By Daniel Chang -
KHN
Nikki Ruston regrets not paying attention to the red flags.
The Miami (Florida) clinic where she scheduled a surgery known as a
Brazilian butt lift
or buttock lift with the Brazilian technique had closed and transferred her medical file to a different center.
The price he was offered, and which he paid in advance, increased on the day of the operation, and he
did not meet his surgeon until shortly before receiving general anesthesia.
“I was ready to go,” said Ruston, 44, of the town of Lake Alfred, Florida.
"But I had already paid for everything."
A few days after the procedure, which was in July,
Ruston was hospitalized for an infection, blood loss and nausea
, according to her medical records.
“I looked for the cheapest, that's what I did,” recalls Ruston.
“I searched for the lowest price and found it on Instagram.”
People like Ruston are enticed to go to surgery centers in South Florida offices.
It happens through social media marketing that portrays the Brazilian butt lift, and other cosmetic surgeries,
as deceptively painless, safe, and affordable
, according to researchers, patient advocates, and surgeon associations.
More than 61,000 buttock augmentation procedures were performed nationwide in 2021.ronstik / Getty Images/iStockphoto
Unlike ambulatory surgery centers and hospitals, where a patient may stay overnight for observation after treatment, office-based surgery centers offer procedures that typically do not require hospitalization, and are regulated as an extension of the office. deprived of a doctor
But these centers are often owned by corporations that offer cut prices
by contracting with surgeons who are incentivized to see as many patients as possible
per day, in the shortest amount of time, according to state regulators and doctors who are critical of these centers.
constant pain
Ruston said she
now lives in constant pain
, but other patients have had a Brazilian butt lift cost their lives.
After a spate of deaths, and in the absence of national rules, Florida regulators were the first to enact rules in 2019 aimed at making procedures safer.
More than three years later, the data shows that deaths are still occurring.
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Patient advocates and some surgeons—including those performing the procedure themselves—anticipate the problem will worsen.
Emergency restrictions imposed by the state medical board in June expired in September, and the business model popularized in Miami has spread to other cities.
“We are seeing entities with a strong footprint in high-volume, low-cost cosmetic surgery, based in South Florida, that have popped up in other parts of the country,” said Bob Basu, MD, vice president of the American Society of Surgeons. Plastics and Medical in Houston, Texas.
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During a Brazilian butt lift, fat is removed by liposuction from other areas of the body, such as the torso, back, or thighs, and injected into the buttocks.
More than 61,000 buttock augmentation procedures, both lifts and implants, were performed nationwide in 2021,
up 37% from the previous year, according to data from the Aesthetic Society, a group of plastic surgeons.
As with all surgery, complications can arise.
The Miami-Dade County coroner has documented
nearly three dozen cosmetic surgery patient deaths since 2009
, 26 of which were the result of a Brazilian butt lift.
In each case, the patient died of a fatty pulmonary embolism, that is, the blockage of blood vessels by fat that entered through the veins in the gluteal muscles and prevented blood flow to the lungs.
No national reporting system or insurance codes track the results and demographics of patients who undergo a Brazilian butt lift.
Globally, about 3% of surgeons have had a patient die as a result of the procedure, according to a 2017 report by a task force for the Foundation for Cosmetic Surgery Education and Research.
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Medical experts said the problem arises, in part, from having
physician assistants and nurses perform key parts of the butt lift instead of doctors
.
It is also the consequence of a business model motivated by profit, not by safety, which incentivizes surgeons to exceed the number of operations stipulated in their contracts.
Surgeries with deadly results
In May, after the fifth patient died after several months of complications in Miami-Dade County, Dr. Kevin Cairns proposed an emergency state rule to limit the number of butt lift operations a surgeon could perform per day. .
“I was sick of reading about women dying
and seeing cases come to the board,” said Cairns, a physician and former member of the Florida Board of Medicine.
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Some doctors performed up to seven surgeries, according to disciplinary files against surgeons, opened by the Florida Department of Health.
