Miami consolidates its position as the US capital of the Brazilian butt lift

They come to Miami from all corners of the country, to the city that has established itself as the mecca of the Brazilian butt lift, or BBL, a cosmetic surgical procedure for buttock augmentation. Despite problems that have accumulated over the years, including clinics operating in legal gray areas and the highest number of deaths from cosmetic surgery in the country, the latest statistics show that nothing can move Miami from the top spot. While mortality has decreased thanks to stricter regulations and more precise surgical methods, not everything is rosy, and a large part of this vibrant industry remains in the shadows.

Thousands of people travel to South Florida each year to undergo this surgery, which involves extracting fat from different parts of the body through liposuction and injecting it into the buttocks. According to the latest statistics, of the nearly 30,000 buttock augmentation surgeries performed in the United States last year, half were performed in the southeast region, which includes Florida. Miami, with hundreds of plastic surgeons and dozens of clinics, is the epicenter of the vibrant American cosmetic surgery industry, and BBLs are the crown jewel.

It has been the fastest-growing cosmetic surgical procedure over the past decade. While the number nationwide has remained unchanged in recent years, between 2022 and 2024, it has doubled in the Southeast, according to figures from the American Society of Plastic Surgeons. BBLs have also been the cosmetic surgery with the highest mortality rate. South Florida leads the nation in the number of cosmetic surgery-related deaths, and the majority of cases have been from BBLs. Alarmed, state lawmakers have passed laws regulating the practice, and the industry appears to have matured with a greater focus on patient safety. However, the sector still operates in a large regulatory vacuum, and complications continue to occur, particularly in post-operative care, according to surgeons and experts consulted for this story.

The BBL boom in Miami predates the image popularized by the Kardashians. Experts point out that its popularity is largely due to the influence of the aesthetic ideals of the large Latin American diasporas living in the region, to the warm climate, and to a culture obsessed with image, fascinated by the promise of physical transformation. Studies indicate that many patients believe that reshaping their figure boosts their self-confidence and see BBL as a way to achieve an “ideal physique.” Studies also point to the effect of social comparison, with exposure to “curated images of curvy bodies” on social media as a significant factor in the conception of these norms.

“This procedure is so popular because it’s so powerful — there’s no other that can create these results,” explains Dr. Pat Pazmiño, a Miami-based plastic surgeon and member of the ASPS. “In the past, in plastic surgery, when we wanted to define contours or increase volume, we used implants. But you were inserting a foreign body, and implants have to be replaced. On the other hand, when you use the patient’s own fat graft, you can create any contour, of any size, in many areas where implants wouldn’t be used. And you don’t have to replace them.”

Pazmiño was part of a team that identified that most deaths from BBL occurred due to a complication called pulmonary fat embolism (PFE), which occurs when fat enters the bloodstream through veins in the gluteal muscles and impedes blood flow to the lungs. To prevent this, the adipose tissue must be injected directly above the muscle, avoiding penetration, a method that was implemented as a law in the state and has been widely adopted in the profession. Pazmiño also promoted the use of ultrasound during surgery to improve visibility and avoid puncturing the muscle.

It seemed the problem had been resolved, but deaths continued, mostly at low-cost clinics that had helped boost Miami’s popularity as a BBL mecca. “Women from all over the U.S. were coming to Miami to get BBLs and dying. This was giving Florida and Miami a terrible image,” says Pazmiño. “They offer dangerously low prices. If you go to Google and type ‘BBL price Miami,’ you’ll see prices as low as $2,000 or $2,500 at these clinics, which is crazy. Because when you work with a board-certified surgeon, our prices are five or six times that amount,” he adds.

In 2023, more laws were passed, but this time, rather than focusing on the method, they focused on practice. For example, the doctor had to see the patient for the first time at least 24 hours before surgery, and could only see one patient at a time.

