Risk and Reward: Public Perception of Gluteal Fat Grafting
Darya Fadavi, BS, Waverley He, BA, Franca Kraenzlin, MD, Pragna N. Shetty, MPH, Karan Chopra, MD, Justin M. Sacks, MD, MBA, FACS.
Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, USA.
BACKGROUND: Buttock augmentation via autologous fat grafting (colloquially known as “Brazilian Butt Lift” or “BBL”) is a rapidly growing aesthetic procedure in the United States. However, BBL has the highest mortality rate of any cosmetic procedure, with 1 in 3,000 procedures resulting in death. Fat can be accidentally lipoinjected beneath the gluteal muscles, introducing fat emboli to the circulation through gluteal vessels. This study aims to understand sociodemographic factors influencing perception of BBL procedures among adult women, and to investigate whether education about the mortality risk of BBL changes willingness to receive the procedure.
METHODS: The survey was administered through Qualtrics. 489 female participants located in the United States were identified through Amazon Mechanical Turk. Survey participants were given $0.25 for completed questionnaires. The survey included questions regarding demographics, experience with cosmetic procedures, and opinions of buttock shape. Participants were given step-wise information about the BBL procedure, its safety record, its safety compared to other common procedures, and the most common manner of death (embolus), and after each piece of information, were asked about their willingness to undergo a BBL.
RESULTS: Of individuals surveyed, 78.1% found the BBL death rate to be higher than expected. Regarding change in participant willingness to receive a BBL from the beginning to the end of the survey: 96 participants changed from willing to unwilling, 81 remained willing, 308 remained unwilling, 4 changed from unwilling to willing. Learning about the death rate, safety concerns amongst surgeons, and fat emboli as the main cause of death decreased overall participant willingness (Figure 1). Individuals who had previously considered a BBL and self-identified as being unhappy with their buttock shape or size were more likely than individuals happy with their body shape to continue to desire a BBL (OR 5.44, p<0.001).
CONCLUSIONS: Providing information regarding death rates, community safety concerns, and manner of death changed the survey participants’ willingness to undergo this procedure. However, individuals that self-identified as being unhappy with their buttock shape were much more likely to continue to desire a BBL. This study highlights that individuals who are unhappy with their body shape may accept high levels of risk to improve their looks, thereby fundamentally compromising the informed consent process. Therefore, it behooves the surgical community to potentially regulate this procedure and improve safety using evidence based risk-reduction techniques. Patient education regarding risks for the BBL procedure is critical for an optimal informed consent process. 
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