(CNN) — Looking back, Nikki Ruston admits to spotting the red flags.
The Miami office where he scheduled what’s known as a Brazilian butt lift (BBL) had closed and transferred his records to a different facility, he said. The price she was quoted—and she paid in advance—increased the day of the procedure, and she didn’t meet her surgeon until she was about to be placed under general anesthesia.
“I was ready to go,” said Ruston, 44, of Lake Alfred in Central Florida. “But I had already paid for everything.”
A few days after the July procedure, Ruston was hospitalized with an infection, blood loss and nausea, her medical records show.
“I did it cheap. That’s what happened,” Ruston recalled recently. “I searched for the lowest price and found it on Instagram.”
People like Ruston are often drawn to South Florida surgery centers through social media marketing that misleadingly claims Brazilian butt lifts and other cosmetic surgeries are painless, safe and affordable, say researchers, patient advocates and groups of surgeons.
Unlike hospitals and ambulatory surgery centers, 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 a physician’s private practice. .
But such surgical offices are often owned by corporations that can offer discount prices by hiring surgeons who have incentives to work on as many patients per day as possible, in the shortest amount of time, according to state regulators and doctors who criticize the facilities. .
Ruston said he 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 standards, Florida regulators were the first in the country to enact rules in 2019 aimed at making procedures safer. More than three years later, the data shows that people are still dying.
Patient advocates and some surgeons—including those performing the procedures—anticipate the problem will only get worse. Emergency restrictions imposed by the state medical board in June expired in September, and the corporate business model popularized in Miami is spreading to other cities.
“We are seeing entities that have a strong footprint in high-volume, low-cost cosmetic surgery, based in South Florida, manifest in other parts of the country,” said Dr. Bob Basu, vice president of the Society American Plastic Surgeon and practicing physician in Houston.
During a Brazilian butt lift, fat that is removed by liposuction from other areas of the body such as the torso, back, or thighs, is injected into the buttocks. More than 61,000 buttock augmentation procedures, both butt lifts and implants, were performed nationwide in 2021, an increase of 37% over the previous year, according to data from the Aesthetic Society, a trade group of plastic surgeons.
As with all surgery, there can be complications. The Miami-Dade County Medical Examiner has documented nearly three dozen patient deaths from cosmetic surgery since 2009, 26 of which were due to a Brazilian butt lift. In each case, the person died of a pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood flow to the lungs.
No national reporting system or insurance code tracks the results and patient demographics for a Brazilian butt lift. About 3% of surgeons worldwide suffered a patient death as a result of the procedure, according to a 2017 report by a task force for the Cosmetic Surgery Research and Education Foundation.
Medical experts say the problem stems, in part, from medical professionals, as well as physician assistants and nurse practitioners, performing key parts of the butt lift instead of doctors. Also because it is driven by a business model motivated by profit, not safety, and this incentivizes surgeons to exceed the number of surgeries described in their contracts.
In May, after the fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed the state’s emergency rule to limit the number of butt lifts a surgeon can perform each day. .
“I was getting tired of reading about women dying and seeing cases brought before the board,” said Cairns, a physician and former member of the Florida Board of Medicine.
In January, Republican Florida State Senator 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 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 surgeons to delegate some parts of the procedure to other doctors under their direct supervision, and the surgeon must use an ultrasound.
The Florida legislature meets on March 7.
People considering cosmetic procedures should be cautious. Like Ruston, many people base their expectations on before-and-after photos and marketing videos posted on social media like Facebook, Snapchat, and Instagram.
“It’s very dangerous,” said Basu, of the American Society of Plastic Surgeons. “They are excited about the low price and forget to take care,” he said.
The average price of a buttock augmentation 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 fees, prescriptions, or other expenses. A “safe” Brazilian butt lift, performed in an accredited facility and with proper aftercare, costs between $12,000 and $18,000, according to a recent article on the American Society of Plastic Surgeons website.
Although Florida requires a medical license to perform liposuction on patients who are under general anesthesia, it is common in the medical field for mid-level physicians, such as physician assistants and nurse practitioners, to perform the procedure in the office, according to Dr. Mark Mofid, co-author of the 2017 Cosmetic Surgery Foundation for Research and Education task force study.
By relying on staff who don’t have the same specialized training and who are paid less, in-office surgeons are able to complete more butt lifts per day and charge a lower price.
“They’re doing it simultaneously in three or four different rooms, and it’s being done by one surgeon,” said Mofid, a plastic surgeon in San Diego, adding that he doesn’t do more than one Brazilian butt lift in a day. “The surgeon is not doing the operations. They are the attendees.”
Basu said patients should ask if their doctor has permission to perform the same procedure at a hospital or ambulatory surgery center, where stricter rules apply than office surgery centers as to who can perform butt lifts and how. must be done.
Bargain-seekers are reminded that cosmetic surgery can have other serious risks in addition to deadly fat clots, including infection and puncture of organs, as well as problems with the kidneys, heart and lungs.
Ruston’s surgery was performed by a board-certified plastic surgeon she found on Instagram. He originally quoted her $4,995, which he said he paid in full before surgery. But when he arrived in Miami, he said, the clinic added charges for liposuction and for post-surgical garments and devices.
“I ended up paying like $8,000,” Ruston said. A few days after returning to her Lake Alfred home, she said, she began to feel dizzy and weak and called 911.
Paramedics took her to an emergency room, where doctors diagnosed her with anemia due to blood loss and blood and abdominal infections, her medical records show.
“If I could go back in time,” he said, “I wouldn’t do it again.”
KHN’s Chaseedaw Giles contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.