The Brazilian butt lift, a buttock augmentation that uses the patient's own fat, earned its reputation when a large surgeon survey linked gluteal fat grafting with significantly higher mortality rates than any other aesthetic surgical procedure[1][2].
A review of the international literature found that the main reason for death in 2015 was fat embolism to the lungs related to grafting fat into or beneath the buttock muscle[3]. After the 2017 task force recommendations on safer technique, a follow-up survey found that trends indicated a decrease in the mortality rate from 1 in 3448 in 2017 to 1 in 14,952 in 2019[4].
For liposuction performed on its own, see our separate guide on whether you can die from liposuction.
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The Brazilian butt lift gained that label because survey and review data reported a higher death rate for gluteal fat grafting than for other aesthetic procedures[2][5].
In a task force survey sent to 4843 plastic surgeons worldwide, 692 responding surgeons reported 198,857 cases of gluteal fat grafting and, over their careers, 32 fatalities from pulmonary fat emboli[2]. The same responding surgeons reported 103 nonfatal pulmonary fat emboli[2].
The task force also confirmed 25 fatalities in the United States over the previous five years through autopsy reports and interviews with surgeons and medical examiners[2].
A retrospective safety study from an Oslo clinic stated that the rate of death after gluteal augmentation with fat is the highest compared with other aesthetic procedures, at 1 in 3448 patients compared with 1 in 55,000[3]. The same study reported that use of gluteal augmentation with fat increased by 3267% from 2002 to 2015[3].
A 2023 survey study stated that the number of Brazilian butt lift fatalities remained high in the United States despite numerous practice advisories aimed at patient safety[6].
Fat embolism during a Brazilian butt lift happens when injected fat passes into injured gluteal veins and causes a pulmonary embolism, a blockage in the lungs[1][7].
The gluteal veins lie deep to the buttock muscles, and avoiding intramuscular injection of fat has been suggested as a way to prevent fat embolism deaths[7].
A 2026 narrative review attributed the higher mortality of gluteal fat grafting to three interacting factors: significant intramuscular gluteal veins, the grafting technique, and the amount of fat transferred[8]. The same review found that breast and facial fat grafting are associated with significantly lower risks of pulmonary fat embolism[8].
Macro fat emboli, defined as fat emboli larger than one centimetre in diameter, can quickly cause catastrophic heart and lung compromise and death[1]. Few survivors of such events have been reported because macro fat emboli are almost universally lethal, although a 2022 report described two patients who survived after rapid transfer to a tertiary care setting[1].
Current guidelines emphasize that fat grafting should remain in the subcutaneous layer, the fat that sits above the buttock muscle, and should avoid intramuscular injection[9][7].
Based on the 2017 survey, the task force recommended avoiding fat injections into the deep muscle, avoiding cannulae smaller than 4 mm, and not pointing the injection cannula downwards[2].
A multi-society task force released a practice advisory on January 31, 2018, after several highly publicized patient deaths, and produced a second advisory in August 2019[10].
A 2022 practice advisory recommended ultrasound-guided documentation of cannula placement before and during fat injection, and a limit of 3 Brazilian butt lift cases as the maximum total operative cases per day[10]. The case limit followed an observation that in Florida the majority of Brazilian butt lift deaths occur at the end of the week, which the authors said most likely reflects fatigue or distraction[10].
In the UK, the British Association of Aesthetic Plastic Surgeons set its advice against Brazilian butt lift surgery in October 2018[11]. In a later survey of its members, 96.9% of respondents performed only subcutaneous fat injections, and 66.7% felt the association should keep its recommendation against the operation until further data became available[11].
A follow-up surgeon survey suggests the guidance changed technique and was followed by fewer reported pulmonary fat emboli[4].
In the two years after the 2017 recommendations were published, the incidence of any pulmonary fat embolism was 1 in 2492, compared with 1 in 1030 reported in 2017[4]. Over the same comparison, trends indicated a decrease in the mortality rate from 1 in 3448 in 2017 to 1 in 14,952 in 2019[4].
Only 0.8% of surgeons in the newer survey reported injecting into deep muscle, compared with 13.1% in 2017[4]. Only 4% reported angling the cannula down, compared with 27.2% in 2017[4].
The picture is not uniformly reassuring, because a 2023 survey of US board-certified plastic surgeons found that 48% of the respondents who performed Brazilian butt lifts did not use ultrasound[6]. That survey had a response rate of 10%[6].
Ultrasound lets the surgeon watch the cannula and the tissue layers in real time, to confirm that fat is placed in the subcutaneous layer[12][13].
In a 2018 study of 15 consecutive female patients, real-time ultrasound accurately and reliably identified the planes of fat injection, and all injections were subcutaneous[12]. The downsides reported in that study were the purchase cost of the ultrasound device, increased surgical time, the need for an assistant to follow the cannula, and the learning curve[12].
A 2025 meta-analysis of four studies with a total of 6235 female patients found no reported mortality or fat embolism with ultrasound-guided gluteal fat grafting[9]. In that pooled analysis, minor complications occurred at a rate of 6.32 per 100, with seroma at 2.94 per 100 and infection at 0.23 per 100[9].
