I’m Dr. Arthur Perry, a plastic surgeon who won’t perform Brazilian Butt Lifts because they’re deadly. AMA!

Why are Brazilian butt lifts deadly?

Hello - the technical reason is because fat is easily mis-injected into enormous veins that lead to the heart and lungs. That fat kills instantly or within hours of surgery.

Is there a way to do it safely?

Unfortunately, no. An advisory was issued warning plastic surgeons to not inject deep into the muscle because that's where most of the big veins are. However, it is virtually impossible to determine exactly how deep the tip of the injection tube is. Under anesthesia, the muscle softens. Think how soft filet mignon is...you can cut it with a fork. That's why the tubes easily are misdirected.

Getting outside of the topic of butt injections - but I've been curious about medicines that use oil as a carrier and the risks of that oil making its way directly into veins. Can you speak to the risks of something like that? I have a weekly IM injection that sometimes results in a little chest pressure and coughing for 5-10 minutes that I've been told is a little oil leakage into the blood but nothing to be worried about.

That's a tough one to answer. I really would need to know more about the drug that is injected, the precise location, and the disease it is treating. Unfortunately, this forum is about to end...

Is fat transferring to breasts as deadly?

This procedure does not have the same likelihood of fat embolism to the lungs because the blood vessels are much smaller. It is still possible, but less likely. On the other hand, there are other issues involved with injecting fat into the breasts. Some people believe that mammograms are more difficult to interpret and the calcifications that occur with fat grafting might be confused with cancer and require biopsy. Others believe that the stem cells in the fat could possibly stimulate breast cancers. For these reasons, I do not inject fat into breasts.

Many people ask what are acceptable risks in cosmetic surgery. That's a difficult question to answer, since there have been deaths with most procedures, including the injection of botulinum toxin! In that case, the neck muscles were paralyzed and the person aspirated food into her lungs, developed pneumonia, and died. So, we start with the assumption that everything has risks (you have a 1/3000 chance of dying in a car accident every year!). But our goal in plastic surgery is to optimize the chance of a great outcome - both medically and cosmetically. That starts with choosing the right doctor, anesthesiologist, and facility. I feel strongly that every patient that undergoes cosmetic surgery under sedation or general anesthesia should visit a board certified internal medicine doctor before surgery and be "cleared" for surgery. Let's face it, plastic surgeons are great at what they do - making you look better - but internists are experts in your overall health...

Just work out right?

Absolutely. Squats are effective.

Why are they called "Brazilian Butt Lifts"?

As a brazilian I am geniunely curious if its because its a procedure that originates from Brazil or is it some dumb unrelated reason.

Also, are there any common procedures that could be considered stupidly dangerous and not worth the payoff?

Actually, the procedure did originate in Brazil.

Plastic surgeons have not been at a loss in coming up with silly procedures. One really stupid procedure is shaving down the calf muscles for large calves. This one can result in numb areas, blood clots, and problems walking.

The commonly performed plastic surgery procedures are quite safe, however,

My answer appears to have disappeared. Briefly, yes - it originated in Brazil. And another silly dangerous procedure is Calf sculpting - actually cutting out pieces of the calf muscles to slim the calves. Pretty stupid, in my opinion.

is there an alternative butt-enhancing surgery that is safer?

Unfortunately, the other surgical alternative is a buttock implant. That procedure, too is fraught with problems, although it is not as dangerous. Exercise (squats) has been proven to increase the buttock size in just a few weeks

Squats will never beat genetics, though..

True, but sometimes we have to live with imperfection. Surgery is not always the answer.

What got you into plastic surgery?

What is your favorite operation to perform? Least favorite?

I've been doing this a long time. Actually, I read a plastic surgery book on the library shelves as a freshman in college and it was fascinating. Plastic surgery is the most creative field within medicine. Dr. Arthur Perry

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Elaborate on this. What makes it creative?

Every cosmetic or reconstructive problem is different and plastic surgeons must have the ability to "think up" an operation for a particular problem. I find this an incredibly rewarding and fun experience. For instance, recently, I had a patient who destroyed her earlobes by putting 3/4 inch diameter "gauges" in her earlobes. She wanted normal earlobes, but there was very little skin left. The literature had scant information about how to reconstruct this new problem so I "made up a solution". I injected Restylane into the remaining skin to grow the skin. After several months, enough growth had occurred so I was then able to perform a traditional earlobe reconstruction, She loves the result and I am writing up this new technique for the medical literature. A Perry MD

brb stealing this and publishing a paper on it before you get around to it.

Just kidding, I work in IT and I have no clue how any of this works. Totally fascinating, thanks!

Please reference me when you publish it... A Perry MD

Favorite operation - rhinoplasty - nasal reshaping, I also love doing facelifts.

