Booty-ful … and wide awake?
Brazilian butt lifts (BBLs) have been the shortcut to a perkier behind for years. Now, more patients are choosing to stay alert during the procedure, watching their curves get crafted in real time.
To learn more about the trending “awake BBL,” The Post spoke with board-certified plastic surgeon Dr. Sean McNally about the upsides — and downsides — of staying conscious while doctors boost your backside.
What is an awake BBL?
It involves removing fat from areas like the abdomen, thighs or back through liposuction and injecting it into the buttocks to create a fuller, curvier appearance.
Traditionally, the procedure is performed in an operating room with the patient under general anesthesia.
But during an awake BBL, patients remain fully conscious. The surgery is typically done in an office setting using local anesthesia and oral sedatives.
What are the perks of an awake BBL?
Patients are usually drawn to an awake BBL for two main reasons, said McNally, who serves as the lead provider at Doctor PDX and Réviance in Portland, Ore.
“One, there’s no anesthesia provider and either a reduced or no facility fee, which makes the procedure more affordable,” he explained.
“Two, patients are concerned about the safety profile of standard BBLs, and they feel like being awake makes it safer.”
Some clinics also promote faster recovery times, avoiding the nausea and grogginess sometimes linked to general anesthesia and allowing patients to return to daily activities sooner.
Why do some surgeons not perform awake BBLs?
“I don’t perform them, and I know many others who don’t,” McNally said. “It’s not that it’s a bad surgery per se — the big issue is patient comfort versus results.”
Because doctors can only use a limited amount of local anesthetic based on a patient’s weight and height, there’s only so much pain relief they can provide.
“I have heard absolute horror stories from patients who went to chop shops for cheap liposuction, and once the surgeon hit the max local anesthetic volume they could give them, they were told to hold still and bare it if they wanted a good result, while the patient could feel everything,” McNally said.
Some surgeons have pushed past safe limits, risking potentially deadly lidocaine toxicity by giving patients too much local anesthesia to ease their pain.
“I’m not a fan of any of these options,” McNally said.
There’s also a legal catch: Many states cap how much fat can be removed during liposuction in an office setting, leaving less to work with — and potentially disappointing outcomes.
“You never want to have to balance patient comfort during a case against whether you’re getting the result you and the patient want.” McNally said.
What are the other risks of an awake BBL?
Besides pain, McNally said the safety profile of an awake BBL are generally similar to the traditional procedure.
“More common risks include swelling, bruising, bleeding, infection, contour irregularities where we do the liposuction to collect the fat, variable take of the transplanted fat and hard lumps of fat that didn’t take, known as fat necrosis,” he explained.
The “most dreaded” complication is fat embolism — a rare but life-threatening condition that strikes when fat enters the bloodstream and travels to the heart or lungs. This can occur whether the patient is awake or under general anesthesia.
“We help mitigate this risk by being mindful of our injection volumes, and we complete the injection under ultrasound guidance to avoid injecting fat into the muscles where the largest vessels are,” McNally said.
Advice for anyone considering an awake BBL
“As always, seek a knowledgeable and reputable provider based on the experience — not by price point,” McNally said.
Before getting the procedure, he recommends having a frank and honest conversation with your doctor about your goals and concerns.
“The right provider will help guide you to the option that’s right for you and if you don’t think that surgeon is a good fit for you, find a surgeon who is,” McNally said.