A 2026 scoping review identified nine studies, consisting mostly of observational case series, and found no randomized or high-quality comparative studies[13]. The scoping review reported no cases of fat embolism or procedure-related mortality, and concluded that ultrasound appears to be a useful safety adjunct but that current evidence is limited and primarily non-comparative[13].
Researchers have also described adding artificial intelligence to handheld ultrasound to help with tissue-layer recognition, while noting that larger datasets are needed to validate its impact on outcomes[14]. Another proposed tool is a cannula that uses impedance sensing to detect when its tip leaves the subcutaneous plane and enters muscle[7].
Ultrasound is not required everywhere, and approximately 60% of respondents in the 2023 US survey disagreed with imposing regulations to require ultrasound[6].
A recent large series using strict subcutaneous-only injection reported zero embolic events[15].
A retrospective review of 7,000 consecutive Brazilian butt lift procedures performed between 2018 and 2024 with a subcutaneous-only protocol reported no pulmonary fat embolism, fat embolism syndrome, deep vein thrombosis or pulmonary embolism[15]. Minor complications in that series included seroma in 23%, anemia in 6.6%, fat necrosis in 1.9% and infection in 0.43%[15].
Another series of 3000 patients treated between 2018 and 2022 combined liposuction of the abdomen, back and waist with fat transfer to the hips and buttocks[16]. That series reported one serious complication and some minor complications, all managed through conservative measures, and 86% of patients expressed satisfaction with their outcomes[16].
A smaller report described 47 gluteal lift operations in 32 female patients under local anesthesia over 52 months, with no deaths or complications[17].
The authors of the 3000-patient series concluded that the operation is safe when performed by experienced surgeons who adhere to fundamental principles[16].
Some reviews now place the mortality risk of a Brazilian butt lift close to that of abdominoplasty, or tummy tuck, but a 2023 survey still described fatalities in the United States as high[18][19][6].
A British safety review stated that the risk of death from fat embolism was previously reported as 1 in 2500 and was later estimated to be nearer 1 in 15,000, similar to the mortality risk in abdominoplasty[18].
A 2021 literature review concluded that abdominoplasty and the Brazilian butt lift appear to have similar safety based on mortality, although the nature of their deaths differs[19]. In that review, most abdominoplasty deaths followed deep venous thrombosis or pulmonary embolism, while Brazilian butt lift deaths were associated with pulmonary fat embolism caused by the procedure itself[19].
Accurate mortality estimates are limited because the total number of Brazilian butt lift procedures is hard to determine, partly because most of these cases are performed at budget clinics[1]. A 2026 review also pointed to a lack of uniform complication reporting and called for mandatory complication registries[8].
Beyond fat embolism, a British review listed hypothermia, sepsis, skin necrosis and poor aesthetic results as serious risks of gluteal fat grafting[18].
Across breast and gluteal fat grafting, the majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention[20]. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fat necrosis[20].
The overall complication rate of the Brazilian butt lift has been reported as ranging from 1.5% to 6.8%[1].
Gluteal implants, the other main technique for buttock augmentation, also have significant limitations and problems of their own[5].
Our overview of the Brazilian butt lift and our guide All About Fat Transfer may help as you prepare questions.
The setting appears to matter, because complications are better controlled and managed in strictly regulated healthcare settings[18].
Patients seeking surgery at unregulated facilities or through medical tourism are deemed to be at higher risk of serious complications or inadequate subsequent management[18].
In the UK member survey, 20.6% of 102 respondents had treated Brazilian butt lift complications, the majority as a result of surgical tourism[11].
US plastic surgeons surveyed in 2023 named high-volume budget clinics among the greatest contributors to Brazilian butt lift mortality[6].
Knowing the risks can change decisions: in an online survey of 489 women, 78.1% found the Brazilian butt lift mortality rate higher than expected, and 70.1% of the 177 initially willing or neutral participants became unwilling after education[21].
Early recognition and immediate aggressive support of vital functions are key for survival after a large fat embolism[1].
If you notice chest pain, sudden shortness of breath, confusion or fainting during or after surgery, contact emergency services right away.
If you develop a fever, spreading redness or a rapidly growing swelling, contact your surgeon or emergency services right away.
Questions like these can help you understand how a board-certified surgeon approaches safety:
Our page FAQ: Choosing A Surgeon offers more questions to bring to a consultation.
Gluteal fat grafting is associated with rare but potentially fatal complications, particularly fat embolism related to inadvertent intramuscular injection[13]. Surgeon surveys found that trends indicated a decrease in the mortality rate from 1 in 3448 in 2017 to 1 in 14,952 in 2019 after new safety recommendations[4].
The gluteal veins lie deep to the buttock muscles, and injury to these veins resulting in fat emboli has been identified as the cause of gluteal fat grafting deaths[7]. Guidelines therefore emphasize keeping fat in the subcutaneous layer and avoiding intramuscular injection[9].
A meta-analysis of four studies with a total of 6235 female patients found no reported mortality or fat embolism with ultrasound-guided gluteal fat grafting[9]. A later scoping review called ultrasound a useful safety adjunct but said current evidence is limited and primarily non-comparative[13].
The fatal fat embolism risk discussed here was linked to gluteal fat grafting, with intramuscular gluteal veins, grafting technique and the amount of fat transferred as contributing factors[8]. Ask your surgeon about the separate risks of liposuction performed alone.