Risk and Reward: Public Perception of Gluteal Fat Grafting Safety

Abstract

Background

This study aims to understand how sociodemographic factors influence perceptions of “Brazilian Butt Lift” (BBL), the cosmetic procedure with the highest reported mortality rate, among adult women. We also investigate whether education about risks changes willingness to receive this procedure.

Methods

A Qualtrics© survey including education about BBL was administered on Amazon Mechanical Turk, with inclusion criteria of female sex.

Results

Survey data from 489 female participants were included. 78.1% of participants found the BBL mortality rate to be higher than expected. 70.1% of the original 177 willing or neutral participants became unwilling to undergo a BBL after education. Multivariate logistic regression indicated that individuals who were more willing to undergo BBL after education were individuals who have a diagnosis of body dysmorphic disorder (OR 60.5, p = 0.02) or have an acquaintance who received a BBL (OR 230.2, p < 0.01).

Conclusions

Overall, survey participants were less willing to undergo BBL after learning its risks, indicating the critical role of patient education during informed consent. Additionally, individuals who are unhappy with their body shape, or who feel cultural or social pressure to attain a certain body shape, may accept higher levels of risk to improve their looks, suggesting patient motivation for the procedure may limit even the most effective informed consent process. In light of these findings, the surgical community may consider regulating the BBL procedure and improving safety using evidence-based risk reduction techniques. Ensuring that patients fully understand the risks associated with the BBL procedure is critical for both surgeon and patient.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Appendix: BBL Survey

Q1 What is your age?

• 18

• …

• Over 100

Q2 Choose one or more categories you identify as:

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or Pacific Islander

• Hispanic or Latino

• Other

Q3 What is the highest level of school you have completed or the highest degree you have received?

• Less than high school

• High school graduate

• Some college

• College degree

• Masters degree

• Professional degree

• Doctorate

Q4 What is your approximate household income?

• Less than $24,999

• $25,000–$49,999

• $50,000–$74,999

• $75,000–$99,999

• More than $100,000

Q5 Do you alter your image for social media by using applications such as Photoshop or Facetune?

• All the time

• More than half of the time

• Half of the time

• Less than half of the time

• Never

Q6 Have you ever been diagnosed with body dysmorphia?

• Yes

• No

• Don't know

Q7 Have you ever had a cosmetic surgical procedure?

• Yes

• No

Q8 Do you personally know someone who has ever had a cosmetic procedure?

• Yes, a family member/friend

• Yes, an acquaintance

• No

Q9 Would you ever consider undergoing a cosmetic procedure of any kind?

• Yes

• No

Q10 Have you undergone a Brazilian Butt Lift, also known as a BBL?

• Yes

• No

Q11 Do you know anyone else who has undergone a BBL?

• Yes

• No

Q12 How would you describe your feelings regarding the size and shape of your buttocks?

• I am happy with the shape and size of my buttocks

• I am neither happy nor unhappy

• I am unhappy with the shape and size of my buttocks, and have thought about altering them through plastic surgery

• I am unhappy with the shape and size of my buttocks, but would not consider altering them through surgery or other procedures

Q13

 

Focusing on the buttock area, which buttock shape is most appealing to you?

• A

• B

• C

• D

• E

Q14

 

Focusing on the buttock area and waist, how appealing is the above body shape to you?

• Very appealing

• Appealing

• Neutral

• Unappealing

• Very UNAPPEALING

Q15 A Brazilian Butt Lift (BBL) is a buttock injection procedure in which fat is liposuctioned from the back, abdomen, flanks, and inner thigh, and reinjected into the buttocks to achieve a fuller and rounder look of the buttock while simultaneously slimming the waist. The surgery can last from 2–6 h. Patients typically have very small incisions that can be easily hidden and are sent home the same day after surgery. Recovery at home can take several weeks as patients heal from the liposuction they receive. To prevent fat death after injection into the buttock area, patients are advised to sleep on their stomachs and to not put direct pressure on their buttocks for 2–4 weeks after the procedure.

 

For the remainder of the survey, please do not consider cost as a factor. Please answer questions as though the described surgeries would be free to you.

How willing would you be to have this procedure?

• Definitely willing

• Probably willing

• Neutral

• Probably not willing

• Definitely not willing

Q16 What do you consider to be the highest acceptable death rate to still consider this surgery safe for patients?

• 1 death in 100 surgeries

• 1 in 1000

• 1 in 10,000

• 1 in 100,000

• 1 in 1,000,000

Q17 The true death rate of a BBL procedure is approximately 1 death in 3000 surgeries.

After learning this information, how willing would you be to undergo this procedure?

• Definitely willing

• Probably willing

• Neutral

• Probably not willing

• Definitely not willing

Q18 Does a death rate of 1 in 3000 appear higher or lower than what you expected?

• Higher than I expected

• About what I expected

• Lower than I expected

Q19 Other procedures that carry similar death rates are kidney donation and bariatric surgery. The death rate of liposuction alone is 0.57 deaths in 3000 surgeries. Removing your appendix has a risk of death of 2.4 in 3000 surgeries. Breast surgery for cancer removal has a risk of death of 3.8 in 3000 surgeries.

After learning this information, how willing would you be to undergo a BBL procedure?

• Definitely willing

• Probably willing

• Neutral

• Probably not willing

• Definitley not willing

Q20 Many hospitals do not allow their surgeons to perform BBLs because of the high risk of death associated with this procedure. The academic community feels death rates from cosmetic procedures should approach zero.

After learning this information, how willing would you be to undergo this procedure?

• Definitely willing

• Probably willing

• Neutral

• Probably not willing

• Definitely not willing

Q21 Deaths from BBLs typically occur because fat is inadvertently injected into a vein and then pumped up to the heart and lungs. The patient suffocates as the fat blocks unoxygenated blood from returning to the lungs.

After learning this information, how willing would you be to undergo this procedure?

• Definitely willing

• Probably willing

• Neutral

• Probably not willing

• Definitely not willing

Q22 A board-certified surgeon has undergone surgical training for a minimum of 6 years and passed an oral and written exam administered by the American Board of Plastic Surgery. A board-certified surgeon also has to demonstrate competency with a specific range of surgical procedures. Currently, there is no evidence that a Board Certified Doctor has lower death rates than a non-board certified doctor. However, a board certified doctor has met a threshold of competency set by the board.

If you were to receive a BBL procedure, how important is it for you that your doctor is a board-certified surgeon?

• Very important

• Moderately important

• Slightly important

• Not at all important

Q23 When choosing a surgeon to perform your BBL, how important are the following? Drag and drop the following choices to rank them in order of importance (1 is most important).

• Board-certified surgeon

• Price of the procedure

• Images of previous results

• Location of surgeon

• Surgeon safety record

Q24 Has the information provided in this survey changed your likelihood of receiving a BBL procedure?

• I am significantly more likely to get a BBL

• I am more likely to get a BBL

• No, it did not change my mind

• I am less likely to get a BBL

• I am significantly less likely to get a BBL