Signs: skin that turns dusky, purple, blistered or black, usually over a liposuction area, in the first days or weeks.
• Prevention: not smoking, avoiding overly superficial liposuction and overfilling, and a correctly fitted garment that is not too tight.
• Treatment: urgent review, wound care and dressings, and sometimes surgical removal of dead tissue, with scar revision later.

Sciatic nerve irritation

• How common: temporary sciatic symptoms affected around 1% of patients after buttock fat transfer^[6]; permanent injury is very rare.
• Signs: shooting pain, tingling or numbness down the back of the leg. Weakness of the foot or ankle needs same-day assessment.
• Prevention: keeping fat superficial and away from the deep lower buttock, where the sciatic nerve runs, under ultrasound guidance.
• Treatment: symptoms usually settle over days to weeks with pain relief; persistent symptoms need a scan and nerve tests.

Anaesthesia risks

• How common: serious anaesthetic complications are rare in healthy patients.
• Signs: nausea, a sore throat or drowsiness are common and short-lived; breathing problems or allergic reactions are rare and treated immediately.
• Prevention: a BBL at Centre for Surgery is a day case under TIVA (total intravenous anaesthesia), with a pre-operative assessment, fasting (6 hours for food, 2 hours for clear fluids), warming during the 3 to 4 hour operation and 1 to 3 hours of monitoring afterwards.
• Treatment: managed by the anaesthetist at the time. Our anaesthesia for cosmetic surgery page explains TIVA.

BBL scars

• How common: every BBL leaves small scars, but they are only 3 to 4 mm long and placed in natural creases.
• Signs: scars that stay raised, darken or thicken; darker skin is more prone to pigmentation changes and keloids.
• Prevention: good wound care, avoiding sun on healing scars and not smoking.
• Treatment: silicone gel or sheets, and steroid injections for raised scars. Read more in will a BBL leave scars?

Psychological dissatisfaction

• How common: body dysmorphic disorder (BDD), a condition where people are preoccupied with perceived flaws, was found in 18.6% of patients across 65 plastic surgery studies^[8]. People with BDD are rarely satisfied by surgery.
• Signs: feeling worse rather than better about your body after recovery, fixating on small differences, or wanting repeated procedures.
• Prevention: honest discussion of motivation and realistic results at consultation, a recommended two-week cooling-off period before booking, and judging the result only once it has settled at 3 to 6 months.
• Treatment: follow-up with your surgeon, and referral for psychological support where appropriate.

BBL Gone Wrong: What Does a Bad BBL Look Like?

A bad BBL usually means clear asymmetry, uneven deflation, hard lumps from fat necrosis, or dents at the liposuction areas. Many “BBL gone wrong” pictures, though, show an extreme shape the patient asked for, which now looks dated rather than technically wrong. A natural result looks proportionate to your frame, with a smooth waist-to-hip curve, as in this real Centre for Surgery result.

Tap to reveal

Real Centre for Surgery patient, photographed at least six months after BBL surgery.

You can see more results in our BBL before and after photos gallery. A BBL cannot be fully reversed, as the surviving fat has its own blood supply, but it can be revised.

Who Is at Higher Risk of BBL Complications?

• Smokers and vapers: nicotine lowers fat survival and raises infection and skin necrosis risk. Stop for 4 weeks before and after surgery.
• Higher BMI: raises the risk of clots, infection and wound problems. A BMI of about 23 to 28 usually gives enough donor fat.
• Very slim patients: harvesting from many small areas raises the chance of contour irregularities.
• Blood-thinning medicines and supplements: stop aspirin 2 weeks before, along with anti-inflammatories, fish oil, vitamin E, ginkgo, garlic and St John’s wort. Paracetamol is fine.
• Previous buttock filler, implants or surgery: scarring makes the tissue layers harder to read, so tell your surgeon.

Is the BBL Banned in the UK? BAAPS Guidance Since 2018

No, the BBL is not banned in the UK, but UK guidance has changed several times:

• October 2018: after deaths linked to the procedure, BAAPS advised its members not to perform BBLs until more safety data were available.
• 2021–22: after reviewing outcomes and new technology, BAAPS published guidance allowing gluteal fat grafting with two conditions: fat is placed only in the subcutaneous layer above the muscle, and continuous ultrasound is used to guide placement^[1]. Surgeons at Centre for Surgery contributed to the development of the ultrasound-guided technique and to these guidelines.
• October 2024: BAAPS called for urgent regulation of BBL procedures, including restricting them to suitably trained GMC-registered surgeons, performing them only in CQC-regulated clinics or hospitals, and controlling the use of dermal fillers^[9].
• August 2025: the Department of Health and Social Care announced that the highest-risk non-surgical procedures, such as non-surgical BBLs, would only be performed by qualified healthcare professionals working for CQC-registered providers^[10].
• 21 October 2026: the government proposed that fillers injected anywhere other than the face, including liquid BBLs, be legally defined as cosmetic surgery so that only doctors could perform them. The draft regulations are out for consultation and due before Parliament in spring 2027^[11].

What Are the Risks of a Liquid BBL?

A liquid BBL uses injectable filler instead of your own fat. Its risks include infection, abscesses, lumps, filler migration and, if filler enters a blood vessel, blocked circulation. Serious infections and at least one death have been reported in the UK after injections by non-healthcare practitioners, which is what prompted the government’s 2025 and 2026 proposals^[11].

