# Botched Surgeries: Brazilian Butt Lift

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 16 Sep 2026, 44 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/01M2HXRKEA7PE2AE29HG8JCT8W.mp3

What really happens when a Brazilian Butt Lift goes wrong? Specialist Plastic Surgeon Professor Mark Ashton explains what makes BBL different from other forms of fat grafting, how serious complications such as fat embolism can occur, and why anatomy matters. He also explores fat survival, fat grafting versus implants, and ultrasound guidance. Professor Mark shares complications he’s encountered following procedures performed overseas or in settings where safety standards may differ - including what recovery and revision surgery can involve, and the emotional impact when things don’t go to plan. This episode features personal experiences, professional perspectives and emerging research. It is intended for general informational and entertainment purposes only and is not a recommendation or endorsement of any procedure. Please speak with an appropriately qualified health professional about your individual circumstances. Find us on Instagram: @vainishpodcast and thanks to our guest Professor Mark Ashton Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at LiSTNR

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hi guys, it's Bec Judd and Jess Roberts and welcome to Veinish.
[0:52] Welcome to Veinish.
[0:53] So today we have got Professor Mark Ashton and we've actually had him on before.
[0:58] He is the body guy, isn't he?
[1:01] Yeah, yeah, yeah, yeah.
[1:01] He's so well known in Australia as being one of the most experienced plastic surgeons for tummy tucks, also known as abdominoplasty.
[1:11] That's what he came on.
[1:12] Yes, and talked about.
[1:13] And talked about it.
[1:14] And it was awesome.
[1:15] We had such great feedback.
[1:17] So what we're going to do on Vanish is you guys always love when we talk about different kind of surgeries and risks and what can go wrong.
[1:25] So we thought we would introduce our first botched video.
[1:28] episode and we thought who better than to get Professor Mark Ashton on given his experience and also given how many botched jobs he's had to fix himself.
[1:41] So welcome back to Vanish, Professor Mark Ashton.
[1:45] Thank you very much for having me.
[1:46] We're so excited to have you, especially for this episode.
[1:49] Yeah.
[1:49] But before we get into it, what is your qualifications?
[1:52] So I'm a professor of anatomy and a professor of surgery, both at the University of Melbourne.
[1:56] I'm a past president of the Australian Society of Plastic Surgeons.
[2:00] I was head of Royal Melbourne Plastic Surgery Unit and Royal Women's Plastic Surgery Unit for over 20 years, and now work in private practice at Epworth Hospital.
[2:08] It's amazing.
[2:09] You're smart.
[2:10] Smart cookie.
[2:11] Very, very smart.
[2:12] How long did you train for?
[2:13] All up.
[2:14] I'm old.
[2:15] So I'm 62.
[2:16] I started training at 17, went into Union of Melbourne Med School and came out when 17 years later.
[2:23] 17 years.
[2:25] So how did you make money during that time?
[2:28] Like what was your part-time job?
[2:29] Yeah.
[2:29] I worked as a barman and as a waiter.
[2:34] I worked at Country Road selling clothes.
[2:36] Iconic.
[2:36] That's so iconic.
[2:38] Oh, my God.
[2:39] They should use you for one of their shoots.
[2:41] They should.
[2:41] Yeah.
[2:42] Like, we're all uni students, right?
[2:43] Yeah.
[2:44] So, we all had to make money because… Especially when you're at uni for bloody 17 years.
[2:48] Yeah.
[2:49] I mean, you become a junior doctor within that 17 years, right?
[2:52] So, you take a wage from that.
[2:53] Yeah.
[2:53] So, after six years at medicine, then you go on what they call an intern or a junior resident doctor and then you start earning money.
[2:59] Mm-hmm.
[3:00] In those days, it was long hours, you know, going to work on Friday, come out on Monday night.
[3:04] Was it like Grey's Anatomy?
[3:05] It was.
[3:05] Wow.
[3:08] It was full on.
[3:09] That is so good.
[3:10] I love it.
[3:10] Oh, my God.
[3:11] That's a high episode.
[3:12] That's my next live.
[3:13] I know.
[3:14] I know, right?
[3:14] Oh, my God.
[3:15] That's amazing.
[3:16] It's such a delight to have you in for our first botched episode.
[3:20] We're starting it with something that's very kind of on trend on social media.
[3:23] You see it in celebs overseas.
[3:25] It is the BBL or the Brazilian butt lift.
[3:28] For people who might not know much about it, can you explain what a Brazilian butt lift is, its history, and what the procedure involves?
[3:38] So in its simple terms, a Brazilian butt lift is where we take fat from somewhere in the body, we distill it or decant it, and then we re-inject it back into someone's butt.
[3:48] So it originated in liposuction and then in fat grafting, which we'll talk about later on.
[3:54] And then people said, well, I've got all this fat, which we're discarding.
[3:57] Why don't we put it somewhere else?
[3:59] And as you know, in Brazil and South America, the butt is particularly...
[4:03] protected and has an iconic status.
[4:07] And so they used the fat which was otherwise going to be discarded and
[4:11] and injected it back into that same patients.
[4:13] Right.
[4:14] Okay.
[4:15] And it evolved from there, which we can talk about.
[4:18] Yeah.
[4:18] Okay.
[4:19] So, side quest question.
[4:21] You know how you said with liposuction, they've taken all this fat out and it's sitting there and they used to discard it and then they've thought, let's use this.
[4:28] Let's use that, yeah.
[4:29] You know, like with blood types, you can donate blood.
[4:32] Can someone donate fat to another person?
[4:35] Ask for a friend.
[4:36] Somebody who doesn't have much fat.
[4:38] I'm like a full face.
[4:39] I know, I know.
[4:40] Can someone donate me their fat?
[4:41] Yeah, yeah.
[4:42] Can you do that?
[4:43] Short answer, no.
[4:44] Oh, why not?
[4:45] So it's very different to blood.
[4:46] Yeah, in that it has a whole heap of what they call antigens or little markers on those cells, which means that if you get someone else's fat, you're going to react to that in a very severe way.
[4:57] So you've got to use your own fat.
