The classic first-time plastic surgery trope for young women used to go something like this: Girl turns 16 and returns to school after the summer break with a new nose. Or maybe, girl turns 18 and saves money from a part-time job for a breast augmentation. But now, the common narrative of a woman’s first plastic surgery experience looks something like this: Girl turns 18, saves up her money, goes off the grid for a month and returns with an Instagram post of her new thicc butt.
We’ve been in the midst of a Big Butt Era for years, but it’s only recently hit a saturation point, which is marked by the fact that for many women, their first experience of plastic surgery comes in the form of butt augmentations. According to the 2018 Plastic Surgery Statistics Report from the American Society of Plastic Surgeons (ASPS), although breast augmentations continue to be the most popular cosmetic surgical procedure for women overall (313,735 were performed that year), rhinoplasty has decreased by 45 percent over the last 18 years, and it’s butt augmentations that have experienced the biggest jolt in popularity: There were nearly 25,000 butt augmentations performed in 2018 by ASPS member surgeons, as well as 1,000 butt implant surgeries, 4,900 butt lifts and 9,000 lower body lifts.
Overall, since 2000, butt and lower body lift procedures have grown by 256 and 4,296 percent respectively, according to ASPS, although it should be noted that some of the numbers are a little fuzzy. That is, ASPS didn’t begin recording data for butt implants until 2005, and augmentations until 2013. Complicating matters further is the fact that not all American plastic surgeons are ASPS members. There’s also the issue of American women traveling abroad for procedures, which muddies the stats further. Because while, according to the same data, people ages 40 to 54 were most likely to undergo plastic surgery performed by an ASPS doctor, younger women are more likely to seek more affordable procedures in other countries.
Still, it’s clear from both the existing numbers and simple anecdotal evidence that the procedure is gaining steam. On YouTube, dozens of women have shared their personal butt augmentation stories, many of whom had no prior experience with plastic surgery. “I got it when I was 18 years old, two months out of high school,” Cristina Villegas explains in one of her videos. “I knew for a super long time that this was something that I wanted, so when I was a junior in high school I started saving for the surgery. I worked at McDonald’s for two years to save.”
In another video, YouTuber DaniellaNaomixo discusses how, at 18 years old, she flew to the Dominican Republican from Atlanta in order to get her surgery, after watching hours of YouTube videos of other women. “I even watched videos of how to talk to doctors in Spanish,” she says.
As for what exactly these surgeries involve, there are a variety of procedures that broadly qualify as enhancements to the butt. A butt augmentation, as it’s defined by PlasticSurgery.org, “is used to improve the contour, size and/or shape of the buttocks. This is done through the use of buttock implants, fat grafting or sometimes a combination of the two.” The process of fat grafting — where fat is taken from one area of the body and placed into the butt — is sometimes referred to as a Brazilian Butt Lift, and is the most popular form of butt enhancement. However, a “lower body lift” or “butt lift” may also refer to a procedure where fat and excess skin are removed, resulting in a smoother, more toned look, without the volume being increased. These procedures range in cost from $2,500 to $10,000, on average.
Dr. Michael Salzhauer, better known as Dr. Miami, is one of the biggest faces of butt augmentation, becoming famous over the last few years for documenting the Brazilian Butt Lifts (BBLs) he performs on Instagram and Snapchat. According to Salzhauer, his average BBL patient is a woman between the ages of 20 and 30 from a metropolitan area, of a middle-class income. “About half are doing them before they have kids, and half are doing them after,” he says. “I’d say five or six years ago, the average BBL patient had, had breast augmentation or rhinoplasty or something else before. Now, for about 70 percent of BBL patients, it’s their first surgery. I see this in my own practice, and with other surgeons around the world. I think it’s because of social media and just awareness of the procedure in general.”
The prevalence of BBLs on social media is something Salzhauer himself helped proliferate and normalize, of course. But he also believes that part of the popularity of the procedure stems from the fact that it essentially offers a complete body transformation. “It’s a pretty dramatic operation, it changes your entire silhouette,” he explains. “You take areas of fat from places you don’t want it, and move it to the places you do.” Essentially, the procedure kills two birds with one stone.
But is such a “dramatic operation” safe for a woman who can’t even legally drink alcohol yet? Per Salzhauer, yes. Instead, he believes the biggest thing to consider is whether one plans on having children soon. “There are no added risks [to having the surgery before children],” he says. “[But] when you have kids, your body changes. It’s not like you’re any worse off because you have breast implants or BBL before you have kids, but you need to anticipate that, for about 50 percent of people [who have had plastic surgery], you’re going to want a touch up after you have babies. There’s no extra danger, however –– it doesn’t impact your ability to give birth, or nurse or be a mom or anything like that. It just won’t necessarily look as good as it did before.”
