The Brazilian Butt Lift (BBL), formally known as gluteal fat grafting, is a cosmetic procedure. It involves transferring a patient’s own fat from areas like the abdomen or flanks into the buttocks to enhance volume and shape. The BBL is a legal procedure in the United States when performed by a licensed medical professional in a compliant surgical setting.
The Legal Status of Brazilian Butt Lifts in the US
The practice of cosmetic surgery, including the Brazilian Butt Lift, is regulated at the state level, not by federal agencies like the Food and Drug Administration (FDA). State medical boards are the primary entities responsible for setting the rules and licensing requirements for surgeons. These boards determine who can perform the procedure and under what conditions, which results in variations across the country.
A licensed physician is legally permitted to perform a BBL, although the level of specialized training can vary significantly. Professional organizations, such as the American Society of Plastic Surgeons (ASPS), establish voluntary safety guidelines for their members. These guidelines represent a standard of care that qualified surgeons are expected to follow. The legitimacy of the BBL as a recognized surgical option is established by its inclusion within the scope of practice for licensed surgeons.
State-Level Safety Mandates and Restrictions
The BBL’s legality is often questioned because of its historically high mortality rate. This is primarily caused by a complication called pulmonary fat embolism. This life-threatening event occurs when fat is inadvertently injected into the deep gluteal veins, which then travel to the lungs. Recognizing this specific risk, medical boards in high-volume states, such as Florida, have implemented strict mandates to enhance patient safety.
The most significant regulatory response is the rule prohibiting the injection of fat into the deep gluteal muscle, often referred to as the intramuscular plane. Surgeons are now required to perform a “subcutaneous-only injection,” meaning the fat must be placed only into the layer directly beneath the skin. This restriction is designed to keep the fat away from the larger, more dangerous blood vessels that lie deeper within the muscle.
To ensure adherence to this safety standard, some state medical boards have mandated the use of intraoperative ultrasound guidance during the fat transfer portion of the procedure. The ultrasound allows the surgeon to visualize the cannula tip in real-time, confirming that the fat is being injected exclusively into the safe, superficial layer. Further restrictions in some areas limit the number of BBLs a surgeon can perform in a single day, such as a cap of three procedures. These state-level actions are not a ban on the BBL but rather a set of precise rules dictating the anatomical technique and procedural environment.
The Difference Between Legal Practice and Illegal Operations
The dangers frequently associated with the BBL often stem from illegal or non-compliant operations, not from the procedure itself when performed under legal, regulated conditions. A legal BBL is conducted by a state-licensed physician, typically a board-certified plastic or cosmetic surgeon, within an accredited surgical facility. This legal framework includes adherence to the strict anatomical mandates and equipment requirements set by state medical boards.
Illegal operations involve practitioners who are either completely unlicensed or licensed physicians who operate outside of safety regulations and accredited facilities. These unauthorized procedures may occur in non-sterile environments, often referred to as “back alley” operations, where the lack of appropriate medical equipment increases the risk of infection and complication. Illegal operations sometimes involve the injection of non-medical-grade substances, such as industrial silicone, instead of the patient’s own harvested fat. This use of foreign, non-approved materials is a criminal act and is entirely separate from the legal surgical procedure of gluteal fat grafting.