[4:59] The other thing that just from a history point of view is that when they first started doing fat graph, because it's not a new concept, when they first started doing it, it all died and everyone's trying to work out, well, what are we doing wrong?
[5:10] And there was two guys, one guy called Roger Coorey and another guy called Sidney Coleman, two American plastic surgeons.
[5:15] And they worked a variety of special techniques that meant that you could keep the fat.
[5:21] Now, even with the best techniques in the world with the latest technology and all the whiz-bang machinery...
[5:27] you only get to keep between 40% and 45% of your fat, sometimes less.
[5:33] Right.
[5:33] After it's been injected back in.
[5:34] After injected.
[5:35] Yeah.
[5:35] So that's really important.
[5:37] Why is that?
[5:38] Because your body...
[5:39] Correct.
[5:40] That's exactly right, Bec.
[5:41] So you've got to transfer the fat into tissue, which has a good blood supply, and you're then relying on those little fat cells to pick up a blood supply and oxygen and nutrients over the next 24, 48 hours.
[5:53] And 40.
[5:54] To feed the fat.
[5:54] To feed the fat.
[5:55] And if you have too many cells in one particular clump, then what happens is the blood supply can't get in and the fat dies and you end up with what they call fat necrosis and scarring and things like that.
[6:07] So you can only put in a certain amount of fat.
[6:10] And even when you do that, under the best circumstances, you only get to keep 40% of that.
[6:15] Is that why like when they do the Brazilian butt lift with the fat grafting, they overdo it because they know half of it's going to die?
[6:22] Yeah.
[6:22] Correct.
[6:23] So people intuitively say, oh, not a problem.
[6:26] If you're only going to keep 40%, let's just put twice as much in.
[6:29] Yeah.
[6:30] But that goes back to the first point, which is you can't put too much in because then your fat doesn't get a blood supply, so it dies anyway.
[6:37] But now it's dying inside your body, causing scar tissue and fat.
[6:43] Yeah, ripples.
[6:44] Yeah.
[6:45] Gosh, gosh, this sounds high risk.
[6:47] So to that note, we have a listener question.
[6:51] Mm-hmm.
[6:51] Hey guys, I'm Jasmine.
[6:53] Why is it seen as a high-risk procedure compared to some of the other cosmetic surgeries?
[6:59] Thanks, bye.
[7:00] Good question, Jasmine, and the answer is because it is.
[7:04] They did a big study in 2017.
[7:05] They got all the American societies together, collated their information.
[7:09] They worked out the chance of you dying from a Brazilian butt lift.
[7:13] Dying is 1 in 3,000.
[7:16] And that compares to all other plastic surgery combined, which is in the order of 1 in 50, 1 in 60,000.
[7:22] So it is a high risk procedure that does kill people regularly.
[7:28] I find that amazing because it's like when people get their boobs done, it's so close to your heart.
[7:32] It's so close to like your brain and everything.
[7:35] But then something down there is more high risk than up here.
[7:39] Can you explain to us why that?
[7:40] Yeah.
[7:41] So remember we said that Brazilian butt lift at its basis involves liposuction.
[7:46] So you take fat from somewhere in the body, you modify it or process it via these techniques we talked about, and then you re-inject it back into another part of your body.
[7:57] In the butt, there's a series of veins called the gluteal veins, and they're about between four and five millimeters in diameter.
[8:05] So they're about the size of a small garden hose.
[8:08] And they sit deep in your butt and they communicate directly from your butt straight up into your lungs.
[8:18] Four to five millimeters is about exactly the same size as the cannula that they use to inject the fat in.
[8:25] And in theory, what you're meant to be doing is putting the fat into the subcutaneous tissue, into the existing fat of your butt is what you're meant to be doing.
[8:35] You're not meant to be putting it deeper.
[8:37] The problem is, is that they've done a whole heap of studies and no one can really work out where the tip of that cannula is and people get it wrong all the time.
[8:47] So even the best hands think they're in the right spot and they're not.
[8:52] And they're not.
[8:53] So what happens is if you're in the wrong spot, you're injecting fat under pressure, it goes into one of these veins and you might inject 20 or 30 mils of fat into one of these veins.
[9:04] It goes straight down the vein, straight into the inferior vena cava, into your lungs and causes what they call a pulmonary embolus or a blockage in the lung, which means that your lungs are getting lots of air, but there's no blood and so you die.
[9:17] Yeah.
[9:18] Okay.
[9:18] Okay.
[9:18] And how is that indicated?
[9:19] Like when this patient is on the operating table, is this instant or is this something that shows up the next day when they're at home?
[9:27] Very, very good question.
[9:27] If you've got a little bit of fat injected, then you would get some temporary shorter breath.
[9:33] You might not even notice there's all that much going on.
[9:36] If you get a big bolus, then you die within 5, 10 seconds on the table, unrecoverable.
[9:43] You cannot solve this problem.
[9:46] How is this even legal?
[9:47] Yeah.
[9:48] Well, it's like so many things in medicine, particularly in cosmetic medicine, is that often the technology and the operations have evolved in front of the regulatory reform.
[9:59] And the government is trying their best now to play catch up.
[10:03] But for a very, very long time, as we saw with the cosmetic cowboys.
[10:06] Mm-hmm.
[10:07] Lots of people were doing stuff which was just completely unethical.
[10:10] So, for example, you can't store fat in your domestic refrigerator in the tea room.
[10:16] Is that where they were storing it?
[10:17] Yep.
[10:17] In a fridge.
[10:19] Oh, my God.
[10:19] That's terrible.
[10:20] Can't do that.
[10:21] Yeah.
[10:22] Just on that, what have surgeons done to try and make the operation safer?
[10:25] So, the key thing is knowing where the tip of that cannula is.
[10:29] And one of the things they do now is you can either put a little locator on the tip of the cannula, so it tells you exactly where it is.
[10:35] You can do it in conjunction with ultrasound because you want to be superficial.
[10:39] You don't want to be deep near these veins.
[10:40] I wanted to ask that, can you do it under guided ultrasound so you know you're not hitting the veins?
[10:44] key take-home point on that is that if you're considering Brazilian butt lift, make sure your surgeon is using some form of modality that allows him to see exactly where that tip is, either under ultrasound guidance or a special cannula that's got a special locator on it.