The emergency rule limited them to no more than three, and required the use of an ultrasound to help surgeons reduce the risk of lung fat clots.
But a group of doctors performing Brazilian butt lift operations in South Florida responded by forming the organization Surgeons for Safety.
They argued that the new requirements would make the situation worse.
Qualified doctors would have to do fewer procedures, they said, leading patients to go to dangerous medical professionals who don't follow the rules.
Since then, the group
has donated more than $350,000 to the
state Republican Party, candidates and Republican political action committees, according to campaign contributions data from the Florida Department of State.
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Surgeons for Safety declined KHN's repeated interview requests.
Although the group's president, Dr. Constantino Mendieta, wrote in an editorial in August that he agreed that not everyone has followed the standards of care, he called the limits imposed "arbitrary."
The rule sets "a historical precedent for controlling surgeons," he said during a meeting with the Florida medical board.
In January, Florida Republican Sen. Ileana Garcia introduced a bill to the state legislature that proposes there be no limit to the number of Brazilian butt lifts a surgeon can perform in one day.
Instead, it requires office-based surgery centers, where procedures are performed, to have one doctor per patient, and prohibits surgeons from working on more than one person at a time.
The bill would also allow some parts of the procedure to be delegated to other doctors under their direct supervision, and the surgeon must use an ultrasound.
The Florida legislature reconvenes on March 7.
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Lured by false low prices
Like Ruston, many people base their expectations on before and after photos and videos posted on social media platforms like Facebook, Snapchat, and Instagram.
"That's very dangerous
," said Basu, of the American Society of Plastic Surgeons.
“They get excited about a low price and forget to do their homework (to research),” he added.
The average price of a butt lift in 2021 was $4,000,
according to data from the Aesthetic Society.
But that's just for the doctor's fees and doesn't cover anesthesia, operating room costs, prescriptions, and other expenses.
A “safe” Brazilian butt lift, performed in an accredited facility and with proper post-op care, costs between $12,000 and $18,000, according to a recent article on the American Society of Plastic Surgeons website.
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Although Florida requires a medical license to perform liposuction on patients under general anesthesia, it's common for mid-level medical professionals, such as physician assistants and nurse practitioners, to perform the procedure in an office setting, according to Dr. Mark Mofid, co-author of the study, from 2017, of the work group of the Foundation for the Education and Investigation of Aesthetic Surgery.
By relying on staff who don't have the same specialized training and are paid less, office-based surgeons are able to complete more butt lifts per day and charge a lower price.
“They are all done at once, in three or four different rooms, and seen by one surgeon,”
explained Mofid, a plastic surgeon in San Diego, California, adding that he does not perform more than one Brazilian butt lift a day.
"The surgeon is not the one who is on the real case, they are his assistants."
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Basu said patients should ask if their doctor can perform the same procedure in a hospital or ambulatory surgery center, where there are stricter rules than in offices, in terms of who can perform butt lifts and how they should be done.
Cosmetic surgery can have other serious risks beyond deadly fat clots, such as infection and organ perforation, as well as kidney, heart and lung problems.
A surgeon he found on Instagram
Ruston's surgery was performed by a board-certified plastic surgeon who he said he found on Instagram.
Initially, she charged him $4,995, which she said she paid in full before the surgery.
But when she arrived in Miami, she said the clinic added charges for liposuction, and post-surgical garments and devices.
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“I ended up paying about $8,000
,” Ruston detailed.
A few days after returning to Lake Alfred, she began to feel dizzy and weak, and she called 911.
Paramedics took her to the emergency room, where she was diagnosed with anemia from blood loss and blood and abdominal infections, according to her medical records.
"If I could go back in time," he concluded, "I wouldn't do (the surgery)."
KHN's Chaseedaw Giles contributed to this report.
KHN
(Kaiser Health News) is the newsroom of
KFF
(Kaiser Family Foundation), which produces in-depth journalism on health.
It is one of the three main programs of KFF, a non-profit organization that analyzes the problems of health and public health in the nation.