Least favorite - hair transplants - they are long procedures that for the most part do not look great long term. I stopped doing them

Why are these your preferences? What is it about these surgeries?

Rhinoplasty -no two noses are alike and there is no imaging preoperatively that can tell me what to expect inside the nose. I have to be prepared for anything, such as broken cartilage, etc.

Hair transplants - these are very long operations and the hairs will still follow their genetic destiny...that means they may stop growing in a few years. I don't recommend it.

How often do you do rhinoplasty? Will a surgeon who is focused primarily on rhinoplasty provide better outcomes or does a surgeon derive benefits from being "well-rounded" with experience in multiple procedures?

There really are only a handful of plastic surgeons who only do rhinoplasties. These surgeons seem to have excellent results. Most plastic surgeons do a wide variety of procedures - some do all of plastic surgery and others only do cosmetic surgery. While weekly/monthly/annual surgical volume is very important in cardiac surgery, it is probably less important in plastic surgery, as long as your surgeon has a cumulative experience based on his or her lifetime experience. I know plastic surgeons who do great noses a couple of times a year and other plastic surgeons who do them daily with not so good results.... A Perry MD

Hey Doc. What's your memorable surgery or memorable moments during surgeries?

I've been doing this a long time...and there are so many memories. One of the crystallizing moments in my career was helping out with a leg reimplantation as a medical student. It was early in microsurgery and the procedure took all day. They let me cut the skin graft and it was an incredible thrill. I've got about 1000 other stories to tell....

I wrote a book about this - it is called Real Life of a Surgeon. You'll love the stories. https://www.amazon.com/Real-Life-Surgeon-Stories-Student/dp/B006LWEFIE A Perry MD

Do you prefer to work on fixing some "unnatural" (can't think of a better word for not fresh-out-of-the-box human) problem e.g., scarring, cleft lip etc. or truly cosmetic e.g., breast augmentation, liposuction etc.?
I presume the latter is more technically challenging, if perhaps, potentially more morally questionable (TV adds and the like)

Plastic surgery is divided into reconstructive surgery (surgery to repair defects caused by trauma, cancer, or congenital conditions. Cosmetic surgery classically is surgery on "normal" structures. I enjoy most procedures in plastic surgery, but have focused my practice on cosmetic surgery, which I find fascinating. By the way, both types of surgery are very technically challenging, A Perry MD

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Cosmetic surgery is such a popular field - but it is still surgery. It is a field that has become "entertainmentized", with some people equating surgery to a spa experience. If you are interested in cosmetic surgery, and staying safe with cosmetic surgery, check out my book "Straight Talk about Cosmetic Surgery" A Perry MD

25/F/The Netherlands here. After gastric bypass surgery, i lost 85 KG (About 187 LBS if I converted it right). I used to weigh 170 KG (about 375 LBS). I have a lot of loose skin, and the PS here adviced "fleur de lies" surgery, (with a scar running all around me to do the back as wel) and to use the skin left under my armpits (like what is under the side of my bra) for a breast enhancement? Like, to tuck that in my boobs as a way to get the volume back, cause they are completely empty.

What is your advice/take on this? What kind of surgery would you recommend? And, advice on pregnancy around this topic? Im 25, want to have kids, but not yet. The skin is really bothering me, both mentally and physically.

Sorry for my horrible English, not a native speaker.

This is a very complex topic and it would not be fair to give an answer without examining you. Post bariatric reconstruction involves upper and lower body lifts, thigh and arm lifts, and facelifts. Breast lifts and implants might be necessary. I would make sure your surgeon had a lot of experience in these procedures and perhaps get a second opinion, A Perry MD

Has any of your patients died from plastic surgery complications?

That is certainly every plastic surgeon's greatest fear. Since I have been a plastic surgeon, I have not had any deaths from cosmetic surgery (knock wood!). However, during my residencies at Harvard, the Cornell Burn Unit, and the University of Chicago, I helped take care of some very sick patients, some of whom did die following their injuries or reconstructive surgery. There isn't a plastic surgeon in the country who has not had the same experience. A Perry MD

Are breast lifts/implants/fat transfer possible in overweight/obese people? Are they made in a different shape to look proportional?

My girlfriend is on the cubby side and she's flat chested. She dreams of a breast job, but would it work?

The complication rate for surgery is directly related to patient's weight. If someone is obese, they are usually advised to lose weight before surgery. Remember that if she needs her appendix out, she has to accept all risks, but when risks are excessive, an ethical plastic surgeon will not perform the procedure. A Perry MD

It is reported that auto-immune disorders are on the rise. Have you witnessed an increase in post surgery complications due to inflammation in cartilage etc or any other auto-immune related issues impacting healing and surgery outcome?