[11:00] You just can't do it blind or she'll be right.
[11:03] No, no.
[11:04] You've got to make specific adjustments to the technique to maximize the safety.
[11:09] Gosh, if I was a plastic surgeon, there's no way I would offer this.
[11:12] Yeah, yeah, yeah.
[11:14] Do many surgeons offer this?
[11:15] I know you don't do it.
[11:17] So I don't do it and there's a whole cohort of people who don't do it because the risk profile, even in really, really good hands, is still, I believe, unacceptable unless you are doing it all the time and you have those special requirements.
[11:32] You've got to have the technology behind you.
[11:34] Can that embolism, is that what it's called?
[11:36] Yeah, embolism.
[11:37] Can it bypass the lungs and go up to the brain as well?
[11:40] Like, can you get a stroke from it?
[11:41] No.
[11:41] So, the lungs act like a filter.
[11:44] And so, it's a bit like your pool filter's blocked and it just doesn't allow any flow.
[11:47] This embolism is exactly the same thing we're talking about if, you know, people go on long-haul flights and they get clots in their leg.
[11:52] You can get a blood clot in your leg.
[11:54] And that can go from your leg, deep venous thrombosis, into your lung as a pulmonary embolus.
[11:59] It's exactly the same mechanism.
[12:00] Same pathway, same mechanism.
[12:02] But what's happening here is that instead of a blood clot going from your calf into your lungs, here someone is injecting fat.
[12:09] The other thing is that in an effort to try and
[12:12] Again, we talked about regulatory reform and technology.
[12:15] A lot of people thought then it was a really good idea to be faster.
[12:18] Let's just connect this fat up to a pump.
[12:20] So we're just going to pump fat in at, you know, like 100 mil or 150 mil.
[12:24] It's almost like hose it in.
[12:25] Like hose it in.
[12:26] Well, the problem here is that if you're going into your soft tissue, so there's a set resistance because you're trying to fill something up, which is not distensible.
[12:33] You suddenly connect it up and you put it into one of these 4 mil veins.
[12:36] You're going to dump 150 mils of fat in an instant straight into that vein, patient dead.
[12:41] Dead.
[12:42] Wow.
[12:42] Is this how Kanye's mum died?
[12:44] Was it in a BBL?
[12:45] No, I don't know.
[12:46] I know she had liposuction and she died from the liposuction.
[12:49] I don't know if it was because it was transferred into her butt, but she did die from liposuction.
[12:53] I don't know, but the other thing with liposuction, and I've had a couple of patients, this particular patient who came to see me who almost died had a liver liposuction by a person who wasn't a plastic surgeon.
[13:03] And what did they go inside a liver?
[13:04] They sucked fat out of the liver?
[13:06] No, they just sucked out, in the wrong spot.
[13:07] Oh.
[13:08] Oh, my goodness.
[13:09] And they didn't realize.
[13:10] And she's in an operating theater, which wasn't a proper hospital, above a gym in Berwick.
[13:15] Stop.
[13:16] What could possibly go wrong, right?
[13:18] I didn't think that this was in Australia.
[13:19] And how does this happen?
[13:20] I thought it was like in Mexico, this stuff.
[13:22] And this patient goes in, she goes to see this particular surgeon who told her that she was a, I'm a surgeon, a cosmetic surgeon, as she's walking in, she said, this is a gymnasium.
[13:32] Where's the hospital?
[13:33] Like alarm bells.
[13:34] Yeah.
[13:35] And she still went through with it.
[13:36] Oh, babe.
[13:37] And she's in recovery and she's going, I feel really terrible.
[13:40] Yeah.
[13:40] And I've got all this shoulder tip pain, which is a marker of someone's been messing around with your liver.
[13:45] Yeah.
[13:45] Yeah.
[13:45] And she herself called the ambulance.
[13:47] They didn't want to call the ambulance.
[13:49] Stop.
[13:49] Oh, my gosh.
[13:50] So, she goes to Cabrini, gets investigated by a general surgeon, fixes the bleeding.
[13:55] So, what I'm trying to say is that the reason why the Brazilian butt lift is particularly dangerous is, one, you've got the liposuction component, which is dangerous in itself in the wrong hands.
[14:06] And then you have
[14:08] fat transfer, which you lose 40%.
[14:10] There's lots of things that can go wrong with that.
[14:12] And then the administration of that fat into that tissue is high risk uniquely to the butt because of these gluteal veins that make the whole thing super, super dangerous.
[14:23] If you don't die on the table straight away, so if your embolism is not huge, if you've got a small embolism, how does it show up and what's the treatment?
[14:31] So if you've got a small one, so if you just inject a little bit of fat, so it blocks off
[14:35] a segment of your lung or patches of your lung, but doesn't cause enough to block the entire flow to your lung, then the person would be short of breath.
[14:43] And we would manage that patient in the same way as if someone who was suspected having what they call a pulmonary embolism from a clot.
[14:48] So there's a couple of scans where we can measure the airflow going into your lung and the blood flow going into your lung.
[14:55] And in an ideal world, they're the same because the
[14:57] should be exactly the same.
[14:59] In this scan, if there's a problem with the blood flow, that is you've got an embolism, your airflow is normal, but there's patches of your lung which aren't getting any blood to them.
[15:08] And as long as that percentage is not too high, then over time your body can recover.
[15:15] But it's still with fat.
[15:16] It's not going anywhere.
[15:18] So you can't go in and pull it out.
[15:20] No.
[15:21] Why not?
[15:21] It's like injecting sand into your carpet and then trying to – it's just everywhere.
[15:27] So it's not even a nice little – it doesn't ball up.
[15:30] It doesn't become like a bolus that you can just go in and pull it out.
[15:32] No, it's just everywhere.
[15:34] It's diffuse.
[15:34] So –
[15:35] If you had a deep venous thrombosis from long-haul flight or something like that, then we can use a drug which dissolves the blood, which... Like a blood thinner.
[15:44] Like a blood thinner.
[15:44] And you might be on that for three or six months.
[15:46] Yeah.
[15:47] But over time, you progressively dissolve that blood away.
[15:49] Yeah.
