‘I was convinced I was going to die’: Meet the people risking their lives for the perfect BBL

Brazilian Butt Lifts are now considered the world’s most dangerous cosmetic procedure. So why are they soaring in popularity?
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There is a point during our conversation when Christina Escamilla hesitates. In the scene she’s describing, Christina – or Tina, as she goes by on TikTok – is just minutes away from an operation that she’s been planning for over a year now, one that she's convinced will vastly improve her quality of life. 

Yesterday, she stepped off a plane, after a three-hour flight, and checked into a recovery home where she will spend the next seven days. Now, she’s alone in an unfamiliar room, “waiting, and waiting,” she says. “I sent voice notes to my mum and sister and my son,” Christina, 35, continues. “I told them, I love you. If anything happens, I love you.”

Perhaps that sounds dramatic for one of the most popular procedures in the world right now. The Aesthetic Society reports that there were more than 40,000 BBL, or Brazilian Butt Lift, surgeries in 2020 alone and, while liposuction and breast augmentations still vastly outweigh the numbers, they're rising fast. Browse Instagram or TikTok and you might get the impression that the procedure – which involves liposuction to remove fat, which is then injected back into the buttocks to give a fuller effect – is even more common; standard, even. Yet, headlines from the last few years tell a different story.

Rather, the BBL is now considered the world’s most dangerous cosmetic procedure, with one report published by the Aesthetic Society in 2017 estimating that one in 3000 surgeries results in death. In the last few years, three British women – Leah Cambridge, 29, from West Yorkshire, Abimbola Ajoke Bamgbose, 38, of Dartford, Kent, and Melissa Kerr, 31, from Norfolk – have all died through complications of BBL surgeries performed in Turkey, dubbed the capital of medical tourism. 

Patients undergoing the surgery are at risk of death if fat is accidentally injected into large veins. If this occurs, the fat can travel up to the heart, lungs or brain (a fat embolism).

“I remember them telling me that we were going to get started with the operation,” Christina, a hospital volunteer coordinator from Tulsa, Oklahoma, who paid $6100USD (£4600) says, “and then I remember waking up on my stomach … I compared the pain to childbirth. I shot a video immediately and the first thing I said was, don’t get a BBL. Don’t do it. Go to the gym, it’s not worth it.”

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One of the main things Christina looked for when choosing her surgeon was that they’d had “zero deaths”; she was well aware of the risks that come with the search for a perfect bum. For a few years prior to electing for surgery, she’d been feeling self-conscious and low about her shape. She’d actually tried working out, she says, but found that her weight loss left her bum flatter than before. Eventually, after settling on a clinic in Miami she had the op in August 2021.

“Imagine that you could have everything you ever wanted, but you might have to risk everything to get it,” Chad Teixeira, who lives in Mayfair, London, is telling me. He is a 26-year-old PR who, after a lifetime of battling weight issues and insecurity about his body, underwent a complex BBL and extensive liposuction surgery, plus a tummy tuck, back in February 2021. 

“It was a whirlwind decision,” says Chad, who had 18 litres – or 35 kg of fat – removed plus a tummy tuck during his eight-hour operation, something that more than 50 UK clinics he called deemed a deadly risk; a procedure that cost £18,000. “In the UK they wouldn’t operate on me, they considered it a risk. So I had no option but to go to Turkey. The first doctor I found, I booked. And three days later, I was getting surgery.”

Chad credits lockdown with his impulse decision – the culmination of spending so many months without social distraction from his body, and staring at his reflection in the camera on Zoom. 

At the Centre For Surgery, a cosmetic surgery clinic in Marylebone, London, they say this has been something of a pattern. “Due to lockdown, I would say the number of enquiries we received about procedures across the board – but including BBL surgery – went up by 20-25%,” Michael Smith-Hardy, chief operating officer of the clinic, says. 

With more time to scrutinise, more time to research and, perhaps most significantly, more time to spend scrolling social media, the popularity of cosmetic work surged, so much so that the phenomenon became known as the Zoom Boom. On TikTok, the #BBL hashtag has more than 4.9billion views and even spawned a culture in and of itself: the BBL effect, a sort of mockery of the “precious” perception of women who have had BBL surgery.

Arguably, this has been a long time in the making. There was a time when Pamela Anderson’s breasts were the look-du-jour; another when size zero was the hottest diet challenge on Channel 4 and Cara Delevingne’s thigh gap had its own Twitter account but now, times – and beauty standards – have changed again. 

Now, the well-documented Kim Kardashian (or, perhaps more appropriately, Jessica Rabbit) effect has been firmly in action for years. Both anecdotally and evidentially, the pressure that Black women have and still face to be curvy, and the documented cultural appropriation that fed this procedure’s popularity have arguably never been more present.

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“Many women come in for a consultation asking for this extreme look,” explains Mr Omar Tillo, from the Centre for Surgery, who has been a qualified surgeon for 20 years and specialised in plastic surgery for more than a decade. “For the last five years, the BBL has been a large part of my practice. It’s not a new procedure – it’s been done for more than 40 years, since the 1980s, originating in South America … It’s a very complex surgery; lots of things can go wrong.” 

For years, Dr Tillo explains, it was routine to inject fat taken from areas like the stomach (the procedure’s commercial name is the BBL, but clinically it’s a fat transfer injection that always involves liposuction from fatty areas of the body) and inject into the gluteal muscles. “The reason being you get more pressure, more blood flow, so you can expect more fat tissue will survive in the muscle and get bigger volume – the exaggerated look. But now we know from studies that this should not be done.”

