Bodacious butts are in, and operations to get them are too.
In the last five years, plastic surgeons have seen a 150 percent increase in the Brazilian butt lift business.
Plastic surgery, as a field, is fairly low risk, with average mortality rates across all such procedures hovering around one in 55,000.
But some surgeries are far more dangerous than others.
Traditionally, plastic surgeons consider the tummy tuck one of the riskiest procedures they do, with about a four percent risk of major complications.
That procedure is complex and invasive, and patients are at risk for developing blood clots that travel up to the heart and can quickly turn deadly.
By comparison, Brazilian butt lifts seem like a surgical walk in the park.
For the procedure, a surgeon suctions excess fat from one part of a patient's body and transfers it to the buttocks via injection.
"It really requires relatively little technical finesse," says Dr Mark Mofid, a San Diego-based plastic surgeon.
But then in 2015, he saw a study from doctors in Colombia and Mexico, reporting high rates of mortality associated with the procedure.
He had never heard of any deaths from Brazilian butt lifts.
Then the following year, he happened to be present when a medical resident in Texas presented a study abstract reporting in 80 such lifts, there had been eight fat embolisms that landed patients in the intensive care unit.
'This was something no plastic surgeons had discussed in the US, and now I was hearing these high rates from a single surgeon in Texas,' says Dr Mofid.
He started doing his own digging, connecting with coroners, pathologists, plastic surgeons and even an NBC reporter in Miami who had begun identifying women who had died from the procedure in South Beach, a plastic surgery hot bed.
In South Beach alone, 10 women who had died after having Brazilian butt lifts were identified.
The victims were mostly mothers, including Ranika Hall, who had only just had her first baby at 25, and wanted her pre-pregnancy figure back.
Heather Meadows, a mother of two, died at the exact same facility in Florida that Hall did.
Outside of academic circles and professional organizations, bad butt lifts were beginning to make an appearance in the media around the time Dr Mofid first started looking into them.
Most infamously, Padge-Victoria Windslowe was sentenced to 10 to 20 years in jail after the self-styled, and completely uncertified implant surgeon injected almost a gallon of silicon into a dancer's buttocks and the woman died in the process.
Dr Mofid and his team published a study on the incidences of these deaths and serious complications.
They were shocked by what they found: About one in every 3,000 Brazilian butt lift patients died of a pulmonary fat embolism. Twice as many developed chronic or serious complications.
Fat embolisms happen when a glob of fat gets into the blood stream and when it travels toward the lungs it can stop blood flow to them. The blockage can be fatal, or cause a lifetime of subsequent cardiac and breathing problems.
The American Society of Plastic Surgeons and partner organizations established a task force to further investigate why these embolisms were happening and to warn doctors and patients of their findings.
"Even on the task force, we had people who had had patients who died during this operation," says Dr Mofid.
"If they had a patient die, they remembered for the rest of their lives, so they know if they had two people die, but doctors don't remember the exact number of cases they've done, so the rates are probably a underestimate.
"I'm convinced that the number is not one in 3,000, I think it might be higher."
The task force is still investigating, but it appears that Brazilian butt lifts turn deadly when the transferred fat is injected into the muscle, where there are many blood vessels for the fat to find its way into.
"This is how it was taught when I was in school," Dr Mofid says.
Blood vessels in the muscle of the buttocks feed that fat "so we can get it to live," which means more full, longer-lasting results, he explains. But this is also where the danger lies.
Now, the task force is recommending that plastic surgeons only do Brazilian butt lifts by injecting fat beneath in a more shallow location, just beneath the skin.
Patient's may not get the same aesthetic results, but the change will almost certainly save lives.
"We can't control patient demand for this," says task force co-chair, Dr J Peter Rubin of the University of Pittsburgh, "but we want to make sure it is done safely."
"Of all the cosmetic procedures available, at present time this appears to carry the highest risk, and people need to know that."