[15:50] The problem with fat is there's no technology, no fat thinner.
[15:53] There's nothing that we… We'd all be on it.
[15:55] And in fact… Maybe it's a GLP-1.
[15:57] A GLP-1.
[15:57] GLP-1 inject that into the thing.
[16:01] Maybe, maybe.
[16:03] Wow, that's so interesting.
[16:04] That makes sense now.
[16:05] And so the technique there absolutely determines whether you live or whether you die.
[16:10] So if you've got someone who's super careful, knows where the veins are, and even if they inject a bit of fat into one of the veins…
[16:17] The amount is so small, it's going to go into your lungs and the person might say, I'm feeling short of breath.
[16:21] And it goes, okay, right, stop.
[16:23] We picked this up early.
[16:24] Is the person awake when you're doing it?
[16:26] Depends.
[16:26] Depends on how you do it.
[16:28] So some people do it under sedation and local anesthetic.
[16:33] a technique called tumescent liposuction and tumescent injection.
[16:37] Other people do it when they're completely asleep.
[16:38] So it depends on the operator.
[16:40] But the basic minimum you would expect is that they should be hooked up to some form of oxygen monitoring so you can see that their breathing is okay.
[16:48] You might have a vascular surgeon in there while you're at it just in case.
[16:52] Have there been any recent changes in guidelines or safety practices around BBL procedures that people should know about?
[17:00] Yes, they have.
[17:01] The first thing is that they've banned the term testimonial.
[17:03] So you can't get someone and just gives an unqualified, gives an advertisement for a surgeon or a practitioner performing this.
[17:11] The other thing is that by law, the guidelines around where you're having this procedure done and who's performing this procedure have also changed.
[17:19] Personally, I think they should be stronger and I think they should be much more transparent and
[17:25] What I would like to see is that a person who is performing any form of surgery, doesn't have to be cosmetic surgery, but any form of surgery very clearly says what their training is, what their expertise is, where they're having the procedure, and then we'll talk about later on, but also full transparency on...
[17:44] what can go wrong, how much it's going to cost and all those things.
[17:46] So it's a very transparent, upfront thing.
[17:49] And at the moment, that is not being enforced nearly enough.
[17:52] There are still ways in which people can blur.
[17:57] So there are rules.
[17:58] One of the things which is most important is that you can't call yourself a plastic surgeon
[18:02] unless you are a plastic surgeon.
[18:04] Yes.
[18:04] So, duh, that would seem to me.
[18:06] I just find it crazy that doctors can do some sort of plastic surgery.
[18:10] But also, I'm shocked that we've got friends who do this where they know they're not a plastic surgeon, but, oh, they're a cosmetic surgeon and it's half the price, so they still do it.
[18:18] Yeah.
[18:18] Yeah.
[18:19] It's like, no.
[18:20] So they are informed, they're aware, and they still choose that option.
[18:24] So I wouldn't be, I'd be so scared if I wasn't a plastic surgeon doing some sort of surgery, just in case I stuff up that person.
[18:30] Yeah.
[18:30] Or kill them.
[18:32] Yeah.
[18:32] Yeah.
[18:33] I don't know.
[18:34] As a medical provider, you mean unless you're a plastic surgeon, you wouldn't be doing plastic.
[18:37] Plastic surgery.
[18:38] Yeah.
[18:38] So we're talking here about a thing called ethics and morals.
[18:41] And like, duh, shouldn't this be the basic tenet of every person doing medicine?
[18:47] To be a plastic, 17 years.
[18:48] Don't do it for six and then think you can do it.
[18:51] Yeah.
[18:51] You've got good ethics.
[18:53] I have a friend who's a plastic surgeon and he specializes in cleft lips and palate surgery.
[19:00] Does a lot of work overseas.
[19:02] And I said to him, it was about 10 years ago.
[19:07] I said, hey, you're a plastic surgeon, right?
[19:09] He's like, yeah.
[19:09] And I'm like, you've done heaps of breast implants.
[19:12] He goes, yeah, yeah, yeah.
[19:13] And I said, oh, you can do mine.
[19:14] He goes, no.
[19:15] No.
[19:16] He said, I've done them.
[19:17] I've done plenty of them, but I am not the best guy at doing it.
[19:22] I'm not the best person for you.
[19:23] Go and see this person who specializes in it.
[19:26] This is who I would send my wife to see and my friends, and he actually sent me off.
[19:30] It was so ethical, and I wish more surgeons were like that.
[19:34] Yeah, I've done them, but I'm not going to do it.
[19:36] I think that's a really, really important point.
[19:39] And like you can't be good at everything.
[19:42] There are also other things is you're not necessarily passionate about everything.
[19:46] So if you're a patient looking to find a surgeon, then you want to ask those questions.
[19:52] What is their level of training?
[19:53] Are they passionate about it?
[19:55] And how often, how many times a week do they do that?
[19:58] Because it's not just...
[20:00] the operation, it's also the follow-up care and spotting complications and things.
[20:05] And if you've got someone who does this all the time, not only is the surgeon up to speed, but the team around him, the nursing staff that work with him, the reception staff around that particular surgeon can pick up the nuances of what's going on.
[20:19] Yes.
[20:19] They do the same surgery every day, all the time because that's their specialist, you know.
[20:24] And it means that they also, because they're doing it so often, they're investing in the technology, which makes that surgical procedure more straightforward and simple.
[20:34] Whereas if you're doing it occasionally, you're going to say, well, okay, an ultrasound guided assistant device for a Brazilian butt lift, it's going to cost you a lot of money.
[20:42] How much they cost?
[20:43] Oh, yeah, their machines are huge.
[20:45] They cost – and you remember we talked about the gizmos to purify the fat?
[20:50] They just go – so if you're invested in it and that's what you do, then that's the person that you should be seeing, not the person who's the occasional punter who does it every now and then.
[21:01] That's why they charge so much money.
[21:10] So because of the fat grafting, it's so dangerous.
[21:13] Is that why people then do the implants?
[21:15] So, yeah, so there's two things.
[21:17] The fat grafting member said you can only keep about 40%.
