A 31 y.o. woman presents to the ED one week after a Brazilian butt lift with sepsis and a temp of 104.

purulent material is draining from the top of the gluteal cleft.

A Brazilain butt lift is a cosmetic procedure that removes fat from other parts of the body and injects it into the buttock to create an hourglass shape. Brazilian plastic surgeon Ivo Pitanguy is credited with inventing the procedure in the 1960’s.  Results last for several years and our patient had previously had the procedure in Miami four years earlier. 

 Candidates for the procedure  include patients between size 8-12 and slightly overweight.  A BMI of 30 is considered the upper limit of weight.  The procedure has become popular, with more than 60,000 people receiving it each year. Unfortunately, it is also the cosmetic procedure with highest risk with reported cases of fat necrosis and fat embolism. Eight pulmonary fat embolisms were reported in  2021 alone, with six deaths. Our patient developed a large abscess of the R buttock and sepsis.

THE PROCEDURE

1.       Harvesting the fat- fat is collected through liposuction from areas of the body with excess fat. Areas most frequently used for the collection include the lateral hips and abdomen. A large volume of crystalloid fluid called Klein’s solution is injected into the subcutaneous  tissue. This contains low concentrations of epinephrine and lignocaine. Cannulas are then used to suction the fat through tunnels formed in the tissue. The excess fluid causes blood vessels to constrict lessening the risk of bleeding.

1.  Purification- The material collected during liposuction can contain blood, plasma, lysed fat cells and Klein’s solution. Either gravity separation or centrifugation can separate out pure fat. 

2.       Injection of fat into the buttocks- Fat is injected by trochars into multiple areas of the buttock. The fat is injected into the subcutaneous tissue, not into muscle.

Our patient had a large abscess in the R buttock.  An I+D was performed by extending the area where it was originally draining. While the culture showed mixed organisms,  gram negative bacilli predominated.  This was identified as Prevotella which is in the same phylum as Bacteroides.   The patient is still hospitalized.

FUN FACT

You can kill the fat cells injected into the buttocks by wearing tight clothing or sitting on the buttocks before healing takes place.

 Pazmino P, Garcia O.   Brazilian butt lift – associated mortality: the south Florida experience Aesthet Surg J. 2023.  Feb;43(2);162-178.

 Toledo LS. Gluteal augmentation with fat grafting. The Brazilian buttock technique: 30 years’ experience. Clin Plast Surg. 2015;42(2):253–261. doi: 10.1016/j.cps.2014.12.004 

 Siva D. Embodying Modernity: race, Gender and Fitness culture in Brazil.  University of Pittsburgh Press, 2022.

https://www.wahingtonpost.com/made-by-history/2022/08/01/hidden-anti-black-history-brazilian-butt-lifts/is injected into each buttock.