In July, a new law intended to reduce the unusually high number of deaths from Brazilian butt lift procedures in Florida took effect.
Between 2010 and 2022, 25 deaths were recorded in South Florida alone. The Brazilian butt lift, or BBL, is the deadliest procedure in plastic surgery, and also one of the most popular — between 2011 and 2021, BBLs increased from 3,700 to more than 61,000 nationwide, according to the Aesthetic Plastic Surgery National Databank.
The efficacy of the new regulations will be tested in the coming months as patients — almost all women — continue to seek out discount procedures in Miami.
“The law has all our hopes on it, because for the longest time Florida has stood out for having so many problems,” Pat Pazmiño, M.D., a board-certified plastic surgeon who runs a clinic in Miami, tells The Messenger.
“Ninety-two percent of the deaths in South Florida happened in high-volume clinics,” says Dr. Pazmiño, who published a study in February that examines the causes of these deaths.
Miami’s low-budget, high-volume clinics
“The average price for a BBL is between $9,000 and $13,000,” Dr. Pazmiño says. But some of the low-budget clinics charge as little as $3,000, according to their websites.
“That's a huge, huge, huge difference. And I would say that's not just low. I think that's dangerously low. And that would raise concern,” he adds.
To offset the low cost, many of these clinics increase the volume of procedures, some doing eight to 10 in one day — and causing surgeons to work dangerously fast, the study finds.
Even experienced and skilled plastic surgeons have difficulty performing a safe procedure in such a short time, Pazmino says. The study found board-certified plastic surgeons were responsible for two-thirds of the BBL deaths, but the majority of them were working in Miami’s budget clinics.
“That's why we don't hear about this in the rest of the country, because when experienced doctors are doing this, but not in a high-volume clinic, it's not an issue,” Dr. Pazmiño says.
“It’s incredible that this problem that’s affecting the state, that’s affecting the country, is isolated to a section of a street here in Miami.”
Most of these budget clinics are clustered just south of the Miami airport, making them easy to access for medical tourists — people who fly into South Florida specifically to have the procedure done. A map search shows that clinics line SW 8th Street central Miami.
Just two of the deaths occurred at a non-budget clinic.
Medical professionals say bargain-hunting for elective surgeries is dangerous — many have died from various procedures done abroad for cheap, in addition to the budget BBLs in Miami.
How will the new law help?
The legislation, which was passed unanimously by the Florida State Senate and was signed by Governor Ron DeSantis at the end of June, requires doctors to use an ultrasound to guide them during the fat transfer.
“When you use the ultrasound, you can see where your instrument is at all times,” he says.
Without an ultrasound machine, “it’s a blind procedure,” Dr. Pazmiño says.
When surgeons perform a BBL blind, they may accidentally inject fat into the gluteus maximus muscle — the body's largest muscle that stretches across the butt and helps to control hip and thigh movement — and one which has many large veins. If doctors inadvertently damage a vein, it may allow fat to get into the bloodstream and enter the heart and lungs, causing a pulmonary fat embolism (PFE), which is the cause of death in most of the cases studied.
A PFE can cause death during the operation or a few hours after the surgery.
The law also requires the surgeon to meet the patient at least 24 hours prior to the procedure, which was not the standard in some clinics.
“Before, in these high-volume clinics, it was routine for the patient to meet the surgeon a few minutes before they go into the operating room. And it's simply not possible to evaluate a patient, establish rapport, communicate what you're going to do — when it’s a few minutes before you go into the operating room."
This is not a tattoo. This is going to be a life-changing surgery.
Further, the law requires the surgeon to be in the operating room during the entire procedure. The study found that some surgeons in budget clinics were allowing less trained staff to operate on patients while they oversaw multiple procedures.
“It's so crazy that you have to legislate that,” he says. “Now these deaths, we really consider them the tip of the iceberg when it comes to BBL injuries. And so we think there are many, many more patients that are injured that do not die.”
The tip of the iceberg
Dr. Pazmiño says it’s much harder to gather the data on BBL injuries, because patients do not always go to the hospital. For those that do, they may seek care at one of the many hospitals in Miami or back in their hometown if they traveled for the procedure.
Not only are doctors around the country reporting that patients who traveled to Miami for a budget BBL are returning home with serious complications, but Dr. Pazmino says that more budget clinics are opening up in other states and cities.
“Our study is a warning to other communities,” he says.