[21:21] So this guy, Sidney Coleman, we were talking about before, he developed a worldwide reputation for doing breast reconstruction using the patient's own fat.
[21:29] But he would have to do it on three or four separate occasions, do a little bit, wait for it to take, do a little bit more, wait for it to take.
[21:36] So the implant has the advantage over fat grafting,
[21:40] because it's more instantaneous and it's more controllable.
[21:43] The other problem with fat grafting is you only keep 40%.
[21:47] We don't know which bit you're going to keep and which bit you're going to lose.
[21:49] So you could be asymmetric.
[21:51] Yeah, so it doesn't all die off evenly.
[21:53] No, it dies off asymmetrically, which can lead to lumpiness, irregularities, contour irregularities.
[21:58] Yeah.
[21:59] So before we had Brazilian butt lifts using fat, we had breast implants.
[22:03] Right.
[22:04] And people used to regularly put breast implants into people's butts.
[22:07] And not surprisingly, South America was where it was all occurring because the South Americans in particular love big butts.
[22:14] That's just their thing.
[22:17] That's crazy.
[22:18] I thought they would have had special butt implants shaped, not breast implants used in the butt.
[22:23] So they started off just using straightforward breast implants and there was a couple of reasons for that.
[22:28] One was that they were tested, tried, had a safety profile, knew what was going on, and they said, we'll just do that.
[22:35] They are designed to go on a breast, not into a butt.
[22:37] So there's a different dynamic, a different shape, all those sorts of things.
[22:41] So then they designed specific butt implants.
[22:45] And the advantage of that as compared to fat grafting was that
[22:50] you didn't have that risk of injecting fat into someone's veins.
[22:53] The downside was that you sit on your butt.
[22:56] So these implants were moving around all over the place.
[22:59] And the problems with infection and extrusion, that's where the implant comes through the skin.
[23:04] So lots and lots of problems.
[23:05] So whilst it had been around for a long time, the reason why the Brazilian butt lift became so popular so quickly is it completely avoided all those problems with the implant butt lift.
[23:17] But there's other problems, obviously.
[23:18] Yeah.
[23:18] Is anyone still doing the implants, the butt implant?
[23:21] There are people who still do implants and they might do it in conjunction with fat grafting as well.
[23:27] So you do a bit of both.
[23:28] Okay.
[23:29] The advantage of the implant is it gives you an instantaneous effect and it's much more robust and much more structural.
[23:35] So the problem with fat is it doesn't have any inherent structure.
[23:38] So you volumize your butt, but you're relying upon the inherent ligaments and... Yeah.
[23:43] tension within those ligaments in the skin to get the nice result.
[23:46] If you've got a really saggy bum and you fill it up with fat, you're going to end up with a saggy big bum.
[23:50] Yeah, yeah, yeah.
[23:51] So what you want to try and do in that situation is you might say, look, let's use a smaller implant.
[23:55] Yeah, to get the perk.
[23:56] To get the perk.
[23:57] But it comes with a whole variety of other side effects.
[24:01] Hence, going back to what we said before, this is not for the occasional punter.
[24:05] No.
[24:05] No.
[24:06] It isn't.
[24:06] This is full on.
[24:08] Do you go for the butt implants?
[24:09] Do you go under the glute muscle or over?
[24:12] So when we're doing the butt implant, it's meant to go underneath the fascia so that it locates it and stops it moving around because you sit on your butt.
[24:21] With the fat grafting, you must stay on top of the surface, must stay on top of the fascia.
[24:27] And that's where the ultrasound and things we talked about are helpful because they can tell you where that cannula is sitting.
[24:33] So you spoke about this one particular person where it was performed above a gym and it damaged her liver.
[24:42] What else have you seen in your experience that is a botched example of a BBL here in Australia?
[24:50] So we see a lot of people with botched surgery and almost invariably, whether it's someone who's been overseas and come back or whether it's someone who's locally using someone who is not necessarily trained to the level that I would like them to be, they come in and the patients have one of two things wrong.
[25:06] There's either a problem with the liposuction component because you've got to suck the fat out to harvest it and that can be irregular or done too much in one spot or it's a result of the infiltration of the fat.
[25:20] subsequently down the track.
[25:21] So let's just talk with the liposuction first.
[25:23] If you're taking fat and you say, I need to get, I don't know, 200 mils of fat, what you want to do is you want to take it over a wide area as a very thin harvesting of the fat over the abdomen or the hips or something like that.
[25:37] It's like feathering.
[25:38] Yeah, correct.
[25:39] You don't want to be taking it all out of one spot over and over and over and over because you only end up with a divot.
[25:44] I see that all the time.
[25:45] People over-harvest in one place and don't harvest in another place.
[25:49] And so the harvesting is uneven and they end up with contour irregularities.
[25:53] That is super, super common.
[25:55] A lot of celebrities I have seen as well.
[25:57] And how do you fix that?
[25:58] Then you've got to get fat from another part of the body and redistribute?
[26:01] Short answer is you can't, but you're exactly right, Bec.
[26:03] So what you would do then is you would try and fat graft back the area they took the liposuction from.
[26:09] But then it goes back to the second question is that,
[26:12] The other problem is how the fat is inserted or how it's injected.
[26:17] Is that done evenly?
[26:18] And then remember that we... You get die off.
[26:21] Die off.
[26:21] We only keep 40%.
[26:23] And if you try and push that really hard, then what happens is they put big blobs of fat in an area
[26:29] The fat on the outside of that blob gets its blood supply and lives, but the fat on the inside dies.
[26:36] It becomes liquefied fat and falls what's called a fat cyst.
[26:40] And then you end up with these golf ball botches of scarring all over where it's been injected.
[26:46] Again, how do you get rid of those?
[26:47] Well, you've got to either cut them out or try and liposuck them out, which never works.
[26:53] So you end up with contour irregularities again.
[26:55] So it's about if you want to have the best BBL, the person needs to be conservative in the harvesting, use the best techniques to preserve and process that fat and being conservative in the injecting.
[27:09] And you might say to that person, if this is what you want, we might do this over two or three.
[27:14] Like they do with the boobs.
[27:15] Yeah.
[27:16] It's safer and you're much softer and you're much more gentle and you're not trying to overdo a particular area.
