The perfect body, in Diana Dayyani’s estimation, belongs to a cartoon character. Not just any animated character, nor Wilma Flintstone or Betty Rubble, but a rabbit. Jessica Rabbit.
“I love that hourglass look,” said Dayyani, 23, of Houston. “The small waist, the nice, beautiful hips.”
Dayyani was so enamored with Rabbit’s physique that in April she decided to acquire it for herself. She enlisted the sculptural assistance of Dr. Patrick Hsu, a board-certified plastic surgeon in Houston. He suggested a breast reduction ($7,400) and a gluteal enhancement, or Brazilian Butt Lift (BBL), for $9,190, in addition to anesthesia and facility fees.
In the latter procedure, which typically costs around $15,000 and is not covered by insurance, fat would be liposuctioned from her flanks, tummy and lower back and injected into her derrière. “It’s like moving money from your checking to savings account,” she said.
Diana Dayyani in Houston (Cindy Elizabeth/The New York Times)
And with that, Dayyani became another one of the thousands of women worldwide undergoing one of the most popular cosmetic surgeries (some men get it too, but not very many). In 2020 alone, there were 40,320 buttock augmentations, which include both implants and fat grafting, the Aesthetic Society reports. According to Google keyword data, “BBL” was searched roughly 200,000 times per month between January and May 2021.
It’s also one of the deadliest. A July 2017 report by the Aesthetic Surgery Education and Research Foundation in Aesthetic Surgery Journal noted that one to two out of 6,000 BBLs resulted in death, the highest mortality rate for any cosmetic surgery. In 2018, the British Association of Aesthetic and Plastic Surgery advised surgeons in the United Kingdom to stop performing it, although they couldn’t ban it outright.
It didn’t matter: Women would travel to Turkey or South America for the surgery, where it was significantly cheaper. At least two British fatalities have been traced to a clinic in Izmir, Turkey.
The Deadliest Plastic Surgery
The reason the procedure is so dangerous is fairly straightforward. The buttocks have a multitude of blood vessels, some as large as drinking straws. These drain into the inferior vena cava, which is a direct line to the heart. With a lift, fat is injected into the buttocks with a cannula, or long metal tube.
But it can be difficult for doctors to know where exactly they’re injecting; they have sometimes mistakenly injected fat into the gluteal muscle, or right below it. Fat can then travel directly to the heart and into the lungs, obstructing blood flow and causing immediate death.
In 2018, concerned about the mortality rate, the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgery, among others, formed the Task Force for Safety in Gluteal Fat Grafting, to develop safety guidelines around the procedure.
Among their recommendations: that doctors stop injecting into the muscle, and use bigger instruments. “Those cannulas bend, and if they bend when you put them in the buttock, you have no idea where the tip of the cannula is,” said Dr. Luis Rios, a board-certified plastic surgeon in McAllen, Texas, and past president of the Aesthetic Surgery Education and Research Foundation, the research, education and philanthropic arm of the Aesthetic Society. A 2020 follow-up study found that 94% of doctors are aware of the recommendations.
“When properly done, when carefully done, it is safe,” said Dr. Steven Teitelbaum, a board-certified plastic surgeon in Santa Monica, California, who was involved in drafting the guidelines, but does not perform the surgery. “We know exactly the mechanism that can lead to death, and we know how to avoid it. The surgeon just has to maintain intense focus and concentration.”
Yet people are still dying, most notably at “chop shops”: low cost, high-volume centers typically found in Las Vegas, Los Angeles and Miami — with doctors who may not be board-certified or even surgeons. Over the past eight years, one such doctor, Ismael Labrador, has had eight patients die at clinics he has run, four from botched BBLs, USA Today and Naples Daily News reported. The clinics’ names were changed two times starting in 2016, making it almost impossible for new clients to research him. (Labrador did not return calls.)
Neither Brazilian, Nor a Lift
It’s unclear how exactly the Brazilian Butt Lift got its name, since technically nothing is being lifted. A Brazilian plastic surgeon named Ivo Pitanguy is credited with pioneering the procedure in the 1960s. It slowly migrated north, gaining popularity in the United States around 2010 thanks to Jennifer Lopez, Kim Kardashian West and Nicki Minaj, each of whom is revered for her hind. (The women deny having had any surgical help. Kardashian West got an X-ray during an episode of “Keeping Up With the Kardashians.” Doctors found no implants, though fat grafting was not discussed.)
But a January 2020 editorial in the journal Plastic and Reconstructive Surgery argued that the procedure was actually named in 1996, when the Learning Channel featured a segment with Dr. Leonard Grossman, a board-certified plastic surgeon who liposuctioned fat from a Brazilian woman and injected it into her glutes. The segment was called “Building the Brazilian Butt,” and a moniker was born. (The authors proposed that the procedure should be called “Safe Subcutaneous Buttock Augmentation” instead.)
Dayyani was so enamored with Jessica RabbitÕs physique that in April she decided to acquire it for herself. (Cindy Elizabeth/The New York Times)
Since then, the amounts of fat injected have only increased. “I don’t know at what point in time we got into bigger is better, but we put in larger and larger volumes the moment we realized we could,” said Dr. Oni Garcia, a board-certified plastic surgeon in Miami.
No one knows for sure what the long-term repercussions are. But Dr. Arthur W. Perry, a board-certified plastic surgeon in New York and New Jersey and an adjunct associate professor of surgery at Columbia, is so worried that he refuses to do the procedure.
“What happens to fat when you put a large amount of dead fat into the buttocks?” he said. “Because that’s what it is: dead fat. We haven’t even begun to see the cosmetic disasters of people walking around with moonscape buttocks, one cheek bigger than the other.
“As far as I’m concerned, at this moment in time it is not a procedure that is routinely and uniformly done safely,” he said.
A Satisfactory Outcome
Dayyani wasn’t worried about dying. She trusted Hsu, who said he has done about 2,000 of the procedures over seven years and has a year-and-a-half-long waitlist. Besides, she didn’t have any underlying health conditions.
She took a more philosophical approach: “It was like, every time you get on an airplane you get a little bit nervous and there’s a little bit of a risk, but you do it anyway,” she reasoned.
The surgery lasted about three hours, after which she felt as if she had been churned in a Nutribullet. Her butt resembled a swollen beach ball, which freaked her out. But Hsu assured her that it would shrink with time; only about 70% of the fat stays in the body.
She also had to get lymphatic massages for a week after the procedure to drain extra liquid in the body. This hurt. (A viral video on TikTok showed a woman screaming in agony while allegedly getting massages post-BBL.) She was unable to sit or lie on her back for the first few weeks. To sleep, Dayyani cut a hole in a lawn chair that her posterior could fit into, while also keeping her breasts lifted.
She said it was worth it. She went from a G cup to a double D, and her stomach is flat. “I literally have abs now,” she said.
As for her posterior? It is Rabbitesque. “The surgery enhanced my hourglass figure,” she said. “I can’t wear some of my old clothes because my booty doesn’t fit through my pants. I’ve never felt better.”
This article originally appeared in The New York Times.
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