On June 16, 2021, Erica Russell died while undergoing cosmetic surgery for a “Brazilian Butt Lift (BBL),” a procedure that has grown in popularity in recent years. Last March, her family filed suit in Miami-Dade County Court for wrongful death against Seduction Cosmetic Center, the facility where the operation was performed, and Dr. John Sampson, the operating surgeon. The complaint’s allegations echo findings by the Florida Department of Health in disciplinary action against Sampson regarding Russell’s death. There, the Department of Health found that, by puncturing several of Russell’s organs and injecting fat below her gluteal muscles, which caused the pulmonary fat embolism that led to her death, Sampson had violated the standard of care for a cosmetic surgeon.
Although butt augmentation as a cosmetic procedure has been around for decades, in recent years, its popularity has spread like wildfire across the United States, likely due to shifting beauty standards which now favor a shapely posterior compared to the turn of the century, in part due to celebrity endorsements. Only around five hundred procedures were performed nationwide in 2005, whereas in 2020, that number jumped to over twenty thousand.
The standard procedure for a BBL is comprised of two parts: an initial liposuction procedure, which removes fat from elsewhere in the patient’s body, followed by the fat’s insertion and grafting into the fatty tissue on the patient’s buttocks. The American Society of Plastic Surgeons (ASPS) recognizes that while outcomes have improved over the past few years, the procedure inherently involves the risk of death. Complications are rare but usually manifest immediately; fat embolism, the cause of Russell’s death, was found to be the most severe identified complication, prompting the ASPS to recommend that surgeons modify their technique to avoid placing fat near the patient’s gluteal muscles. In response to these recommendations, the Florida Board of Medicine passed a regulation banning fat grafting techniques that inject fat below the gluteal muscles in 2019, two years before Russell’s demise.
Russell’s unfortunate case is an example of how the standard of care and its breach are defined during the two stages of the BBL procedure. Because the initial perforation of her organs occurred during the liposuction while the introduction of fat—which caused the embolism that ultimately killed her—happened during the grafting portion, Sampson is alleged to have breached the standard of care in at least two instances. Russell’s case is also an example of how medical regulatory bodies revise how the standard of care is defined to adapt to current events. In response to Russell’s case and other similar deaths, the Board of Medicine passed an emergency rule in 2022 limiting surgeons to three BBL procedures a day. Sampson and other doctors were found to have performed around double that amount at the time of their patients’ deaths.
Florida’s approach to the regulation of BBL surgeries should serve as a lesson to cosmetic surgeons who wish to avoid patient deaths and malpractice liability while providing an increasingly popular service. While there are no federal regulations on the practice, Florida’s regulatory law represents the sentiments held by the ASPS and other national cosmetic surgeon organizations. Florida is one of the most popular destinations in the country for these procedures; it was estimated in 2019 that practitioners in Miami-Dade County alone accounted for fifteen to eighteen thousand procedures. Should this trend in popular ideals of beauty and self-image continue to grow and other states seek to further their regulations on the practice, their measures will likely be in accord with Florida’s for the reasons held by the Board of Medicine. As a result, these actions will help clearly define the “national” standard of care for BBL surgeries and ultimately help hold malpractitioners accountable wherever they may be.