[27:23] The problem we've got is that's time and money and coming back, you know, two or three times, recovery after surgery, all those things.
[27:29] And you want quick fixes.
[27:30] And you can see why the surgeon is under pressure to try and do it in one go.
[27:34] But you can see from what I'm saying, you're setting yourself up for an increased risk of complications by doing that.
[27:40] And it's also like doing that step-by-step thing.
[27:42] It's kind of seeing how the body, your body actually, how it reacts, I guess, which is also safer.
[27:48] Yeah.
[27:48] You know, it's not so much of a rewind it back, you know.
[27:51] Yeah, because if you didn't like it, you got all liposuction back out.
[27:54] You have like droopy skin.
[27:56] Yeah.
[27:57] There was a lady who recently did it.
[27:58] She's on a reality TV show, one of those like Geordie Shores or something in the UK.
[28:03] Only wears Essex maybe.
[28:04] And she got it done and it was so big.
[28:08] Yeah.
[28:08] so pronounced.
[28:10] And then one day she just woke up and looked in the mirror and was like, what have I done to myself?
[28:14] I have overdone it.
[28:15] And then she had to go and get it reduced.
[28:17] And like, what?
[28:18] The pain, the risk, the cost.
[28:21] Yeah.
[28:21] Because it's a trend.
[28:23] And then the other thing on that is absolutely correct, is that make sure you have control of the outcome.
[28:30] Make sure you have control of the destination.
[28:33] So if you're thinking about having –
[28:36] augmentation of fat to your butt.
[28:39] You need to be very clear and very forceful about what you're looking for, what's the outcome.
[28:45] And you can do that with images.
[28:46] You can do that with photographs of people that you like, particularly those you don't like and those you do like.
[28:52] What you're trying to do is communicate to the surgeon as to what the outcome is that you want that's aligning with what you want to achieve.
[29:00] don't leave it to the surgeon.
[29:02] Oh, you know best.
[29:03] I'll leave it in your hands.
[29:04] Oh my God, that is just such a recipe for disaster.
[29:05] Yeah, you'll be very clear.
[29:07] But the patients have come to see me after having botched BBLs.
[29:11] The other thing is it's that psychosocial post-traumatic stress disorder.
[29:16] These people are shell-shocked.
[29:18] Not only do they realize that...
[29:20] They've got a contour irregularity, which is difficult to fix, and then see plastic surgeons who say it's unfixable, say, oh, my God.
[29:28] And then also the other part of it then suddenly comes through, well, what else could have gone wrong?
[29:32] I could have had my liver liposuct.
[29:36] I could have had my small bowel liposuct.
[29:37] I could have ended up with the fat in the wrong spot.
[29:39] And they suddenly do their due diligence of where they went and...
[29:44] In retrospect, rather than doing a hit.
[29:47] So it's really important if you can to do your homework, research around that person and...
[29:53] And you want to find out exactly, as we talked about before, that it's their area of expertise.
[29:58] They're trained in it.
[29:59] They do it all the time.
[30:00] And when you're seeing that particular clinic, you're seeing that particular surgeon, look at the staff, look at the nursing staff, look at the receptionist.
[30:07] Are they professional?
[30:08] Do they seem to be someone who's, yeah, this is what we do every single day of the week.
[30:12] Or is it the person who's the occasional person who ventures into this every now and then?
[30:17] Absolutely.
[30:17] So the people that are coming to see you with these botched BBLs and liposuction things, have you noticed that they're getting the surgery in Australia and it's getting botched or is it more from overseas surgeries?
[30:27] Great point.
[30:27] So Miami in Florida, which is where a lot of this work around the ultrasound guided cannulas and things like that developed.
[30:36] And that was because in Miami, they were having a death every week.
[30:39] One person was dying from BBL every week.
[30:41] The other is...
[30:42] We are seeing a lot of people from Turkey coming back and they can be finding out they've got their complication halfway between Turkey and Australia on the plane back and suddenly realise their wound falls apart or their wound leaks or there's...
[30:58] And they arrive distressed, upset, and then saying, can you fix this?
[31:02] And suddenly recognize that, hang on, to try and fix this is far more expensive and difficult than had I actually done my homework and gone to a reputable surgeon inside Australia in the first place.
[31:15] Okay.
[31:16] Wow.
[31:16] are there more plastic surgeons who perform this on the Gold Coast?
[31:22] Because there's a lot of amazing butts walking around the Gold Coast.
[31:25] And I'm like, that's not real.
[31:26] That's not squatting.
[31:28] Like if you obviously go to conferences and you... Can you pick it up?
[31:33] Yeah, like are there more good plastic surgeons who do it there?
[31:37] No, it's a good question.
[31:38] I think that the demographic of the patient
[31:41] who is seeking a BBL in the Gold Coast and Queensland is different to someone in Melbourne because their lifestyle is such that they can show their BBL off much more readily.
[31:51] Yeah, babies all the time.
[31:52] And also there's that cultural, that psychosocial influence amongst your peers and friends and social media that is driving...
[32:00] patient to say, look, this is something I would consider.
[32:03] Whereas someone like Melbourne or Adelaide, where we spend a lot more time, it's colder and things like that, we don't have that pressure on us.
[32:10] But there are very good plastic surgeons who specialize in BBLs all around Australia.
[32:16] And the best place to find them is to Google search the Australian Society of Plastic Surgeons.
[32:22] They have a list of everyone.
[32:23] Those people will specify what their interests are, what their training is, how many they do a week.
[32:30] That's a really good place to start.
[32:31] So there are really good surgeons who do this in the best way.
[32:35] There's three in Melbourne that I know of who specialize in BBLs and they are extremely good surgeons and they all use the ultrasound-guided injections, all those sorts of things.
[32:45] All those important points we talked about, they all operate in hospitals, which to me would have seemed to be a great idea rather than above a gym.
[32:52] But that's the problem.
[32:53] The other thing I suppose to really emphasize is that if your radar is telling you that this is not right,
[32:59] then almost certainly it's not right.
[33:01] Listen to your gut.
[33:02] Yeah, 100%.
[33:03] And move away.
[33:04] Like this is elective surgery.
