Why I Prefer to Perform Brazilian Butt Lifts Awake Using Tumescent Anesthesia
Brazilian Butt Lift (BBL) surgery has become one of the most popular body contouring procedures—but it’s also one of the most debated when it comes to safety. As a plastic surgeon specializing in body contouring, I believe patient safety should never be compromised for aesthetic goals. That’s why I prefer to perform BBLs on awake patients using tumescent anesthesia.
What Is Awake BBL?
An “awake BBL” refers to performing the procedure while the patient is conscious but comfortable, thanks to tumescent anesthesia. This technique uses a fluid containing saline, lidocaine (a numbing agent), and epinephrine (to minimize bleeding) to keep patients pain-free and relaxed during the procedure without the risks associated with general anesthesia.
Why Awake BBL Is Safer
One of the most serious risks associated with BBLs is fat embolism—when fat is accidentally injected into large blood vessels in the gluteal muscles, it can travel to the lungs and become fatal. The majority of these complications happen when fat is injected into or below the muscle.
By keeping patients awake, I can avoid this risk. The fat layer between the skin and muscle becomes fully numb with tumescent anesthesia, but the muscle does not. So if a cannula gets too close to the muscle, the patient will feel it—providing a built-in safeguard. This direct feedback helps me ensure that fat is only placed in the safe subcutaneous plane, not in the muscle.
Fat Placement: Where and Why
When performing fat transfer to the buttocks, I only inject fat into the subcutaneous layer—above the muscle. This layer has two planes: a superficial layer closer to the skin, and a deeper layer that’s still safely above the muscle and which tends to retain fat better. This approach offers excellent aesthetic results while dramatically reducing risk.
Awake or Asleep—It’s Your Choice
While I strongly advocate for awake BBLs for safety and recovery benefits, some patients still prefer to be asleep. That’s okay—BBL surgery jcan also be performed under general anesthesia. My priority is to educate each patient on their options and guide them toward the safest, most personalized surgical plan.
Final Thoughts
I will never inject fat into the gluteal muscles. It’s simply too dangerous, and the risk far outweighs the reward. By performing awake BBLs with tumescent anesthesia, I can contour safely, precisely, and with real-time patient feedback.
If you’re considering a BBL and want to know more about your options, feel free to reach out. I’d be happy to help you make an informed decision.
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