I'm a plastic surgeon who won't perform Brazilian Butt Lifts. They're deadly. A butt lift is the 'next big thing' in plastic surgery. But, in this industry, new procedures debut on reality TV shows without enough prior research.

Arthur W. Perry | Opinion contributor

Show Caption Hide Caption Miami doctor's plastic surgery empire left eight women dead Eight women died after operations at a Miami plastic surgery business, some after doctors botched procedures, a USA TODAY Network investigation found.

I spent the first 20 years of my plastic surgery career suctioning fat out of buttocks, so about 10 years ago, it surprised me when women started asking to have fat injected back into their bottoms.

This celebrity-driven procedure, called the Brazilian Butt Lift (BBL), has skyrocketed both in popularity and in notoriety as the most dangerous operation in cosmetic surgery.

When I hear about problems with the BBL, I think of other “next big things" in plastic surgery that have come and gone, often leaving a trail of complications. In my 10 years on New Jersey’s Board of Medical Examiners, I questioned whether deadly procedures were just performed poorly or whether the procedure itself was flawed.

In the 1990s, liposuction was the “problem child.” Too much fat was suctioned and toxic amounts of lidocaine anesthetic were administered. Hundreds, but possibly thousands, of people died. I reviewed a case of a young healthy liposuction patient who received five times the toxic dose of local anesthetic and died that night. I set up a study and ultimately published a scientific paper documenting that lidocaine was not necessary in most liposuctions. With the benefit of time and study, liposuction is much safer now.

Curves are not worth death

According to the American Society of Plastic Surgeons, more than 20,000 people had the BBL procedure by board-certified surgeons in 2017, rising steadily from 8,500 in 2012.

Read the investigation: This business helped transform Miami into a national plastic surgery destination. Eight women died.

The poorly named BBL does not actually lift the buttocks. Rather, flat buttocks are rounded out, grown instantly, with fat transplanted from the belly, hips or thighs. Sounds good — who wouldn’t want to slim their waist while expanding their buttocks in this two-for-one procedure. When fat is in short supply, inventive surgeons find other materials, such as hyaluronic acid, or even silicone or plastic to plump the derriere.

As the procedure rose in popularity, complications surfaced. Early disasters by untrained doctors were dismissed by board-certified plastic surgeons. By 2015, 13 BBL deaths had occurred in Mexico.

From 2011 to 2016, there were 25 BBL deaths among members of the American Society for Aesthetic Plastic Surgery. In 2017, a plastic surgery task force astonishingly reported that 3 percent of plastic surgeons who performed the procedure had a patient die. From 2013 to 2018, just one Florida clinic had at least eight patients die.

Last August, a task force found that BBLs had a death rate of up to 1 in 3,000, the highest from any aesthetic procedure. This approaches the death rate from gall bladder surgery, and the overall death rate for BBLs is even higher than the death rate for patients under 50 years old who undergo gallbladder surgery. Diseased gallbladders must be removed, accepting any risks, but no one has ever succumbed to a small buttocks.

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People die from BBL when fat, accidentally injected into muscle veins with diameters as large as drinking straws, travels to the lungs. Plastic surgeons have been advised to inject fat under the skin, and not into the muscle, but this guideline is technically impossible to follow. Newly reported death rates are as high as 1 in 500. After the procedure, patients can be plagued with rumpled, grotesque, asymmetric buttocks from uneven survival of transplanted fat.

Plastic surgeons must police themselves

Plastic surgery is the only medical specialty where new procedures debut on television shows, without the academic scrutiny required in fields like cardiac surgery. The high BBL death rate among properly trained surgeons is startling — these are the cream of the crop doctors who spend six years in residency and pass certifying exams. When rogue doctors perform BBLs, I shudder to think about what their real death rates are because they are not reported anywhere. Worse, lay practitioners who inject silicone caulk from hardware stores are killing unsuspecting women in garages and hotel rooms.

The British Association of Aesthetic Plastic Surgeons warned their members to stop performing the procedure. Despite this, the BBL is thriving in America.

When patients die from a procedure that until a decade ago was considered ridiculous, something is amiss. I believe that plastic surgeons should stop performing this procedure. I’ll make few friends among my colleagues calling for a BBL ban, but the Hippocratic oath promises to “do no harm.”

BBL procedures are understudied and unsafe. Many patients request the procedure and are disappointed that I won’t perform it. Cosmetic surgery procedures must have a reasonable risk/benefit ratio. Most of cosmetic surgery fits the bill. BBL does not.

Arthur W. Perry, MD, FACS, is a board-certified plastic surgeon in New York and New Jersey. He is the author of "Straight Talk about Cosmetic Surgery," is an adjunct associate professor of surgery at Columbia University, a clinical associate professor of surgery at Rutgers University and was a member of New Jersey’s Board of Medical Examiners from 1995-2005.