As tributes are paid to the first woman thought to have died from a liquid Brazilian butt lift (BBL) carried out in the UK, we ask experts what the procedure involves and whether it should be banned.
What has happened?
Alice Webb, 33, died early on Tuesday morning at Gloucestershire Royal hospital. It is thought she fell ill after undergoing a non-surgical, liquid BBL procedure at a clinic in the UK.
What is a BBL?
A BBL procedure changes the shape of the bottom to make it appear larger or more defined.
Nora Nugent, a consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons (Baaps), said traditionally the term was applied only to a specific type of procedure, in which fat is removed from one part of the body using liposuction and injected into the buttocks. This procedure often involves a general anaesthetic.
But, she added, BBL had now become something of an umbrella term. “The term has evolved a bit to include non-surgical, or liquid, BBLs, which involve filler,” she said.
These fillers are typically hyaluronic acid-based or poly-L-lactic acid (PLLA), which are injected into the buttocks, often after local anaesthetic has been given. Results can last for a couple of years.
Why are BBLs so dangerous?
Traditional BBLs are risky because of the dangers should injected fat end up in blood vessels.
“There were a spate of deaths, particularly in Florida, where the fat injected got into the large veins in the buttock, underneath the muscle, and travelled to the lungs, causing a pulmonary embolism,” said Nugent.
As a result, in 2018 Baaps dissuaded all its members from performing BLLs. However, in 2022 it issued new guidelines, noting that risks could be reduced by ensuring fat is not injected into the muscle, but into the area between the skin and the muscle. This, it adds, must be done with the aid of ultrasound.
Nugent said that while liquid BBLs might seem safer on paper – not least because they do not involve a general anaesthetic or liposuction – fillers can also cause embolisms. “Basically, it’s a gel. And if the gel actually blocks a blood vessel, it can block the flow to wherever that blood vessel was going,” she said.
There is another problem: liquid BBLs are unlicensed and unregulated in the UK.
Should such procedures be banned in the UK?
Some people think so, including Save Face, a UK register of accredited cosmetic practitioners.
“They [liquid BBLs] are advertised on social media as ‘risk-free’, ‘cheaper’ alternatives to the surgical counterpart, and that could not be further from the truth,” said Ashton Collins, the director of Save Face, adding that the organisation had supported over 500 women who suffered complications after these treatments, many of whom nearly died.
“All of the procedures reported to us were carried out by non-healthcare practitioners who are carrying out incredibly dangerous procedures in unsterile environments.”
However, Nugent said, there is a role for BBLs, including those using fillers, if done well, both for reconstructive work and for aesthetic reasons. The key, she stressed, is to ensure they are only carried out by fully trained medical professionals.
“Fillers should be made inaccessible to lay people,” she said. “People who are not trained should not be able to get hold of these products and there should be a consequence if they do. Tt should be illegal for them to do it.”
Omar Ahmed, a consultant plastic surgeon and spokesperson for the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), also said BBLs or liquid BBLs should be carried out only by appropriate medical professionals.
“The crux of the matter [is], it should be done by someone who is trained to do it, someone who has the experience of doing it, someone who’s qualified to do it, and someone who’s doing it in the right way,” he said.
It is understood that the government is looking at options to tighten regulations around around the non-surgical cosmetics sector.
