When Randi Wright got a Brazilian butt lift in 2020 — a complex surgery in which fat is liposuctioned from the abdomen or lower back or other fleshy parts and used to enlarge and shape the buttocks — she knew she couldn’t afford the most expensive post-op care. She underwent the same procedure a year before, traveling from Atlanta, where she lived, to Miami, where the prices were lower and the options were abundant. For Wright, getting the surgeries alleviated the insecurity she felt about her body after having two children. “She changed my life,” Wright said about her surgeon, bringing a finger to the inner corner of her eye to catch a tear. “I could not present myself anywhere in the body that I was in.” After her surgery, she needed somewhere to stay and be cared for during the first two weeks, the most painful part of the recovery period.
The expensive outpatient facilities to which hospitals sometimes refer people, which can be costly, were out of the question. She could go it alone and rent a hotel room where she could convalesce in private and sustain herself on room service. But on Instagram she found a world of recovery houses — many of them decorated in a millennial pink, hyperfeminine aesthetic — where she would be healing alongside other women who had just gone through the same procedure and would be cared for by a team of women who would cook for her, dress her wounds and monitor her progress until she was well enough to catch a flight back home to Atlanta. Wright chose one of the recovery houses, and had such a positive experience that she decided to start a similar business of her own. Within months of leaving, she became the new owner of Dream Body Recovery in Miami, which has three rooms that can accommodate up to six clients. “Being a part of this journey with other ladies, knowing how it changed my life, that’s my why,” she told me. “I just love to see the transition, the growth.”
Dream Body Recovery is just one of countless recovery houses that have cropped up in Miami, which has become the heartbeat of the B.B.L. boom in the United States. The average price of a B.B.L. nationwide is around $5,000, according to the American Society of Plastic Surgeons. But when I spoke to Dr. Angelo Cuzalina, a cosmetic surgeon in Tulsa, Okla., he estimated the cost of the procedure in which patients receive high-quality care to range from $6,000 to $15,000. Patients in Miami can get the butt-enhancing procedure for well below that price, however, and many choose to spend the money saved on additional procedures like liposuction in the arms or thighs.
In 2021, there were 61,387 buttock augmentations, which include both implants and fat grafting, according to the Aesthetic Society, a professional organization and advocacy group for board-certified plastic surgeons. “The B.B.L. trend in the United States started in Miami, no doubt, no question, and then spread to other parts of the country,” said Michael Salzhauer, who is more popularly known as Dr. Miami. “I think the reason is because of the influence of South American culture. It’s called the Brazilian butt lift, not because it was necessarily invented in Brazil, but you think of Brazilian women having like, you know, perky butts, bigger butts.” American women are also traveling to places like Colombia, the Dominican Republic and Mexico seeking even cheaper surgical and recovery options. “Competition breeds lower prices,” Salzhauer says. “In some cities, you might only have two surgeons that do B.B.L. So if you’re one of two surgeons in Cleveland, you can charge a little bit more for people that don’t want to travel.” Lower-cost B.B.L.s in the United States are often performed by cosmetic surgeons instead of plastic surgeons (plastic surgeons are required to have years more surgical training than cosmetic surgeons) in free-standing surgical clinics. Women have increasingly opted for buttock-augmentation procedures in recent years, according to practitioners — a surgery that has grown as fast as any other cosmetic procedure in recent memory. “It’s probably one of the biggest increased procedures as far as the last 10 years, really,” Cuzalina says of the B.B.L. “It was booming. The numbers were huge, increasing like crazy.”
For Black women, many of whom have always possessed a version of the B.B.L. body, it is difficult to square this popularity with the fact that their natural bodies have been denigrated for generations. When the modern beauty standard embraced a more exaggerated hourglass shape — a microscopic waist eclipsed by a large, round bottom — butt-augmentation surgeries that help women achieve this look were propelled into the mainstream.
Evidence of the B.B.L. is ubiquitous on social media; there are even surgical offshoots (read: the “skinny B.B.L.”) for folks who want a more natural-looking but still noticeable plumping. And in many ways the idealized body, one that was considered unattainable for anyone other than celebrities, is now, technically, possible for everyday women to achieve. And Black women aren’t immune to wanting a seemingly quick way of acquiring the figure that defines desire today.
“Everyone says that you should wait, because your body doesn’t fully come in until you’re like 30, and I’m 20 years old, and why am I going to wait until I’m 30 to be snatched?” Catera Northup, an exotic dancer from Rhode Island, said. Many of the women I spoke to felt that they needed to achieve this look before they could feel fully confident, or get a loan, or start a business. For women perpetually left on the fringes of the beauty landscape, there is a dark twist — and serious risk — to the length that they will go to in order to realize this body.
Lower-cost B.B.L.s have created a market for similarly priced postoperative care. These are not the relaxing, spalike havens like the ones that serve wealthier clientele. More often, this corner of the recovery-house market is a place where the racial and class dynamics of the cosmetic-surgical world collide. The photographer Naila Ruechel and I went to Miami in April to visit two recovery houses — Dream Body Recovery and Enchantress — where all the clients at that time were women of color. That butt augmentation and liposuction surgery are more accessible and less costly than ever makes recovery homes a thriving cottage industry among these women.
Most recovery houses offer transportation services following surgery, often a minivan with the passenger seats reclined to make space for an inflatable mattress, where patients, who are not supposed to sit down or lie on their backsides for at least two to four weeks, can lie on their stomachs during the ride. When they arrive, the beds they’ve booked — usually two to a room — can cost anywhere from $80 to $400 a night. Some recovery houses have nurses on site who can check vitals and provide massages that they claim help with healing.
But some women complain that they have experienced poor service and unsanitary conditions at recovery facilities, like toilets that don’t work and inedible meals. There are even social media accounts where women anonymously send photos of recovery homes that they claim falsely advertise their amenities.
Sixty-five complaints have been filed with Florida’s Agency for Health Care Administration, which oversees assisted-living facilities, defined as any home or building where housing, meals, and nonmedical services are provided for more than 24 hours to one or more people who are not related to the homeowner or facility manager. The agency does not have the power to specifically regulate or license postoperative recovery homes. In fact, it is only made aware of the existence of recovery homes if a complaint comes in. This is particularly problematic because B.B.L.s have among the highest mortality rate of any cosmetic surgery. A whole host of things can go wrong; most notably, the repurposed fat can travel through veins in the buttocks to pulmonary arteries and chambers of the heart, causing fat embolisms. Transferred fat can also migrate beneath the muscle, tearing gluteal veins. According to some recent surveys, for every 13,000 B.B.L.s performed in the United States, one results in death.
Kalani Wright, a 24-year old from Mississippi, wanted to have Lipo 360, a procedure that removes fat from all areas of the midsection, and a B.B.L. last year. But she became pregnant. When she was finally able to have the procedures, she said that the pain was worse than childbirth. Before she went into surgery, Kalani made the doctor promise that she would make it back home to her 10-month-old. When she woke up from anesthesia, she recalls saying, “Thank you, God” loudly over and over. The clinic staff asked her to silence her praise because she was scaring patients in the waiting room.
Despite the risks, the popularity of the B.B.L. procedure continues to swell, and it appears that the demand for the recovery houses (and the subsequent need for more regulation) will continue to grow alongside it. When we visited Enchantress, the woman who ran the facility pulled her Chrysler minivan up to the front of the home with a woman lying on an inflatable mattress in the back. Another woman dressed in scrubs waved goodbye to the owner as she walked out of the house. She has been shadowing her to learn how to open her own recovery home in Miami.