I'm a plastic surgeon who does Brazilian butt lifts. BBLs are my most popular procedure, but some people shouldn't have it done.

• Dr. John Paul Tutela has offered Brazilian butt lift surgery since he started his practice in 2014.
• He said its popularity continues to grow and his clientele has doubled over the years.
• Tutela said the surgery is great, but patients who are too big or too skinny shouldn't get it done.

This as-told-to essay is based on a conversation with Dr. John Paul Tutela, a 43-year-old plastic surgeon in Livingston, New Jersey, about performing Brazilian butt lift surgeries. It's been edited for length and clarity.

I started my practice in 2014, and even though I offer a lot of different procedures, The Brazilian butt lift continues to be one of the most popular surgeries that my clients come in for.

My father was a plastic surgeon, so I figured I'd one day grow up and have the same career. As I learned more about it, I realized it was the perfect job for me, since I always liked working with my hands and solving problems.

Being a plastic surgeon means you get to do both cosmetic and reconstructive surgery. You get to help two different populations of people and you get to work on patients from head to toe, while most other surgeons just specialize in one area of the body.

I started offering the BBL procedure as soon as I opened my practice and it continues to grow in popularity. My pricing starts at around $18,000, and I do about one of these a week. 

BBL surgery isn't dangerous

There are a lot of articles that say it's unsafe and has a mortality rate associated with it, but mortalities happen because many people performing the procedure are not properly trained. I'd been trained to do it safely in my residency. I also take annual courses and workshops to continuously improve my skills. 

Getting a Brazilian butt lift requires pretty aggressive liposuction to help sculpt the body's shape. The procedure takes anywhere from three to five hours.

We usually do the liposuction on the patient's sides, waist, or lower and upper back, then we insert the fat down by the hips and in the glutes. In the end, we remove fat from any area where the patient wants fat reduction. The combination of taking in the waist and then bringing the hips out a little bit creates an hourglass shape. 

Who should get BBL surgery?

The popularity of BBLs boomed because of trends. It seemed like in the mid 2010s, thanks to supermodels and Hollywood stars like Kim Kardashian and Jennifer Lopez, having more curves caught the public's attention and became what women wanted for their bodies.

Even now, it's still quite popular, and I don't think it's a trend that's going anywhere. My clients are all different types of people. I've performed this surgery on a woman who worked in an office and wanted to feel more confident as she led meetings daily. I've also performed the procedure for a housewife who had it done as part of her mommy-makeover post baby.

I find myself doing almost double the amount of these surgeries now than I did in 2014, but getting a BBL isn't something that anyone should go off and do. First and foremost, you have to be healthy and not have any medical comorbidities that make going under general anesthesia a big risk. 

Studies have shown that people with a BMI over 30 could have increased complications during surgery. Since an increased BMI decreases wound healing and increases the risk of blood clots, I'd recommend that individuals in this range avoid doing an elective surgery like this one or consider doing this once they've lost weight — I'll often turn them away. 

On the other side are people who are too skinny and don't have enough fat on their bodies to do this surgery. Since a big part of the procedure is doing liposuction to use that fat to enhance the glute area, if there's not enough fat the results might not look good. I'd never tell this category of people to gain weight for the surgery, I'd just recommend they don't do it. 

How much is a Brazilian butt lift? 

A BBL is an elective and cosmetic surgery, so it's not covered by insurance. Things like expertise of the surgeon and location (it might be less expensive in more rural areas where there's less demand) can play into the price. On average, the procedure could cost anywhere between $10,000 and $25,000.  

What is the recovery time for a Brazilian butt lift?

The first week after surgery, you're likely to feel some pain and discomfort in your lower body, but you won't be bedridden from it. I instruct my patients to move around and walk at least 10 to 15 times a day to help prevent blood clots. I tell people that during that first week, nobody should count on you for anything. Also, for two weeks, I instruct patients not to sit or lay on their back. 

During recovery, if a patient is sitting or smushing that area, it tends to lead to less of the fat surviving, so it could deflate or cause hard lumps. After those initial two weeks, I tell my patients to keep a limited seating protocol for the next two weeks and to wear a garment around the area that provides compression to help the swelling. Beyond that, there's minimal recovery that could be needed and a patient can return to normal activities. 

Some of the risks can include fat embolism, which is when fat particles block the blood flow in the bloodstream — it's very rare. I've had zero cases of that and always protect against that happening. You can also have contour abnormalities, which is the most common but can be fixed with a touch-up surgery. 

The outcome of this procedure should last for several years or decades, without any additional treatments. However, body changes that occur with aging and any weight gain or weight loss could affect results over time. I've had repeat clients. You don't know how the results will look until it's all done.

What should I do if I want BBL surgery?

Make sure they're certified by The American Board of Plastic Surgery and not just board certified, which can be vague. Over the years, other boards have popped up that might mislead you into thinking the surgeon you're going with is as qualified as you'd like them to be. 

Also, it's important to go meet the surgeon, see how you feel, and ask questions like, "What complications have patients had in the past?" All of this is important because if a surgeon makes you feel great but isn't good at what they do, they aren't the right person to pick.