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Recovery and risks
A BBL result is visible at once and settles over about a year. ASPS says patients keep 60 to 80% of the transferred fat on average. A 2001 series reported 50 to 75% retained, and a 7,000-case series estimated about 70%.
Recovery
In Florida the operating physician must examine the patient in person no later than the day before a BBL. Delegating any duty during the operation needs the patient's written consent, and fat removal and injection cannot be delegated. An office doing liposuction over 1,000 cc or Level II or III surgery must be registered with the Department of Health.[1][2]
Fatal fat embolism happens during injection or soon after: of 13 deaths in Mexico, 8 occurred during fat injection and 5 within 24 hours. Signs are low oxygen, low blood pressure and slow heart rate. ASPS advises immediate care for shortness of breath, chest pain or unusual heartbeats. Patients may go home after a few hours, with drains and a support garment.[1][2][3]
ASPS advises avoiding prolonged sitting for about two weeks, sleeping face down or on the side, and sitting with a cushion behind the thighs to keep pressure off the grafts. The support garment is worn around the clock.[1]
Most patients can return to exercise after six to eight weeks, according to ASPS. Some surgeons recommend lymphatic massage.[1]
Final results show at about one year, after part of the fat is absorbed. In 50 patients, gluteal fat thickness was 18.2% lower at 12 months than right after surgery.[1][2]
Risks
The 2017 survey found 32 deaths in 198,857 cases, and 3% of responding surgeons had a patient die. After the advisories, the reported rate trended from 1 in 3,448 to 1 in 14,952. BAAPS puts the current estimate near 1 in 15,000, similar to a tummy tuck.[1][2][3]
The Florida Department of Health counted 21 office-surgery BBL deaths from 2015 to 2022, 10 of them in the 36 months after the 2019 rule. A Miami study counted 25 South Florida deaths from 2010 to 2022; 92% followed surgery at high-volume budget clinics with operations of about 90 minutes.[1][2]
In 16 fatal cases, all had microscopic fat emboli and the most severe had large fat emboli. The volume of fat removed or injected had little influence. Miami-Dade medical examiners traced 8 of 10 deaths after gluteal cosmetic procedures to fat transfer.[1][2]
A review of 3,567 fat grafting patients found seroma in 3.5%, under-correction 2.2%, infection 2.0% and pain or sciatic pain 1.7%. A meta-analysis of 6,235 ultrasound-guided cases found seroma in 2.9% and infection in 0.2%.[1][2]
Part of the grafted fat is absorbed; ASPS says patients keep 60 to 80% on average. In a 7,000-case series, fat necrosis followed 1.9%, asymmetry 0.3% and revision 0.2%.[1][2]
In 2,226 implant patients, surgeons counted 848 complications (38.1%). Wound dehiscence was most common at 9.6% in a review of 2,375 patients, followed by seroma at 4.6%.[1][2]
FDA has not approved injectable silicone or any filler for body contouring and warns against filler in the buttocks. Silicone injections can cause scarring, embolism, stroke and death.[1]
BAAPS reports higher risk for patients who have surgery at unregulated facilities or abroad, including hypothermia, sepsis and skin necrosis.[1]
How long results last
A BBL result is visible at once and settles over about a year. ASPS says patients keep 60 to 80% of the transferred fat on average. A 2001 series reported 50 to 75% retained, and a 7,000-case series estimated about 70%. With subcutaneous-only grafting, gluteal fat thickness rose 56.5% after surgery and lost 18.2% of that by 12 months. Grafted fat grows or shrinks with body weight.[1][2][3]