Days after undergoing cosmetic surgery, Chelsea was in a Philadelphia emergency room with what looked like a third-degree burn. The skin around her thighs had turned black, hardened and blistered. The burning sensation was so intense that she had difficulty breathing.
Chelsea, 29, had undergone an increasingly popular cosmetic procedure called a Brazilian butt lift, where fat is liposuctioned from one part of the body – usually the abdomen or thighs – and then injected into the buttocks in the hope to give the patient an hourglass figure.
“I was hoping to do a mommy makeover and it turned into a complete nightmare,” said Chelsea, who didn’t want to use her last name for fear of hurting her career prospects. Before the operation, she was studying to become a nurse. These days, she can’t sit down without feeling a burning sensation.
The Brazilian butt lift is one of the most dangerous aesthetic procedures. In 2017, it had the highest mortality rate of any cosmetic surgery in the United States, according to a group of leading clinical plastic surgery companies. Patients have been left paralyzed following surgery or are experiencing long-term pain due to nerve damage. A task force that looked into the high mortality rate of Brazilian facelifts found that around 3% of surgeons experienced patient death after the procedure.
Despite this, as curvy influential celebrities like the Kardashians fill social media feeds, Brazilian butt lifts have only grown in popularity. Globally, buttock augmentation – including silicone implants – was a $1.5 billion market in 2020, according to Grand View Research, which forecasts the market to grow 22% annually and reach $6.6 billion by 2028. In recent years, the number of surgeries has “increased dramatically,” said Lina Triana, president-elect of the International Society for Aesthetic Plastic Surgery. In 2020, more than 40,000 Butt lifts were performed by board-certified plastic surgeons in the United States, twice as many as five years ago, according to the latest statistics from ISAPS.
These surgeries are not cheap, nor are they covered by insurance. The average cost for a Brazilian butt lift is $4,807, according to statistics from the American Society of Plastic Surgeons. That price doesn’t even cover “anesthesia, operating room facilities, or other related expenses,” an SSPA spokesperson said.
The alarming number of problems with Brazilian lifts is largely the result of a lack of regulation. Although plastic surgery and cosmetic surgery may seem synonymous, they are not. In the United States, a few months of training gives doctors the right to call themselves cosmetic surgeons. On the other hand, a plastic surgeon certified by the American Board of Plastic Surgery requires at least six years of specialized training.
The practice of medicine requires a license issued individually by each state. But the requirements are more vague when it comes to medical specialties. The federal government does not oversee the training and certification of specialists. Instead, the American Council on Graduate Medical Education provides standards for graduate medical education in all specialties. After graduating from specialty-specific residency training, independent, nonprofit organizations called specialty commissions offer multi-year residencies or fellowships to physicians who wish to demonstrate competence in a particular area of medicine. Board certification can give a doctor the privileges and credibility of the hospital. Yet, this is an entirely voluntary process.
To complicate matters further, not all advice is created equal. The American Board of Medical Specialties, widely recognized as the gold standard for certifying physicians, recognizes only 24 boards that meet the criteria for specialty medicine. One such board includes the American Board of Plastic Surgery, which requires its physicians to undergo solid training and perform thousands of operations over a period of six years or more before obtaining certification.
But there are many other boards that do not meet the nationally recognized AMBS standards. The American Board of Cosmetic Surgery, for example, allows physicians to qualify as board-certified cosmetic surgeons after a one-year fellowship that includes performing a minimum of 300 cosmetic procedures and passing a two-year exam. days. The American Board of Cosmetic Surgery did not respond to a request for comment for this story.
The doctor who operated on Chelsea was not a board-certified plastic surgeon.
“You can pay fifty dollars to have a plaque on your wall that says you’re board certified,” said Susan Witt, a medical malpractice attorney representing several women who have experienced the worst side of this problem in Georgia, including including Chelsea, who traveled to Georgia to get surgery from an Instagram-famous doctor. Often, patients seeking physicians simply don’t know that those physicians have minimal surgical training.
