Rapper Nadia Nakai recently underwent a BBL, however Dr. Terry Dubrow says that celebrities are now shifting toward more natural, "maintenance-focused" looks.
Image: Instagram.
For nearly a decade, the Brazilian Butt Lift, better known as the BBL, dominated beauty culture, reshaping everything from Instagram aesthetics to red-carpet silhouettes.
But a quiet shift is underway. Celebrities who once helped popularise the dramatic curves associated with the procedure are now reversing them, while surgeons are increasingly warning that the operation may be one of the most dangerous cosmetic surgeries in the world.
Terry Dubrow, a well-known plastic surgeon from the show "Botched", has said the BBL comes with serious medical risks. This is only now becoming a common topic of discussion.
At its core, the BBL involves fat transfer (liposuction), taking fat from one part of the body (often the abdomen or thighs) and injecting it into the buttocks to create a fuller shape.
While on paper, it sounds simple and straightforward, the procedure is anything but. It's medically complex.
The anatomy of the gluteal (bum) region makes this risk particularly high, as the area is densely packed with blood vessels.
Compounding the issue is the "blind" nature of the procedure. Surgeons rely on tactile feedback rather than direct visualisation to inject fat, making it difficult to ensure the cannula (the tool used for fat transfer) stays in the safe subcutaneous layer, just beneath the skin.
Injecting fat too deeply, into or below the muscle, drastically increases the risk of complications.
According to research published in the Aesthetic Surgery Journal, the mortality rate of BBL surgery was once estimated at 1 in 3,000, making it the highest fatality rate of any cosmetic procedure.
Medical organisations, including the American Society of Plastic Surgeons, have since introduced stricter safety guidelines, including requiring surgeons to inject fat only into the superficial layer beneath the skin rather than deep into muscle tissue.
Even with improved techniques, the procedure remains controversial.
Despite global caution, cosmetic surgeons in South Africa say demand for BBL procedures continues to rise, particularly among younger women.
Image: Pexels.
While fat embolism is the most dire complication, BBLs come with a laundry list of other risks:
Fat necrosis (death of fat tissue): Transferred fat cells that don't receive adequate blood supply can die, leading to painful lumps or oil cysts.
Infection: This risk is especially high in "medical tourism" scenarios, where patients seek cheaper procedures in countries with less stringent safety regulations.
Sepsis: A life-threatening infection that can result from non-sterile operating conditions.
Chronic lung issues: Survivors of fat embolism often face lifelong pulmonary complications.
Despite global caution, cosmetic surgeons in South Africa say demand for BBL procedures continues to rise, particularly among younger women influenced by social media body ideals.
Interestingly, surgeons say the new Hollywood aesthetic is shifting toward subtle, preventative treatments rather than dramatic transformations.
“What celebrities are focusing on now is maintenance,” Dubrow said. “You can call it a preservation or longevity approach.”
Instead of one dramatic surgery, many are opting for smaller, less invasive procedures over time.
Even Kylie Jenner has spoken openly about regretting cosmetic surgery at a young age, sharing that she wished she had waited before undergoing breast augmentation at 19.
Dubrow says transparency matters.
“These procedures are not like having your hair or nails done,” he warned. “These are real procedures with real complications.”
"The problem is that there are small veins in the buttock that connect directly to the inferior vena cava, which leads to the heart," Dr Dubrow explained on an episode of "Hot Goss".
"If fat is accidentally injected into these veins, it can cause a fat embolism – a blockage in the bloodstream that can lead to instant death."
This risk makes BBLs not just dangerous but, as Dr Dubrow bluntly puts it, "the most fatal operation there is."
He adds that "at 50 or 60 it does not look good". Over time, you can expect the buttock area to experience a loss of skin elasticity and natural, gravity-induced sagging, similar to the rest of the body.
BBL became a global beauty obsession during the 2010s, fueled by celebrity culture and social media ideals. Figures like Kim Kardashian, Khloé Kardashian and Kylie Jenner helped popularise the exaggerated hourglass silhouette that defined the era.
But the same cultural tastemakers who helped shape the trend are now quietly walking it back.
American model, television personality, and socialite Blac Chyna famously dissolved her cosmetic fillers and removed silicone injections in 2023 as part of what she described as a personal reset. And rapper Cardi B recently revealed she has also been dissolving cosmetic injections in recent years.
The shift reflects something deeper than changing aesthetics. It signals growing awareness about the long-term health risks of extreme cosmetic procedures.