[33:05] You just don't have to have it done today.
[33:08] Yeah.
[33:08] If you're sensing that something's not quite correct, then walk away, time out, do some research, do some more consultations with different people.
[33:16] See two or three consultants before you make a decision on who you're going to go with because that way...
[33:21] Even if they're saying exactly the same thing, they're saying it in a slightly different way, which means that you pick up the subtleties that you might not have picked up with one person.
[33:30] So you pick up the little things that people do differently, which means you can ask better, more informed questions, which means that you can make a better decision.
[33:39] We have another listener question for you.
[33:41] Hi, I'm Paula.
[33:43] We see a lot of body trends online.
[33:45] How much do you think social media plays a role in people considering procedures like this?
[33:51] Great question.
[33:51] Okay, so there is the obvious influence of social media and the obvious impact that has upon our decision-making process.
[34:01] But in my experience, and I'm old, I've found that almost everyone has a preconceived idea about what their perfect breast looks like, their perfect body looks like, their perfect butt looks like.
[34:16] And there's two things about that.
[34:18] It's individual to that particular person, and it's particularly long-lasting.
[34:23] So if, for example, let's just jump off Brazilian butt lifts for a minute and just go into breasts,
[34:27] So you can have breasts which are small, medium, large, and you can have a person who's got a medium-sized breast, and one person might be thinking of making their breast bigger, doing a breast augmentation, and exactly the same person might be thinking, my breasts are too big, I want to have a breast reduction.
[34:40] That's not because there's something weird with that person.
[34:43] It's because they've got an individual preference as to what they want to end up like.
[34:49] If they don't listen to the inbuilt voice,
[34:52] reference their inbuilt guide as to what they want to look like and in fact modify or change that to another ideal because it's that preference is long lasting almost invariably the other people three years down the track four years down the track could say oh my god i don't know why i did this i never got the result that i was looking for i should have just listened to my gut and
[35:11] The same thing with Brazilian butt lift.
[35:13] So there is no doubt that social media and those postings skew someone's belief as to what is normal.
[35:23] What's really important is you've got to bring that back to what the individual wants, what the individual thinks is right for them.
[35:30] So whilst everyone else might be having the Brazilian butt lift,
[35:33] If that's not aligning with what you believe is right for you, then don't go there.
[35:38] Don't do it, yeah.
[35:39] You've got to be true to yourself.
[35:40] You've got to be very clear about what your identity is rather than following a fashion trend because there's two things about that.
[35:48] It's not just like going and buying a dress or going and buying a new pair of shoes.
[35:52] This is something which is, we've talked about, dangerous surgery, which is expensive and has a very real chance of killing you.
[35:59] So make sure you're doing it for the right reasons and the particular...
[36:03] aesthetic or cosmetic outcome aligns absolutely with what you believe is where you want to end up.
[36:09] So Mark, if someone isn't happy with their results or has had complications, what options are usually available to them for a botched BBL?
[36:18] Yeah, so a couple of things.
[36:21] really important, if it's gone wrong, it's going to be one of two things.
[36:24] It could be that the surgery was just mucked up.
[36:28] The surgery wasn't performed how it was supposed to be performed.
[36:32] And in which case, even though you've gone to a really good surgeon and it's in the right institution with the right team and the right hospital, things just haven't quite gone the way you wanted to.
[36:42] In that situation, it's always worthwhile going back to your original surgeon and asking him,
[36:48] Openly and honestly, what do you think happened?
[36:51] Why do you think we've got the result we have?
[36:53] What can we do to fix it?
[36:54] What do you think that we can do to make it better?
[36:57] So always involve your original surgeon because more often than not, they're the people who are more likely to be able to identify what's going on, particularly if you chose wisely in the first place.
[37:06] Yeah.
[37:06] Okay.
[37:07] If you chose poorly in the first place and you think, oh, in retrospect, I didn't do my due diligence and I didn't do my research and I've ended up with this result.
[37:17] The first thing is that people feel a sense of shame and guilt and, oh my God, I'm silly.
[37:22] Why did I possibly do this?
[37:23] I should have done research.
[37:24] Everyone told me to do my research and I didn't.
[37:27] Don't worry about that.
[37:27] It's about getting the result for you.
[37:29] It's about looking after you.
[37:31] And if you see a
[37:33] qualified specialist plastic surgeon, they should at the very first moment be able to reassure you, explain what's going on, make you feel better.
[37:42] It's not your fault that this has gone wrong.
[37:45] What you're looking for is a solution to make it better.
[37:48] So the second point there is consult widely.
[37:51] If something's gone wrong,
[37:53] Don't just go back to the one person and say, oh, that sounds great.
[37:57] No, get two or three opinions because what you're looking for is a diversity of experience.
[38:03] Someone who's done a little bit of this, someone who's done a lot of this, someone who's done a lot of reconstruction.
[38:07] For example, it may well be that your solution lies not in a,
[38:11] cosmetic procedure, but in a reconstructive plastic procedure where we're doing a traditional reconstructive surgical technique that we're applying to a new problem rather than trying to keep on
[38:23] bashing her head against that wall with the same techniques.
[38:26] So the point is consult widely, see people at a diversity of experience and be guided by what they say.
[38:35] But don't make the same mistake.
[38:37] Make sure you go back to a fully trained surgeon.
[38:40] Make sure you do your research.
[38:41] Make sure it's in a licensed, accredited hospital, that they're using an anesthetist and the team around them testifies that this is what Surgeon A does all the time.
[38:52] Yeah.
[38:53] So what is the recovery like for a BBL?
[38:55] Bad.
[38:56] Really?
[38:57] It's a good two to three weeks of your feeling really, really sore.
[39:02] You know how when we were all growing up, people said, oh, liposuction doesn't hurt.
[39:05] You just walk in in the morning, you have the stuff and you're back at work in the afternoon.
[39:08] Yeah, it's like a lunchtime appointment.
[39:10] No.
[39:10] I can vouch for that.
[39:12] I just had some fat put under my eyes, taken from my leg.
[39:14] The bruising, three to four weeks.
[39:16] Yeah.
[39:16] Horrendous.
[39:17] Yeah.
