Body
What is a BBL?
What is a BBL? A Brazilian butt lift uses liposuction to collect a person's fat, prepares that tissue and transfers it to the buttocks to change volume and shape. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains the process, recovery questions and why safety must be part of the decision.
In this episode.
Episode summary
What is a BBL? A Brazilian butt lift uses liposuction to collect a person's fat, prepares that tissue and transfers it to the buttocks to change volume and shape. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains the process, recovery questions and why safety must be part of the decision.
Originally published November 4, 2020. Recovery examples, prices and safety discussion in the recording reflect that period.
ℹ️ Updated safety context
BBL carries significant risks, including potentially fatal fat embolism. The 2022 joint statement from ASPS and partner societies supports fat placement only in the subcutaneous layer above the gluteal muscle fascia, real-time ultrasound monitoring during injection, appropriate surgical credentials and postoperative care. These measures do not eliminate risk. This later guidance supplements the original recording.
Key takeaways
📍 Donor fat planning
The amount and location of donor fat are planned around the patient's anatomy and goals.
🧩 Lipo 360 and BBL
“Lipo 360” describes torso liposuction; adding a BBL is a separate decision about transferring fat to the buttocks.
🔄 Fat graft retention
Transferred fat is living tissue. Not all of it survives, and the eventual volume cannot be predicted by applying one percentage to every patient.
🗓️ Recovery instructions
Sitting, sleeping, clothing and return to work need individualized instructions that protect healing tissues.
⏳ Swelling and final contour
Changes in swelling and retained volume mean the early appearance is not the final result.
Questions this episode answers
Does every BBL include Lipo 360?
No. Dr. Smith says donor areas are chosen with the patient; the torso is a common source, but other areas may be considered. A procedure name does not define the full plan.
Can I sit normally immediately afterward?
The episode emphasizes that positioning depends on where fat was placed. Follow your surgeon's specific instructions; the recording's examples are not a universal sitting or sleeping protocol.
Will all transferred fat remain?
No. The recording describes variable survival of transferred tissue and the possibility of further treatment. Final shape and volume evolve as healing progresses.
🔗 Related information
Read current information about Brazilian butt lift surgery, liposuction, and Lipo 360, or schedule a consultation.
Educational information, not individualized medical advice. Suitability, risks, recovery and results vary. Show notes updated September 30, 2026.
Original show notes
Board certified NYC plastic surgeon Dr. Darren Smith explores the fine points of BBLs.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. What is a BBL? BBL stands for Brazilian buttic lift. This is a procedure that has become very popular in recent years. and it's designed to increase the size of the buttocks and give them a more desirable shape. How does a BBL work? A Brazilian buttock lift is performed in essentially three stages. The first stage is fat harvest. And during the fat harvest stage, fat is collected from around the body with liposuction. And you can hear more about how liposuction is performed in previous episodes. In the second stage, the fat is processed. This means that we remove any undesirable materials from the fat, like any extra fluid or excess lipids.
[01:18] and prepare it for the third stage of the procedure, which is the fat grafting portion of the procedure itself. To look at each of these stages in a little bit more depth, a BBL is often combined with a procedure called lipo 360, which I've talked about in an earlier episode and I don't... love that terminology because it's a little too vague, but what it means is that fat is harvested from all around the torso, from the abdomen, from the flanks, and from areas on the back. In some instances, outside of lipo360, fat can also be harvested from other areas like the thighs or the arms and Ultimately, the decision of where to harvest fat from for use in a Brazilian butt lift or BBL is decided upon with the discussion between the surgeon and the patient. For the second phase of the procedure, the fat preparation phase, the fat is collected in a large sterile canister as it's suctioned and it's allowed to settle over the course of the first stage of the procedure. And what happens is that fat, because it's less dense than water, floats to the top of the canister, leaving behind the fluids and other materials that we aren't interested in grafting in the lower portion.
[02:42] of the canister. So all we really need to do is open a valve near the bottom of the canister and release that excess fluid that we're not interested in grafting and that clears it out of the fat that we do want to use for the BBL procedure. Finally, in the third phase of the BBL procedure, the actual fat grafting portion of the operation, we make a series of very small, well-hidden incisions or punctures around the buttocks and use these as access sites to inject the fat into the treatment area. And depending on the volume of the fat transfer and the aesthetic goals of the procedure will either do this by hand or by using a power-assisted device.
[03:29] And while this is the portion of the BBL procedure that occurs in the operating room, perhaps the most important part of a Brazilian butt lift actually occurs during recovery. And what I mean by this is that a Brazilian buttock lift is actually a cell transplant. We're taking cells from one part of the body and transplanting them into another part of the body. And all of the tissues of the body need a blood supply and that's what your circulatory system is for. It delivers blood cells and other necessary nutrients to the fat cells and all the other tissues in the body and then it carries waste products away from these cells. So when we initially transplant the cells in a Brazilian butt lift into the buttocks, they are not connected to the body circulatory system. So it's over the next few weeks.
[04:23] that a robust circulatory system is established to these new blood cells. So what happens is when the fat cells are initially placed into the buttocks, they're surviving off of nutrients that are directly floating around them in the graft site. But this is not a sustainable form of cellular nutrition. So over time, new blood vessels actually grow into these cells and that way they are connected to the body's main circulatory system. So that's why, in addition to swelling going down over time, it takes several weeks to months to see the final result of a BBL. We usually find that about 60 to 70 percent of the fat that we transfer as part of a BBL stays there for the long term, and this can be a fairly permanent procedure, but about 30 to 40% of the fat that we transfer will not survive simply because it won't be adequately connected to the body circulatory system. And it's for this reason that some patients after six to 12 months come back for a touch-up and additional fat is added to achieve the desired result. Will I be asleep for my BBL procedure?