“Many of these surgeons at low-budget clinics met with patients for the first time just minutes before the procedure. It’s not possible to establish a strong doctor-patient relationship in such a short period of time,” Pazmiño said. State law also establishes that surgeons cannot delegate the liposuction or fat grafting portion of the procedure to others, nor can they leave the operating room during surgery.

There is no national system tracking BBL case outcomes, but the measures appear to have produced a significant shift in the South Florida market, with surgeons, patients, and lawmakers “hyperaware” of the safety issue, Pazmiño says. “The good news is that the number of PFE deaths has decreased significantly in the year since the law was passed in 2023. The bad news is that patients are still dying from BBL, but from other causes, such as infections, hemorrhagic shock from bleeding, abdominal organ perforation, and inadequate postoperative recovery care. We’ve made a big step forward, but our work is not done,” he notes.

Existing regulations do not require the surgery to be performed in a hospital or outpatient surgery center, where the patient might spend the night for observation, and many procedures are performed in offices in shopping malls that do not offer postoperative care.

Competition is intense in Miami’s crowded BBL market, and it has turned to social media to find new clients. Dozens of cosmetic surgery centers are seeking to attract customers with Christmas or Halloween discounts, simultaneous surgery packages or combos, and installment payment plans. A single BBL, for example, can cost $4,500, and a tummy tuck $3,500, but the combined price is $8,500. The combined price can include more procedures, to “save time and money,” the ads say.

Surgeons explain the benefits and decisions in videos on TikTok, Facebook or Instagram, and clinics post before-and-after photos, patient interviews, and tips for achieving the desired result. Images of patients in underwear or semi-nude show the areas the surgeon will work on with dashed lines painted with markers, and after-procedure images — sometimes so fresh that bruising is visible on the skin — accompanied by hashtags like #BBLMiami or #totaltransformation.

Those who are interested seek recommendations in Facebook groups about which doctor to use or where to undergo postoperative care, ensuring that it’s a “legitimate place, with certified professionals.”

Postoperative care is one of the least regulated areas of the industry. There is an entire network of post-operative care services that revolves around BBLs, particularly for those coming from out of state. Videos on social media show how some transport post-operative patients lying face down in the back of a car on disposable absorbent pads wrapped in compresses, from the clinic to a hotel. Others offer bedside care, helping them change compresses, dress, or bathe. Still others offer “shaping” massages to help “sculpt” the desired silhouette. At Miami Airport and nearby hotels, it is common to find post-operative patients wearing tight compression garments around their waist, thighs, and buttocks.

This concern led Philadelphia resident Valerie Fiorentino to cancel her plans to have a BBL in Miami. “I ended up hearing too many scary stories about complications and not receiving proper care after surgery. I heard from girls who booked stays in recovery houses with the intention of being under the care of a registered nurse, only to be lied to and not given proper treatment for blood clotting and infections,” she notes.

Dr. Michael Salzhauer, known on social media as Dr. Miami, where he has millions of followers, says that “aftercare is just as important as the surgery itself, especially in terms of safety” and that many don’t anticipate “how much medical attention and care they’re going to need” after these procedures. Salzhauer has created a team of nurses who he says he trained over the years, who monitor his patients 24/7 for days at a hotel just yards from his clinic in the affluent Bal Harbor neighborhood north of Miami Beach. “If you don’t take proper care — if you don’t clean them, if you don’t take their vital signs, if the medications aren’t administered at the right times — there are a lot of things that can go wrong,” says the surgeon, who estimates that half of all plastic surgery deaths in South Florida occur after the operation.

“People need to know that it’s a serious operation. It’s surgery. It’s not like going to get a haircut. They have to think about all the medical details, the aftercare, and all that, so that the outcome is good and there are no problems,” he adds.

Dr. Pazmiño, for his part, emphasizes the importance of people ensuring they are being treated by a board-certified surgeon, but adds that “you have to be a little more specific, because that’s like telling someone, when they get into a car, to drive carefully.” Patients should ask their doctor if a hospital would allow them to perform the surgery, to ensure they are actually certified by a legitimate board. The Florida Department of Health did not respond to a request for comment.

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