Interested in Fuller, More Balanced Curves?
Fat transfer or other contouring options may help, depending on your goals and anatomy. BBL carries important risks, and your safety assessment comes first.
Buttock contouring is now one of the most transformative procedures for the female body contour — and also one of the most technically demanding. The Brazilian Butt Lift (BBL) with fat grafting has built a robust body of safety evidence when the injection is exclusively subcutaneous and guided by real-time ultrasound. When the protocol is violated — with intramuscular injection — the risk of pulmonary fat embolism is real and documented1. That's exactly why the choice of the surgeon and the protocol used matters as much as the decision to have surgery.
Dr. Alexandre Charão — with experience in body contouring since 2004, a clinic in Botafogo and surgeries at Hospital Glória D'Or (Glória, South Zone of Rio de Janeiro) — performs buttock contouring with a multimodal approach that combines safety-focused planning and careful technique with a complete sculptural result.
How did real-time ultrasound change BBL safety?
Before ultrasound, surgeons operated blind. With ultrasound, each injection is visually confirmed before and during the procedure.
The SIME protocol (Static Injection, Migration and Equalization) — published in the Aesthetic Surgery Journal in 2023 with a series of 4,150 real-time ultrasound-guided BBLs — showed that intraoperative ultrasound makes it possible to confirm consistent subcutaneous placement, direct the fat transfer to specific compartments, and document on video that the injection stayed above the deep gluteal fascia in every case. A comparative study of 200 patients — 100 with and 100 without ultrasound guidance2 — confirms better fat distribution and a lower complication rate with ultrasound.
The meta-analysis of 6,235 patients published in the Aesthetic Surgery Journal in 2025 and the 2023 BAAPS guidelines establish ultrasound as the most transformative safety advance in BBL — and it is now recommended by the leading international plastic surgery societies, including ASPS, ASAPS and ISAPS.
What approaches are available — and which one is right for you?
Fat transfer, implants, and collagen stimulation have different indications. The correct combination depends on your anatomy.
BBL with ultrasound-guided fat transfer
Preferred technique for patients with enough fat available. The autologous fat graft offers the most natural result, without synthetic material and with simultaneous improvement of donor regions (abdomen, flanks, thighs). Ultrasound ensures that the entire injected volume remains in the safe subcutaneous plane. Argoplasma is applied in the perigluteal regions for skin retraction and definition of contour, especially in the trochanteric region and in the gluteal-thigh transition. See also the page HD lipo with Argoplasma.
Fat only in the subcutaneous layer
In the buttocks, Dr. Charão places fat exclusively in the subcutaneous layer, above the gluteal fascia, confirming each injection with real-time ultrasound. Fat is never injected into the gluteal muscle: intramuscular gluteal fat grafting is prohibited because of the risk of fat embolism.
Gluteal implants
For patients who lack enough fat or want a larger increase, gluteal implants placed in the subfascial/intramuscular plane (dual-plane) are a documented alternative. Ultrasound is also used here for precise positioning and evaluation of the surgical pocket.
Collagen Stimulation and Argoplasma
In addition to any of the above approaches, Argoplasma (argon plasma) promotes perigluteal skin retraction and improves the definition of the contour without additional incisions — especially relevant for patients with skin sagging in the trochanteric region or banana fold.
What do you need to know before you decide?
Transparency about risks and selection criteria is part of real care — not marketing.
BBL with non-guided intramuscular injection remains associated with a high risk of mortality among aesthetic procedures. Dr. Charão's protocol reduces this risk with real-time ultrasound. Weight stability, an appropriate body fat percentage and the Weight-Loss and Metabolic Preparation Method — in line with perioperative nutritional and metabolic support guidelines — are prerequisites for any buttock contouring approach.
Fast Track Recovery — a faster, more comfortable recovery and refined scars — is applied to all procedures, in line with accelerated recovery protocols in cosmetic surgery, with the exclusive WhatsApp group for each patient throughout the postoperative period. O Globo's "Faz a Diferença" Award (2006) and The Washington Post report reflect a track record of results and clinical responsibility that applies to each procedure performed. All surgeries are performed at Hospital Glória D'Or, Glória, South Zone of Rio de Janeiro — D'Or Network, annual JCI accreditation.