That’s because, with implants (both breast and buttocks), weight gain and pregnancy can cause them to shift or sag. With fat grafting, too, your fat cells can change depending on your weight. “Fat cells are a living, breathing thing and they will grow and shrink with you,” says Salzhauer.
That said, BBLs are certainly a more dangerous procedure than breast augmentations in terms of operation complications. “It’s rare to die in a breast augmentation, but unfortunately, in BBL, there’s a higher mortality rate,” Salzhauer admits — indeed, a 2017 study found that among 198,857 BBL operations, 32 deaths were reported. The most common cause is an embolism, where fat enters the bloodstream and travels to the lungs and heart as the result of a doctor injecting fat beyond the muscle. “But there are higher long-term complications with breast augmentation,” reasons Salzhauer (it should be noted, though, that while true, they’re of the less lethal variety). In his experience, 10 percent of BBL patients will undergo a secondary touch-up — for breast augmentations and rhinoplasty, that rate is closer to 30 percent. (Implants aren’t guaranteed to last a lifetime and can potentially leak into the body, while rhinoplasty recipients aren’t always happy with the highly visible results.)
Recovery from BBLs and implants can also be brutal, requiring a month of not sleeping or sitting on one’s butt. As such, patients often need the support of family and friends through the healing process. For some young women, that support comes from their parents, but many of these parents may not approve of the surgery to begin with. Following the popularity of her initial butt implant video, Cristina Villegas uploaded a video with her mother to discuss her feelings about her daughter’s surgery, as well as her job as a stripper.
“I always thought it was something you would do when you were older, not 18 years old,” her mother says. “Older people get plastic surgery, people who have had kids and their bodies have been stretched out… not young women who already look good. When she told me she was going to do it and she went to McDonald’s and saved up all her money and told me at 18 she was gonna do it, I was like, ‘Noooo… wait till you’re 21!’”
“I worried that they would botch you,” she continues, “that something would go wrong and you’d regret it. The butt implants really scared me… boob implants not so much because they’ve been around a long time.” But Villegas’ mother ultimately holds the same attitude toward her daughter’s plastic surgery as she does her daughter stripping: “I’m not letting my kids do anything. They’re going to do what they’re gonna do. I figure, either I’m going to accept it, or I’m not and they’re gonna run away and hide it. I would rather know.” (Which, frankly, is about as sensible an attitude as you could hope for in this kind of scenario.)
Parental consent (or not) can definitely be an issue, and not everyone who wants a butt augmentation necessarily qualifies. Anyone under 18 requires parental permission for plastic surgery, and according to Salzhauer, the vast majority of surgeons won’t perform cosmetic surgery on minors — even those with permission — with the exception of the occasional breast reduction (in 2018, the second most common form of plastic surgery in the 13 to 19 age range, at 26 percent, was breast reduction, specifically, in boys).
Even among adults, not everyone makes the cut. Patients need to have enough body fat for the grafting to work, or at the other end of the scale, patients considered obese are at a high risk of complications and often ineligible for the surgery. The mental health of the patient is similarly important. “We turn away at least 15 percent of patients who walk through the door,” Salzhauer says of his practice. “Either they aren’t ready psychologically or physically, or they think that plastic surgery is like a magic wand [and they have] unrealistic expectations. Plastic surgeons tend to be pretty good psychologists — what we practice is essentially psychiatry with a knife.”
According to Cathy Allsman, a psychologist based in Miami, it’s true that plastic surgery is often used to solve what’s ultimately a psychological self-esteem issue. “Generally, when people correct a nose they’ve been self-conscious about, it’s seen as a good thing,” she says, but adds that it’s important for patients to deeply consider their motives for wanting surgery. Most importantly, she finds it essential that one’s desire for a bodily transformation comes from within, and not, for example, from a romantic partner, or fixating upon social media.
Allsman believes that the emotional maturity of a patient may not necessarily correlate with their age, however: “I don’t think 18 is nearly old enough to have made your peace with whatever genetic lot has been handed to you, but from my perspective, my concerns wouldn’t be that different if the patient was 50.” Echoing Salzhauer, Allsman says that a significant part of patient maturity and readiness boils down to expectations. “They need to have realistic expectations of results, how long these results might last, and recovery time,” she says. And most importantly, they need to consider “how much their life will or will not be transformed by having a bigger booty.”
Many of us might feel horror when recalling the immature, regrettable things we did at 18, but that is the age at which we have the newfound legal independence to make decisions that direct the course of our entire lives. Eighteen may seem too young for a transformative bodily surgery, and for some patients, it is. But someone could just as easily be “too young” to get tattoos, choose their college major, join the military or take up cigarette smoking.
This is the freedom of adulthood: Life, liberty and the pursuit of a fat ass.