[39:18] horrendous.
[39:18] Like, you saw my leg, you're like, what's happened to your leg?
[39:23] Yeah, the bruising took for ages.
[39:24] And then, the pain.
[39:26] It's bloody sore.
[39:27] The sorest thing out of that whole operation was not the eyes, it was the sore leg where they harvested the little bit of fat from.
[39:36] It wasn't even a lot of fat.
[39:37] It was like a mill.
[39:38] Yeah.
[39:39] That bloody hurts.
[39:40] It does.
[39:41] And that's the surprising thing.
[39:42] Like we do a lot of breast reduction and often we do liposuction in addition to the breast reduction, the surgery, the cutting bit.
[39:48] The cutting bit never, ever hurts.
[39:49] But where you do the liposuction, really, really hurts.
[39:52] Why is that?
[39:53] I think it must be because the blunt trauma is hurting, damaging the nerves.
[39:57] Are you quite vigorous when you're harvesting the fat?
[40:00] Yeah, good question.
[40:01] So in the past, we used to absolutely do it manually.
[40:04] So it used to be quite vigorous with a cannula that you would, with your arm, go backwards and forwards, backwards and forwards.
[40:09] It was relatively brutal and it caused a lot of pain.
[40:14] The more common way that we do it now is using a very fine cannula, which is reciprocating.
[40:20] That just goes backwards and forwards at maybe 50 hertz.
[40:23] It goes, and it goes back maybe two or three milts connected to some suction.
[40:28] So it means that you very smoothly pass it through and it sucks out the fat like it's tunneling through things.
[40:35] Yeah.
[40:35] Yeah.
[40:36] So you'd think that, okay, this new technique is more refined and it's, no, it still hurts like hell.
[40:43] Yeah.
[40:43] I'm sure that's what was used on me and it still bloody hurts.
[40:46] It's probably as well, like, you've got to think about it.
[40:48] I'm pushing on it now.
[40:49] You're taking all the fat out and then instead of getting those dints, all the fat's kind of trying to fill that hole again and then all the blood circulation's trying to make it live again.
[40:58] Like, I think there's a lot going on.
[40:59] The fat doesn't try and fill the hole again.
[41:01] Like, it's just gone.
[41:02] But you don't have a hole in your legs.
[41:05] No, you have holes and you have the connective tissue.
[41:08] So it ends up looking a bit like a spider's web.
[41:10] So you have lots of holes with all the fabric, the structural elements of the skin still there.
[41:16] Still there, okay.
[41:17] So the next thing is that you, remember I said we lose
[41:21] 60%, we only keep 40% of the fat we transfer.
[41:24] And what you're relying on that fat to do is to pick up a blood supply.
[41:27] Yeah.
[41:27] So you want to keep everything still so these little baby blood vessels can go in and start re-vascularizing.
[41:33] You don't want to kill the fat cells when you're taking them out.
[41:35] You've kind of got to be a bit gentle with them, right?
[41:37] I can't sit on your butt for ages.
[41:39] So you want, correct, and you want to rest.
[41:41] I mean, like you've invested a lot of money in this and it's a high-risk procedure.
[41:45] So do your very best to make it work.
[41:46] So allocate some time.
[41:48] to rest, allocate some time where you're looking after yourself and you're not trying to shoehorn this procedure into your busy, chaotic, hectic schedule.
[41:58] So you just have to like kind of sleep on your tummy and like sit on your tummy and eat on your tummy.
[42:02] It's like you don't stand.
[42:03] Or stand up.
[42:04] Yeah, but you're not sitting and you're not lying on your back.
[42:06] Is it abdominoplasty, like full abdominoplasty, that would still be, would you say, the most hectic recovery, more so than this?
[42:12] Like where does this fit compared to that?
[42:14] No, the abdominoplasty…
[42:15] Especially if you do the full 360.
[42:17] Correct.
[42:18] That's on steroids.
[42:19] That's recovery.
[42:20] That's six weeks minimum.
[42:21] Minimum.
[42:23] That's six weeks minimum or you're probably looking at probably three months before you're back doing stuff again.
[42:28] So I suppose what I'm just trying to say is if you do have a Brazilian butt lift or if you do have any form of liposuction, it's going to hurt and make sure you allocate some time, at least three to four weeks to recover and heal.
[42:40] So do you think out of all the surgeries, Brazilian butt lift is probably the most dangerous?
[42:46] Yeah.
[42:46] So that's a really super good question.
[42:47] So if we were to line up all the plastic surgery operations, I'm talking about the aesthetic or the cosmetic ones in a line, from best to worst, then breast reduction surgery always comes out at number one because it works, it's safe, it fixes people's back pain, shoulder pain, migraines, all those sorts of things.
[43:05] Mm-hmm.
[43:06] And without any shadow of a doubt, BBL is right down the back.
[43:10] Like the last.
[43:11] It is the last by a very, very long way.
[43:13] One, because it's a difficult operation to do well.
[43:17] It has a very real chance of killing you.
[43:19] And the results that you get almost invariably can have complications such as contour irregularity, fat necrosis, fat cysts, where they take liposuction from, the fat from, can be irregular.
[43:32] So it's just all those things stacking up.
[43:34] You're going, hang on, this is, as you said before, Bec, this is an outlier in terms of you've really got to do your homework before undergoing this operation.
[43:41] Wow.
[43:42] And so I'm not necessarily for a minute saying you can't have a BBL.
[43:45] What I am saying absolutely is choose wisely.
[43:48] Yeah.
[43:48] And know the risks.
[43:49] And know the risks.
[43:50] Thanks for coming on.
[43:51] Thank you so much.
[43:52] Always love having you on.
[43:53] Yeah, so clever.
[43:54] It's a pleasure to be here.
[43:55] So smart.
[43:56] And yes, we are not getting butt blips.
[44:00] BBLs.
[44:01] No, we're not.
[44:01] No, we're not.
[44:03] And we can't wait to have you back on for another botched.
[44:06] Another botched or another surgery.
[44:08] We don't know.
[44:08] Yeah.
[44:09] It's been my absolute pleasure.
[44:10] Thanks for having me.
[44:11] Bye.
[44:18] Hey!

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