By Walt Hickey

Welcome to the Numlock Sunday edition.

This week, I spoke to Rebecca Jennings who wrote “The $5,000 quest for the perfect butt” for Vox’s The Goods. Here's what I wrote about it:

First pioneered in Brazil, the butt lift is a plastic surgery procedure in which fat from the waist is removed and re-injected into the butt. It’s an increasingly popular procedure, with the number of BBLs performed globally increasing 77.6 percent since 2015. Hotbeds in South Florida, Turkey, Mexico and Thailand serve as common destinations for questionable and cheaper versions of the surgical procedure that has come to define an entire Instagram aesthetic. Some of these operations are more fly-by-night or sketchy than others. Most advertise a BBL for $5,500, but some run as low as $3,000. Those bargain prices for a difficult and involved plastic surgery lead to a riskier procedure: the mortality rate was estimated to be 1 in 20,117 as of 2020, higher than the 1.3 in 50,000 risk for liposuction.

This story is fascinating, I love Jennings’ work on social media — she joined us a few months back to talk about figure skating’s recent surge in popularity thanks to TikTok — and her coverage of how even a medical procedure can go viral and the danger that brings was seriously interesting.

We spoke about what a BBL is, what makes it so controversial and dangerous, and the industry that sprung up to sell targets on a fantasy of a perfect $5,000 butt.

Rebecca can be found at Vox and on Twitter.

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This interview has been condensed and edited.

Rebecca, you wrote a story about this cosmetic procedure that's been growing in popularity called the Brazilian butt lift. Can you tell me a little bit about the history of it and what it does?

The concept of the Brazilian butt lift is that, what if you could take fat from your stomach and put it into your butt? Which is obviously a very alluring proposition for a lot of people. Essentially what the surgery is, is liposuction of usually the abdomen or sometimes the arms or the thighs or the neck, wherever you have enough fat for it to be worthwhile to take it out, and then injecting that fat back into your bottom, to make the bottom a little bit rounder and larger.

The whole idea is that you get this hour glass figure, and that is obviously very aspirational.

Readers will know you best for your really exceptional coverage of social media. This procedure has now become inextricably linked with an aesthetic, that you wrote, is getting popular. How popular is the surgery and what's been going on lately that got your attention?

I mean, it is the fastest growing plastic surgery procedure in the world right now. It also happens to be one of the most dangerous. I see it talked about so, so much on Instagram, and TikTok in particular, where people who've gotten them are doing Q and A's or showing off their results, doing little blogs. Just the tenor of the conversations really seemed to ratchet up in the past few months. It's gotten so big that there's this creator, Antoni Bumba, a hilarious TikTok creator, who created this character called Miss BBL, where they act like a woman who's gotten a BBL. It's not even really about the body type, it's just about the energy that this person has.

It's become almost beyond the surgery and the looks itself. The idea of the BBL has become greater than just the BBL itself.

Whenever a medical procedure becomes a meme, you can run into trouble. You wrote about how this is a riskier surgery than other cosmetic procedures or any other kind of outpatient.

Yes, and there's a pretty easy to understand reason why. It's because liposuction, which already has a history of being pretty risky. It's less so now, due to better procedures, but the hard part is when you put the fat back in the butt. The problem is your butt has a ton of very large blood vessels, one plastic surgeon told me they were the size of drinking straws. We sit on our butts a lot so they need to get the bigger vessels. So, there's a lot of big blood vessels there so that your blood can circulate throughout that area, even when you're sitting on it, and essentially, doctors used to think that the best way to insert fat back in is if you go under the muscle so it'll latch on. Fat is like a living organism, it's like a plant, it needs to root itself in existing fat in order to survive.

And so a lot of the times, doctors would insert fat and hit a blood vein or a muscle, and then that fat would travel into the heart and lungs, and you would get a pulmonary embolism and die. The death rates have really not been great. There even were estimates as high as one in 3,000. That number is likely much lower now, probably about one in 15,000, which isn't super different from what you see in a lot of other major plastic surgery procedures. Thankfully, there is a bigger effort to make sure that people are doing the safest practices as possible. But it is still, which is the point of the story, it's still this extremely gross industry that preys on working class women and treats them like shit.

Miami, a hotbed of BBL clinics. Photo by Brett Tiagwad on Scopio

I want to talk about that industrial component, because the way that you described how some of these medical offices worked was just really striking. The packages can be cheap. This isn't the kind of thing that, you wrote, insurance covers. Do you want to get into that?