This blind spot is part of what makes the Brazilian butt lift so dangerous. It can lead to serious health problems and even death if an unqualified doctor uses improper techniques. For example, if fat is mistakenly injected into the wrong place, it can travel to a person’s heart or lungs, resulting in immediate death.
Chelsea experienced something called fat necrosis after her surgery. The flow of oxygen to certain tissues in his body became restricted, causing cells to die. Fat necrosis is one of the most serious things that can go wrong with a Brazilian butt lift. It is usually caused by poor technique on the part of the surgeon.
It’s not just cosmetic surgeon referrals that aren’t regulated. In some states, doctors are free to perform surgery in any practice, whether or not the facility is equipped to handle any complications that may arise. And doctors without good credentials are likely to be barred from performing cosmetic surgeries in establishments with strict vetting processes, such as hospitals.
In Georgia, neither the attorney general nor the state medical board oversees medical practices. Witt, the attorney, has lobbied publicly to change that, including advocating for the creation of a regulatory body to conduct office inspections and investigate complaints. The Georgia Composite Medical Board does not currently audit office surgeries, but said through a spokesperson it has taken steps in recent years to improve safety by updating guidelines. for doctors. In 2021, the council was given the power to set more recommendations for in-office surgery. Some newly proposed rules are awaiting final approval. Guidelines and regulations for in-office surgeries exist in 34 US states and Washington, DC – the rest are completely unregulated. The regulations that exist also differ from state to state and vary greatly in terms of strictness.
For the average consumer, it is difficult to assess whether a physician has the correct board and facility credentials. Opportunistic and underqualified practitioners capitalize on this information asymmetry.
“You have doctors who can’t make a living doing what they do, so they get into cosmetics. Why? It’s a cash cow. There’s no insurance involved. You want it, you pay for it,” said William Rosenblatt, president of the American Association for Ambulatory Surgical Facility Accreditation.
“We see horror stories all the time,” added Rosenblatt, who is also a plastic surgeon. Although there is some risk associated with any surgery, the buttock lift death rate in Brazil had become so alarming that in 2017 several plastic surgery companies joined forces to create a task force designed to tackle the problem.
They discovered that part of the standard surgical technique for butt lift surgery created unnecessary risk. Instead of injecting fat into the muscle, which can send the fat directly to the heart or lungs if a vein is mistakenly punctured, they instead recommended injecting the fat into the tissue between the skin and the muscles. from the body. They also recommended using larger surgical instruments that are less likely to puncture a vein.
In light of the recommendations, buttock lifts have become less lethal, at least among board-certified plastic surgeons. The most recent survey of board-certified surgeons showed the death rate for buttock lifts fell to 1 in 15,000 surgeries in 2019 from 1 in 3,000 surgeries in 2017, putting it at a risk level similar to that of an abdominoplasty.
But the death toll may be far higher than the numbers suggest, given that a doctor doesn’t have to be a board-certified plastic surgeon to perform a buttock lift — and it’s unclear whether physicians who are not would have adopted the new procedures. . Physicians do not need to report cosmetic procedures that result in hospital transfers or deaths to these various companies. And the lack of state and federal surveillance means that deaths and serious adverse events are not collected centrally, making it difficult to determine their frequency.
A big part of the problem, said Thomas Terranova, executive director of the American Association for Accreditation of Ambulatory Surgical Facilities, is that cosmetic surgeries simply aren’t considered an invasive and life-threatening medical procedure.
“It’s considered a vanity project like hair, nails, makeup,” he said. “So there’s this lack of sobriety when we assess it and I think ultimately that’s one of the big challenges.”
A year after the operation, Chelsea are still not fully recovered. She experiences burning sensations in her back, stomach and buttocks. Nerve damage and urinary incontinence impacted his social life. She sees a therapist every week now to deal with the trauma.
“I don’t want to do much,” Chelsea said. “Funny outgoing Chelsea is dead right now and I have to bring her back to life.