At Centre for Surgery a non-surgical butt lift is performed only by surgeons, using hyaluronic acid filler that can be dissolved if needed, in a sterile theatre under ultrasound guidance. The change it gives is modest. Our guide to the liquid BBL in the UK covers its safety in more detail.

Is a BBL Abroad More Dangerous?

Many of the BBL deaths of UK patients reported in the press followed surgery abroad, and BAAPS considers patients who travel for surgery to be at higher risk of serious complications and of inadequate follow-up care^[1]. The injection plane is hard to verify, flying soon after surgery adds to clot risk and clashes with the sitting rule, and complications are often treated by NHS doctors who did not operate. NHS advice is to avoid flying for 5 to 7 days after liposuction and longer after bigger operations^[12]. Our guide is BBL in Turkey safe? looks at the UK data.

How Can You Reduce Your BBL Risks?

• Ask where the fat goes. The answer should be “above the muscle only, under real-time ultrasound”.
• Check your surgeon and hospital. Confirm your surgeon is GMC-registered, ask how many BBLs they perform, and check the hospital is CQC-registered.
• Be realistic about size. Larger volumes mean more risk.
• Follow the aftercare. Wear your garment for 6 weeks, avoid sitting on your buttocks for 2 weeks, sleep on your front or side, keep toilet visits brief and lean forward, and walk every day. Our BBL recovery guide sets out each week.

When Should You Seek Urgent Help After a BBL?

Call 999 if you have breathlessness, chest pain or cough up blood after a BBL. These can be signs of a pulmonary embolism or fat embolism.

Call Centre for Surgery, or NHS 111 out of hours, if you have calf pain or swelling, a fever, or an incision that is red and hot. For the first 24 hours you have your surgeon’s direct number; after that, call 020 7993 4849 (9am to 6pm, Monday to Saturday), and the nursing team stays in touch over the first 2 weeks.

Frequently Asked Questions

Brazilian Butt Lift in London

Every BBL at Centre for Surgery is performed by a GMC-registered surgeon at our Baker Street hospital, rated Good overall by the CQC. Fat is placed only above the gluteal muscle, never into or beneath it, with a blunt cannula and expansion vibration lipofilling under real-time ultrasound on every BBL, as a day case under TIVA. The consultant who assesses you performs your surgery, follow-ups are included, and we recommend a two-week cooling-off period before you go ahead. Your initial consultation is £100, redeemable against the cost of surgery if you go ahead. Finance isn’t available for BBL at Centre for Surgery, so the procedure is self-funded.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Tillo O, Nassab R, Pacifico MD. The British Association of Aesthetic Plastic Surgeons (BAAPS) gluteal fat grafting safety review and recommendations. Aesthetic Surgery Journal 2023;43(6):675–682. doi:10.1093/asj/sjac316 ↗
2. Mofid MM, Teitelbaum S, Suissa D, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF task force. Aesthetic Surgery Journal 2017;37(7):796–806. doi:10.1093/asj/sjx004 ↗
3. Rios L, Gupta V. Improvement in Brazilian butt lift (BBL) safety with the current recommendations from ASERF, ASAPS, and ISAPS. Aesthetic Surgery Journal 2020;40(8):864–870. doi:10.1093/asj/sjaa098 ↗
4. Milani Reis A, Roca Mora MM, Bicudo Bregion P, et al. Ultrasound-guided gluteal fat grafting: what is the evidence? A systematic review and meta-analysis. Aesthetic Surgery Journal 2025;46(1):57–62. doi:10.1093/asj/sjaf059 ↗
5. Domínguez-Millán R, Hoyos A, Cárdenas-Camarena L, et al. Non-embolic complications of gluteal fat transfer: a systematic review of the literature. Plastic and Reconstructive Surgery 2026. doi:10.1097/PRS.0000000000013408 ↗
6. Oregi P, Khatib M, Cavale N, Rahman SM. Comparing the safety profiles of implants and autologous fat grafting in gluteal augmentation: a systematic review. Journal of Plastic, Reconstructive and Aesthetic Surgery 2023;83:463–474. doi:10.1016/j.bjps.2023.04.066 ↗
7. Winocour J, Gupta V, Kaoutzanis C, et al. Venous thromboembolism in the cosmetic patient: analysis of 129,007 patients. Aesthetic Surgery Journal 2017;37(3):337–349. doi:10.1093/asj/sjw173 ↗
8. Kaleeny JD, Janis JE. Body dysmorphic disorder in aesthetic and reconstructive plastic surgery: a systematic review and meta-analysis. Healthcare (Basel) 2024;12(13). doi:10.3390/healthcare12131333 ↗
9. British Association of Aesthetic Plastic Surgeons. The BAAPS calls for urgent regulation of BBL procedures. Press release, 23 October 2024. baaps.org.uk ↗
10. Department of Health and Social Care. Crackdown on unsafe cosmetic procedures to protect the public. GOV.UK, 6 August 2025. gov.uk ↗
11. Department of Health and Social Care. Cosmetic cowboys crackdown continues with new restrictions. GOV.UK, 21 October 2026. gov.uk ↗
12. NHS. Cosmetic surgery abroad. nhs.uk ↗

Related Articles

• BBL Death Rate and Safety Statistics 2026
• Safe BBL: What Is an Ultrasound-Guided BBL and Is It Safer?
• Fat Necrosis after BBL – Causes & Solutions
• BBL Recovery and Aftercare: A Week-by-Week Guide