Injecting into the muscle creates a higher risk of the fat leaking, creating a fat embolism. So now, best practice deems that fat should be injected between the skin and the muscle. This way, the muscle acts as a barrier to stop fat leakage – and also limits the volume of fat that can be administered. 

In the UK, surgeons generally take 1-2 litres of fat to inject, but in other countries, this increases. In clinics outside of UK regulations, large amounts of fat injected into the muscle are much more common, and that’s just one of the risks, says Tillo. “Here in the UK we have very strict regulations – for instance, we have only single-use instruments. But in Turkey, for exa – though that’s not the only country, [just an example] – they use reusable cannula fat conduction systems, so the risk of contamination and infection is much higher. I’ve seen videos of people doing surgery in clinics (not a sterile theatre). I see a lot of patients coming from other countries with terrible outcomes. Just lately there was a case where the patient had paralysis of one leg and it was because the fat was injected too deep around the nerve.”

Even if the surgery goes ahead without complication, British patients travelling can suffer multiple complications. “The biological time for a wound to heal is six weeks,” Dr Stefano Cortufo, who runs a clinic in Harley Street, tells me. Patients are expected to wear a body compression suit – or faja – for at least that amount of time, if not longer, and cannot sit or apply any pressure to the site of surgery for at least two weeks. 

“That is the minimum time that doctors and patients need to be together. If I operate on you, you need to see me every week for six weeks.” Sitting on a plane for hours, days after an op can put a patient at risk, he says. Indeed, a quick search on TikTok and YouTube shows women going straight to A&E in the UK, suitcase in hand, after stepping off the plane. One was admitted with sepsis, a life-threatening infection. “The NHS is full of people coming back with infections,” Cortufo says.

“I was completely sh*tting myself,” Chad says when I ask him about the reality of these risks he took just last year. “I think I was at such a desperate point in my life and with my mental health that I just wanted to do anything to make me feel better, more confident. And even the idea of risking my life was better than feeling the way I did.” He says that lockdown meant he couldn’t seek therapy before taking drastic action – yet, the flight to Turkey (a country still on the red list) for major surgery wasn’t a barrier. 

“I didn’t sleep, I cried the whole time on the plane on the way there and the whole night before. Before surgery, they couldn’t put me under because I was crying so much. It was the worst experience of my life, I was honestly convinced that I was going to die.”

Chad ended up needing two blood transfusions post-surgery and woke up shaking, in excruciating pain but unable to communicate with Turkish-speaking care providers. His experience sounds traumatic – yet, like Christina, he is now very happy with the results. Both are now considering more surgeries. Chad says he is “ready to go again; it’s addictive," he says, and Christina might have a second BBL to enlarge her bum even more.

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The question is, why?

“My mum has had breast implants and a tummy tuck,” Christina explains, “She was younger when the Pamela Anderson body ideal [was prevalent]. The ideal body just changes…” She trails off recalling first looking at images on Tumblr and in magazines as a teen, when thinness (and whiteness), sometimes with improbable breasts, was deemed perfect. Now perfect looks like a 45 degree angle from the base of the spine to the top of the buttocks. What happens when this is achieved? And what happens when this latest construct of how a woman – and, more recently, gay men like Chad – should be?

“Women have been very supportive,” says Christina, who is avidly sharing her BBL story on TikTok. “Men not so much. Men are a little more mean, a bit more like, ‘oh well you’re fake’ and ‘you’re probably on welfare, that’s how you afforded it’ and other really crazy things. Especially when they have a fake or private account they can be really mean.” Is that not galling, since these beauty ideas are constructed by the male gaze, which dictates we have to look a certain way? “Yeah it’s frustrating,” Christina, who is single, says.

BBL surgery has long been a positive part of trans women’s journeys, but Chad says there’s a growing number of gay men who are also seeking it, though it remains more cloaked in silence. “I would say in some ways men suffer more than females,” he says, “because it’s become more normalised recently to talk about the pressures that females face from the media and social media. People don’t really talk about the pressures men feel; it’s still not normalised for men to show their feelings. I think that pressure is still really strong for men, especially those within the LGBTQIA+ community.”

Just like any type of body modification, it’s up to the individual to find what works for them. There should be no hard and fast rules around this or BBL surgery generally – but there should be concern over how this practice is being performed, what regulations are in place, how much information individuals have access to, and whether it’s being done for the right reasons. “This is not like going and buying a product,” Dr Tillo says, “it has a lifelong effect on the health. And there needs to be proper assessment of whether this procedure is going to cause harm, either physical or psychological.

“Nine out of 10 patients have an issue with their body that has bothered them for a long time and they want to fix it, and once it’s fixed, they’re very happy, they’re confident. 

"But one in ten perhaps are patients who are either bothered by many aspects of the body or one aspect that could be minor but it affects them from carrying on with their daily lives. And here is where we consider body dysmorphic issues. In those patients surgery is not the answer – you fix something and then their attention shifts on to something else in their body, or they continue with their body which they will never be happy about. Acceptance is the key – it will not be fixed by surgery.”

“Since I had BBL, I’ve had another surgery again. So I've had about three surgeries now. I still don’t know what my dream body is,” says Chad. “I just feel like we’re chasing a never-ending path. We’re chasing this idea of what perfect is but we don’t really know what it is.

“I feel like I’m becoming addicted to surgery, slowly. And it all started with a BBL.”

If you're struggling with your mental health or body insecurities, please speak to your GP or contact the Mind helpline on info@mind.org.uk or 0300 123 3393.

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