[05:41] This is something that varies from surgeon to surgeon. I personally strongly encourage my patients to be asleep during a Brazilian buttock lift procedure and that's simply because I find that I can be more aggressive with the fat harvesting portion of the operation and I can also get a more defined precise shape of the buttocks when the patient is asleep. Now, I find that while there are many procedures, including a lot of liposuction procedures that we do perform wide awake or with twilight anesthesia, given the number of steps involved and the number of body areas involved in a Brazilian buttock lift, it is the safer and better choice to do these procedures under general anesthesia. In some instances surgeons will do these procedures under twilight anesthesia. I think that's fine and it's a matter of personal preference. In other instances, people will perform these procedures wide awake and I don't think that this is a great idea it's uncomfortable for the patient it's more difficult for the surgeon to do a great job and I also think overall it's hard to maintain exacting safety standards under these circumstances and really the only reason to do one of these procedures on an awake patient is to save on cost so you don't need to pay for an anesthesiologist and to me there's just not a reason to do that. It doesn't seem appropriate to sacrifice safety in favor of saving on cost. How painful is a BBL? The BBL procedure itself, if performed under general anesthesia, doesn't hurt at all. If it's performed under twilight anesthesia, it might be a little uncomfortable, but really nothing horrible. And if it's performed under local anesthesia, in these cases, it can be quite uncomfortable. In terms of the degree of discomfort that you might feel after a BBL during the recovery period, this can be a bit variable but we find that in general the discomfort isn't too bad at all and most people that have this procedure on a Friday are able to return to a desk job early the following week.
[07:53] And this leads to another very common question about BBLs. Can I sit after having a BBL? And the short answer to this is that yes, you can sit after having a BBL, but it depends on exactly where the fat was grafted. And this is a conversation you should have with your surgeon to come up with the best strategy, which may involve using a special seat cushion or sitting in specific positions to protect your fat graft as it's healing. Another related question is, how should I sleep after a BBL? This has a similar answer. It depends on exactly where the fat was placed. And the name of the game is to not put undue pressure on the fat graft while it's healing. So you may be instructed to sleep on your sides or on a special cushion for a certain amount of time after the procedure. How long after a BBL can I wear jeans? Well, it depends on what kind of jeans you're wearing. You shouldn't wear anything too tightly fitting immediately after the procedure, but baggy genes are okay pretty much right away. In terms of tighter genes, I generally advise my patients to wait several weeks after the procedure to give the fat a chance to settle and make sure it has a pretty robust blood supply before putting pressure on it in any way. Is it good to walk after a BBL?
[09:12] Yes, it is good to be up and walking and active right after this or pretty much any other aesthetic surgery procedure to get yourself active, get your blood flowing, get air flowing in and out of your lungs, and all of these things have a very nice effect on minimizing any complications after these procedures. Is BPL surgery safe? This is an excellent question and it's something that has been very controversial in the plastic surgery literature over the past several years. You'll probably get a different answer depending on who you're asking. However, it's my opinion that when a Brazilian buttock lift is performed under regulated situations in either a hospital setting or an outpatient surgical facility by a board certified plastic surgeon with expertise in fat grafting, and in this procedure it is very reasonable to expect this to be a safe thing to have done. BBLs or Brazilian buttock lifts have the potential to be unsafe because it's possible for the grafted fat to make its way into the large blood vessels that are deep in the buttocks and that fat can travel to the heart and cause what's called a fat embolism. And this can be a potentially lethal event in which these fat particles make it impossible for the heart to function effectively. And that's why it's important that you're going to a board certified plastic surgeon practicing under the most stringent safety standards to ensure that you are having a safe procedure.
[10:51] But I would be very careful when looking at these offers because what you'll often find is they might be being performed by people that aren't really qualified to do them or are cutting serious corners with regards to safety and sterility and with the lack of use of proper monitoring and anesthesia. So these are all things that you want to ask about in great detail before you go ahead with one of these surgeries. What is BBL fluffing? When a Brazilian buttock lift is initially performed, the buttocks may appear square and firm and this is because a large volume of fat in many cases has been grafted into a sometimes constricted area. So don't be alarmed by the initial appearance of your Brazilian buttock lift. It's over the weeks and months after the operation. We usually say the final result is invisible until three to six months after the procedure, that all of the swelling leaves the region, and also the final amount of fat that's going to be retained becomes visible. So fluffing with a BBL is used to refer to that time, usually two to three months after the procedure, where the final form starts to evolve and the buttocks soften and come in to a nice round shape. How much does a BBL cost?
[12:16] This is going to vary widely with geography, with surgeon experience, and also with the way in which the procedure is performed. So for example, if you're having this procedure in a safe setting with general anesthesia and an experienced board certified surgeon, these cases often can cost between $9,000 and $12,000. It also depends how many areas are being suctioned to harvest the fat since the more fat that is harvested from the more areas, the longer the procedure takes and the more potentially complicated the procedure is. So all of these things also factor into the cost. Now it is definitely possible to find extremely inexpensive BBLs but I would be very careful when looking at these offers because what you'll often find is they might be being performed by people that aren't really qualified to do them or are cutting serious corners with regards to safety and sterility and with the lack of use of proper monitoring and anesthesia. So these are all things that you want to ask about in great detail before you go ahead with one of these surgeries.
[13:28] Thanks for listening, and don't forget to subscribe, share the show, and head over to DarrinSmithMD.com for more real-world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-11-04. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS