First buttock implant report
Bartels and colleagues reported an unusual use of the Cronin breast prosthesis. A 2017 review of 52 gluteal augmentation studies starts in 1969.[1][2]
Home / Procedures / Brazilian Butt Lift / History
History
From the first buttock implant in 1969 to the Florida ultrasound law of 2023: the steps that changed the operation.
Timeline
Bartels and colleagues reported an unusual use of the Cronin breast prosthesis. A 2017 review of 52 gluteal augmentation studies starts in 1969.[1][2]
Toledo began injecting large volumes of fat into the buttocks in 1985 and first presented the Brazilian buttock technique in 1987.[1]
Vergara described placing buttock implants inside the gluteus maximus, a plane he reported as safe and reproducible.[1]
Gonzalez published the XYZ method for intramuscular implants in 746 patients. De la Pena published the subfascial pocket the same year.[1][2]
In Mexico, 413 surgeons reported 13 deaths from gluteal fat injection, and Colombian records documented 9 more. Autopsies found fat emboli and fat in the injected gluteal muscles.[1]
A survey of 692 surgeons covering 198,857 cases reported 32 deaths and 103 nonfatal fat emboli. The task force advised against deep muscle injection, cannulas smaller than 4 mm and pointing the cannula down.[1]
The Multi-Society Task Force issued a practice advisory on January 31, 2018, and ASPS put the death rate as high as 1 in 3,000. Cadaver studies that year showed fat injected into muscle migrates under it, and the first real-time ultrasound series was published.[1][2][3]
The Board filed an emergency rule on June 27, 2019, prohibiting fat injection across the gluteal fascia. A permanent rule took effect September 3, 2019, and a 2020 amendment deleted the word superficial from the fascia named in the rule.[1][2][3]
After the 2017 recommendations, surgeons injecting into deep muscle fell from 13.1% to 0.8%, and the reported death rate trended from 1 in 3,448 to 1 in 14,952.[1]
An April 2022 practice advisory recommended ultrasound documentation of the cannula and a limit of 3 BBL cases a day. Florida emergency rule 64B8ER22-3, published June 16, 2022, required both for office surgery.[1][2]
CS/CS/HB 1471, chapter 2023-307, took effect July 1, 2023. It wrote subcutaneous-only injection, ultrasound guidance and one physician per patient into s. 458.328, Florida Statutes.[1][2]
CS/HB 1561, chapter 2024-181, took effect May 10, 2024. Offices that perform gluteal fat grafting must show added financial responsibility.[1][2]
Pioneers
Their papers set the methods and safety rules in use today.
Began large-volume fat injection to the buttocks and presented the Brazilian buttock technique.[1]
Led the ASERF Task Force mortality survey of 198,857 gluteal fat grafts and a survey of 2,226 buttock implant patients.[1][2]
Showed in cadavers that fat in the muscle migrates under it, described expansion vibration lipofilling, and co-wrote the 2022 practice advisory and SIME.[1][2][3]
Co-developed expansion vibration lipofilling and showed that fat above an intact gluteal fascia stays subcutaneous.[1][2]
Published real-time ultrasound-assisted gluteal fat grafting and a 12-month ultrasound study of subcutaneous-only grafting.[1][2]
Miami surgeon who analyzed 25 South Florida BBL deaths and co-described SIME in 4,150 ultrasound-guided BBLs.[1][2]
Documented BBL deaths in Mexico and Colombia and linked them to intramuscular fat and gluteal vessel injury.[1][2]
Described the XYZ method for intramuscular buttock implants in 746 patients.[1]
Described the intramuscular plane for buttock implants.[1]
Described the subfascial implant pocket for buttock implants.[1]