This is happening a lot of places in the world, but Miami is what I focused on. Miami is, far and away, the most popular place to go for affordable Brazilian butt lifts and affordable plastic surgery in general, because there's just a huge concentration of plastic surgeons there. They advertise these extremely low prices, as low as $3,000 for this major, major surgery. The common figure that I've seen online is about $5,500. Both of the girls that were featured in the story, that's what they paid for theirs. If people are really committed, if they're like, “this one surgery is going to make me look like an Instagram model,” $5,000 doesn't really seem like that much to pay for it. What I've learned is that insurance doesn't cover any of this stuff because it's an optional surgery, and health insurance just does not cover optional plastic surgery.

But if a doctor is running an operating room and a staff and a clinic the way that they should, it should cost more than double that. Obviously, they're cutting corners in some way or another. The way that many doctors cut corners is by just lumping in, six, seven, eight patients a day under a single plastic surgeon. This surgery is really, really taxing on both the doctor and the patient, because there's a physically taxing part of this surgery that the doctor has to do, and also, obviously, it just destroys your body if you're the patient. Once they get your money and get you in, they just kind of leave you there. They're like, “okay, bye, good luck,” and if you have a problem, they'll be really difficult to get in contact with. They basically operate like a business. I would argue that any kind of medical doctor should not be operating like a business.

Then the other main part of the story is that the laws we have regarding doctors are not robust enough to prevent people from getting taken advantage of, and that people do not have proper education about the doctors that they're choosing for these kinds of things. That's because if you are licensed as a medical doctor, no matter what your specialty is or whatever, you can legally practice any medical procedure on any willing patient, if it's in your own clinic. You could be a dermatologist and tomorrow you could open up plastic surgery center and say you're a board certified because you're board certified in dermatology. People will think that you're board certified in plastic surgery because you make more money that way, so you can see where that can get a little bit dicey.

Oh, wow, that is really dicey. You mentioned Miami, Turkey, and Mexico. You see these clustering in little industrial sectors that can bring people in from across the country, perform the procedure, and then send them back home.

Exactly. There's all these viral videos now that show dozens of girls in wheelchairs at the airport that have just come from BBL surgery. It's a meme at this point, because there are a ton of practice clinics around the world and in Miami that advertise on social media. They are like, "come to Turkey" or "come to Miami, $5,000, BBL, and then you're done!" Obviously, they don't necessarily advertise that the recovery process is awful, or that you're at least doubling your costs if you include the extensive aftercare that the surgery requires. And also, travel and lodging and whatever. You're also talking about potentially months of severe pain, and potentially a lifetime of other health concerns.

The fact is that with a lot of BBLs you might see in the real world, they might've had that surgery multiple times. Because a lot of times women come into the surgery bringing inspiration pictures that one surgery just cannot accomplish. A lot of the plastic surgeons that I talked to said the best possible way is to do it in small increments, a little bit at a time. But then you're talking about two, three BBL surgeries, and that's a lot more money.

They're selling the idea that you're $3,000 away from being a Kardashian, and that's just simply not the case, it seems.

Exactly, and then it's ultimately the doctor's responsibility to temper your expectations and to turn away potential patients that, clearly, are struggling with body dysmorphia or have disordered eating habits or just have very clearly unattainable expectations. But if you're operating like a factory, you don't turn those people away. You just want as many people to come in as you possibly can.

It was a really striking story. You've had a lot of really great work this summer, I feel like summer is always a great time for stories about social media and influencers, just because it's always a wild time. To wrap it up, what's some work that you've been proud of, and what are you looking forward to?

I wrote a story about a month ago for The Goods. Vox's The Goods did a package called All Consuming, about life under consumerism. It was about how TikTok makes certain little items go super viral, and how it also causes them to flame out really fast, and how that's shaping the reasons why we buy things.

The conclusion that I came to is that if you're the first one to really evangelize about a certain product, you can get a lot of clout from that. Regardless of whether it's actually good, as long as you have a shocking video that makes people want to watch it, you can shape the buying trends of potentially millions of people. And then, you can make a lot of money being the kind of influencer that just is like "this product is great," or "this product is awful." I talked to two people in their early 20s, and they're like, "I'm a millionaire now" because they do that on TikTok.

My God.

Yeah, I love that story. That was really fun. My next big story is not coming out until next month, but I'm very excited about it. I can tell you that it is somewhat related to Only Fans.

Where can folks find you and find your work?

On Twitter and at Vox, and on Instagram.

If you have anything you’d like to see in this Sunday special, shoot me an email. Comment below! Thanks for reading, and thanks so much for supporting Numlock.

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Send links to me on Twitter at @WaltHickey or email me with numbers, tips, or feedback at walt@numlock.news.

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