I have operated on a number of people with autoimmune disorders. Prior to their surgery or even most noninvasive procedures, I ask these patients to see their rheumatologists for "medical clearance". If someone is on immunosuppressants like steroids, they could have a higher complication rate following surgery. In these cases, it may be wise to wait until the person is no longer taking these drugs. A Perry MD

What do you think about the safety of fillers such as Voluma?

Fillers have revolutionized cosmetic surgery. I inject various fillers every single day - into wrinkles and folds, to restore lips and cheeks and chins and to fill out the jawline. I use Voluma specifically to make cheekbones larger. Voluma is a particularly robust hyaluronic acid filler and it works very well, A Perry MD

I’ll admit, I don’t know much about this procedure or how deadly it is. Shouldn’t it be ok as long as patients understand the risks? What would you say to people like me who think this?

It is so difficult to fully explain deadly risks to patients. "It would never happen to me" everyone says. So, physicians must take a "parental" role and make decisions as to what procedure is simply too dangerous to perform. Of course, if you will die without heart of gallbladder surgery, you do it, regardless of the risks.... A Perry MD

Is there an effective way to get rid of a double chin without surgery? I've been reading about things like Kybella, but not sure if results are any good.

There are many approaches to the "double chin". Liposuction is really the best procedure and can be performed through tiny incisions under the chin under local anesthesia in the office. I call this one of the "biggest bang for your buck procedures" in cosmetic surgery.

I am not a fan of Kybella because it is expensive, requires many painful treatments, and has a number of associated problems. Some men have lost their beards. Coolsculpting works, but the results are very subtle in most people and so I do not offer it. Beware, because some of the so-called "noninvasive" procedures are just as invasive as surgery. A Perry MD

What's the general cost range for a minor liposuction like that?

It really depends on the location you are in and the skills and educational background of the surgeon. It could be as low as $2500 or as high as $7000. That is assuming the procedure is done in the office. Surgicenters and anesthesiologists add a few thousand to the bill. A Perry MD

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Most other cosmetic surgery is considered safe...but it is SO IMPORTANT to choose your surgeon carefully. Many of the deaths in the USA Today article referenced above were by either non- board certified plastic surgeons or doctors who were not really plastic surgeons. Some reported deaths have been by lay people - that's right - people who literally went to the hardware store and purchased silicone caulk (great for windows, not so good for surgery) and injected it into women's buttocks. Hardly a month goes by when I do not hear another horror story about a death like this. So, choose a plastic surgeon who is certified by the American Board of Plastic Surgery. That's your starting point. Then find out where that doctor went to medical school and which residency they trained at. Then find out which hospital they have privileges at. Then check with the State Regulatory Board to find out if they have been disciplined. Then find out from the same website how many malpractice suits they've had. Then schedule the consult. I'm not a big fan of "reviews" because they can be stacked in either direction. Arthur W. Perry, MD, FACS

Hey doc,

What's your favorite, most rewarding surgery to do?

I love performing rhinoplasties - nasal reshaping - it is the most creative procedure and also the most difficult cosmetic procedure. A Perry MD

What is the safest form of plastic surgery for a man? I've already had liposuction when I was 11 to remove a growth I had on my chest.

Can't really answer a question like this. Most procedures are safe if you are healthy.

How do you deal with the assumption that all plastic surgery is for cosmetic / vanity reasons? Including by insurance companies?

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Like someone might be getting a breast reduction because the current size hurts their back, etc.

Sometimes there is a fine line between what is cosmetic and what is reconstructive. Breast reduction is a perfect example. Excessively large breasts cause neck and back pain, rashes around the breasts, and bra straps that dig in. This is hardly a cosmetic problem when someone wears a GG bra. Insurance companies are inherently suspicious of plastic surgeons who try to get insurance coverage for their patients. They legitimately want to see photographs of the patients and need to know their weight and height. Unfortunately, it doesn't stop there - many insurance companies demand that patients try physical therapy for their back pain for a year. This stalling tactic is ridiculous. Companies also tell patients to see orthopedic surgeons and chiropractors, again for the purpose of stalling and hoping patients will give up (that's what I think anyway). When someone has a legitimate problem, I will write letters to the insurance company and try to help them get insurance coverage, On the other hand, sometimes I am asked by patients to help them get procedures such as rhinoplasties or eyelid lifts covered by insurance. This is insurance fraud and is a felony if it is for purely cosmetic reasons and I simply refuse to do that for patients. A Perry MD

Is there validity to claims that breast augmentation is also dangerous?

I'm referring to the communities that claim implants can cause a variety of health impairments.