Technical Comparison of Procedures
Understand the differences between the conventional BBL without ultrasound and Dr. Alexandre Charão's buttock contouring:
| Criteria | Conventional BBL without ultrasound | Buttock contouring — Dr. Alexandre Charão |
|---|---|---|
|
Intraoperative guidance
|
✕ No confirmation of injection plane | ✓ Real-time ultrasound — documented subcutaneous confirmation |
|
Safety protocol
|
• Variable among surgeons | ✓ SIME + ASPS/BAAPS/ISAPS guidelines |
|
Available approaches
|
• Variable — usually fat only | ✓ Subcutaneous fat transfer + implants + Argoplasma |
|
Skin retraction
|
✕ Not addressed | ✓ Perigluteal Argoplasma — definition without incisions |
|
Embolism risk
|
✕ High without ultrasound guidance | ✓ Minimized with SIME protocol and subcutaneous confirmation |
|
Preoperative preparation
|
• Fasting and basic tests | ✓ Weight-Loss and Metabolic Preparation Method |
|
Recovery
|
✕ 8 to 12 weeks of restrictions | ✓ Fast Track Recovery: faster, more comfortable recovery |
|
Surgical center
|
• Variable | ✓ Hospital Glória D'Or (Glória, South Zone) — D'Or Network, JCI |
Frequently Asked Questions
Is BBL safe? I've heard about procedure-related deaths.
BBL with non-guided intramuscular injection presents a real risk of fat embolism. With a real-time ultrasound protocol, which confirms subcutaneous positioning before and during each injection, the estimated risk is similar to that of an abdominoplasty according to the BAAPS safety review. The SIME protocol with 4,150 cases and the meta-analysis of 6,235 patients confirm the safety of subcutaneous BBL guided by ultrasound.
What is the SIME protocol and why is it a global benchmark?
SIME (Static Injection, Migration and Equalization) is the BBL protocol with real-time ultrasound published in the Aesthetic Surgery Journal in 2023 with 4,150 cases. It allows the surgeon to visually confirm subcutaneous placement, direct the graft to specific compartments, and record every injection on video — making the procedure traceable and auditable.
Why is fat placed only in the subcutaneous layer of the buttocks?
In the buttocks, fat is placed only in the subcutaneous layer, above the gluteal fascia, with real-time ultrasound confirming the position of each injection. Injecting fat into the gluteal muscle is prohibited, because it is associated with fat embolism, a severe complication.
When is an implant indicated instead of fat transfer?
When there is no fat available in sufficient quantity or when the desired increase exceeds what can be obtained with autologous fat. The gluteal implant in the subfascial/intramuscular plane is a documented alternative for these cases, with ultrasound helping in the positioning of the surgical pocket.
What is Argoplasma and how does it improve the gluteal result?
Argoplasma (argon plasma, similar to Renuvion/J-Plasma) is applied subdermally to the perigluteal regions — the trochanteric area, banana fold and buttock-thigh junction — to contract collagen and tighten the skin without additional incisions. It complements any volumization approach, improving contour definition. More technical details on the HD Lipo with Argoplasma page.
Who is a candidate for buttock contouring?
Patients with body fat ≤ 32%, stable weight for at least 6 months and good general clinical condition. The Weight-Loss and Metabolic Preparation Method is initiated as soon as surgery is scheduled, in line with perioperative nutritional support guidelines. Patients who do not meet the body fat criterion are followed by an endocrinologist until they are ready for the procedure.
How long does recovery take?
With Fast Track Recovery, aligned with accelerated recovery protocols, the return to light activities takes 7 to 10 days. Sitting directly on the buttocks is restricted for 2 weeks. Physical activity is gradually cleared between weeks 4 and 6. The exclusive WhatsApp group ensures direct follow-up with Dr. Charão throughout recovery.
Where does Dr. Charão perform buttock contouring?
At Hospital Glória D'Or, Glória neighborhood, South Zone of Rio de Janeiro — part of the D'Or Network, with annual JCI accreditation. The consultation clinic is in Botafogo, also in the South Zone. Care in Portuguese, English and French.
Ready to plan safe, natural-looking buttock contouring?
Schedule a face-to-face consultation in Botafogo or an exclusive teleconsultation directly with Dr. Alexandre Charão's team.
📅 Ask Our Team📚 Scientific Bibliography
- Del Vecchio D, Kenkel JM. Practice advisory on gluteal fat grafting. Aesthet Surg J. 2022;42(9):1019-1029. doi:10.1093/asj/sjac082
- Bruno A, Cilluffo M. Beyond the Brazilian butt lift: how to objectively measure outcome. Aesthetic Plast Surg. 2025. doi:10.1007/s00266-025-04744-9