The controversies over breast implants from the 1990s were unfounded. They were, in fact, safe. Brand new information that certain textured surface silicone gel implants may cause a very rare type of lymphoma has recently been released. This problem will need more time and study to determine just how common it really is,. A Perry MD

Which cosmetic surgery procedure is the most fun to perform?

That's like asking if someone likes skiing or skating more. It depends on the surgeon. I find all the procedures that I do to be fun. I don't particularly enjoy procedures that go beyond 6 hours. A Perry MD

What are your thoughts regarding symmetry in plastic surgeries? (I.e. making sure that whatever you do to the left side looks symmetrical to the right side.) Is it something that people obsess over or generally not a big deal.

Great question - everyone is asymmetrical - we all have different sized feet, hands, and breasts. And our faces are asymmetrical. I love to use the "asymmetry tool" on my Mirror Image digital photography program. This shows patients how different the two sides of their face are. It is important to point out asymmetry before surgery because certainly they will notice it after surgery. I tell patients that they will still be asymmetrical after surgery, but my goal is to lessen the degree of asymmetry. When I do a breast augmentation, for instance, sometimes I need to use two different sized implants. A Perry, MD

Why is this procedure called Brazilian Butt?

https://www.usatoday.com/story/opinion/voices/2019/01/31/plastic-surgery-brazilian-butt-lifts-florida-death-column/2374585002/ AW Perry, MD

Do you think Brazilian butt lifts or a similar technique will be perfected so it can be performed safely?

It's really hard to know. I suppose that if someone came up with a technique where fat could be injected and absolutely avoid the blood vessels, then it would be safe. We are not there yet. A Perry, MD

Thanks everybody. This has been fun. I do a radio show on WOR in NYC every Saturday at 6 pm. Feel free to tune in and ask me questions on the radio! Arthur Perry MD

Have you ever refused someone cosmetic surgery on ethical grounds? Like they had so much surgery before or you didn't think it would be healthy for them to have it? Cheers

I turn patients down frequently. Remember - a consultation is not an agreement to perform surgery - it is a fact finding experience for both the doctor and the patient. Sometimes patients are not appropriate candidates for surgery because they have medical problems like heart disease that would make surgery perilous. Sometimes patients have unrealistic expectations or severe depression and they likely be unhappy after surgery. Some people look fine but will never be happy - they should not have surgery. And finally, some people have had so much surgery that they look terrible and more will make the worse. It is difficult for those people to accept that the best treatment for them is no treatment at all. Arthur Perry MD

Nice answer thanks, I think the world could do with a lot more plastic surgeons like you for sure.

Thank you!

Hello! Appreciate what you're doing!

Question: Have you heard about leg lengthening surgeries and what do you think about them?

That really is in the realm of orthopedic surgery, so my comments would not be particularly useful.

Have you personally had any plastic surgery procedures done?

I have had Ulthera - high energy focused ultrasound - to lift my newly developing jowls and try and pulverize some of that pizza induced neck fat. I've done it 3 times and I'm due for another treatment. I like Ulthera. - no downtime and minimal risks. But subtle results, to be honest. A Perry, MD

Interesting, thanks for answering. Just out of curiosity, how does ultrasound reduce fat/flab? I’ve never heard of that before.

This is high energy focused ultrasound. This focuses a lot of energy to a half a square millimeter area. This heats up, destroying some tissue. The tissue shrinks and collagen is generated. Some fat is also destroyed. A Perry MD

Hi Dr. Perry! I use your line of skin care and just wanted to say thank you! I’m 34 this month and genetics are definitely not on my side when it comes to skin. I started using your products about 5 years ago and my skin looks really good! I just started Botox for prevention but when they took that light thing to look at my skin they asked what I was using because my skin looked so great. They usually try and get you to buy a bunch of products but all they could say was keep up with what you are doing your skin looks great! I credit that all to you, thank you! My question would be besides your products and botox should there be anything else I should add into my skin care routine, like facials, peels, microdermabrasion etc for maximizing my skins health? I know aging is inevitable but if I can do things for my skin to age gracefully I want to take those steps. Thank you so much for your research and effective affordable products!

Thanks so much for using my products. For those of you who are interested in a simple, scientifically correct line, check it out at www.drperrys.com. I feel strongly that skin care is the foundation for looking good and it makes no sense to spend money on cosmetic surgery if the skin is rough, splotchy and wrinkled. I am not a fan of facials - complex reasons - but microdermabrasion is a great skin cleaning procedure. After that, the procedures that you have a very individualized and should only be recommended by a plastic surgeon after a consultation. My book, Straight Talk about cosmetic surgery https://www.amazon.com/Straight-Cosmetic-Surgery-University-Wellness/dp/0300121040 goes into great detail about this. Arthur W. Perry, MD