If your surgeon performs Brazilian butt lifts in Florida, state law now has a say in how they do it – from where the fat goes, to whether they've met you before surgery day, to whether the office is registered and inspected. Here are the six rules to check before you book.
Why does Florida have a BBL-specific law at all?
Florida lawmakers stepped in after a string of patient deaths. According to the American Society of Plastic Surgeons, BBLs have one of the highest mortality rates of any cosmetic surgery – because fat placed too deep can enter the bloodstream and travel to the heart, lungs, and brain. That pushed the Board of Medicine to issue emergency rules in 2019 and 2022, and the state to pass HB 1471 – which MedEsthetics called Florida's first plastic surgery law – effective July 1, 2023. The law lives in Florida Statute §458.328.
Rule 1: Does the fat go only into the subcutaneous space – never into or under the muscle?
What the law says: Florida Statute §458.328 prohibits injecting fat into or below the gluteal muscle – the fat may only go into the subcutaneous space, the layer just under the skin, above the fascia covering the muscle (LegalClarity).
Why it exists: As MedEsthetics explains, going too deep risks injecting fat into the superior and inferior gluteal veins, from where it can travel to the lungs and cause a pulmonary fat embolism – the major cause of BBL deaths.
How to check: Ask the surgeon, in plain words: "Where exactly does the fat go during your BBLs?" The right answer is "subcutaneous space only, above the muscle." If they can't say that – or they wave the question off – walk away.
Rule 2: Is ultrasound being used while the fat is injected – and is the video saved?
What the law says: Under HB 1471, the surgeon must use ultrasound guidance while placing and navigating the cannula and while injecting fat into the subcutaneous space – and must keep the ultrasound video recording, time- and date-stamped, in your medical record (MedEsthetics).
Why it exists: According to MedEsthetics, the imaging lets the surgeon see exactly where the fat goes, which lowers the risk of injuring gluteal veins while improving the aesthetic result. Before the law, ultrasound guidance during a BBL wasn't required in Florida – surgeons could place fat without watching it on a screen (MedEsthetics).
How to check: Ask two questions: "Do you use ultrasound during every BBL?" and "Is the video saved to my medical record?" A clinic that talks around the question is a red flag.
Rule 3: Has the surgeon actually met you – and is the surgeon doing the surgery themselves?
What the law says: A surgeon may not meet you for the first time on surgery day. They must examine you in person, in the same room, no later than the day before the procedure. And they can't hand off the core of the operation: the fat extraction and injection steps can't be delegated to a nurse or an assistant (MedEsthetics; LegalClarity).
Why it exists: An in-person exam the day before gives the surgeon time to evaluate your body, your health history, and whether you're a safe candidate. And the no-delegation rule makes sure the surgeon you chose is the one doing the critical work.
How to check: Make sure your consult happens in person before surgery day, and ask: "Who performs the fat extraction and injection steps – you, or someone else on the team?" The answer should be the surgeon. Every time.
Rule 4: How many BBLs is the surgeon doing on your surgery day?
What the law says: In its 2022 emergency rule, the Board of Medicine capped surgeons at three BBLs per day – later codified into permanent rules and statute, according to LegalClarity.
Why it exists: BBLs are long, detailed operations – the cap keeps fatigue from creeping into the last case of the day.
How to check: Ask: "How many BBLs do you do on my surgery day?" If the number sounds like an assembly line, ask how they space them out. A straight answer is a good sign; a defensive one is not.
Rule 5: Is one surgeon focused on one patient at a time?
What the law says: Florida Statute §458.328 requires a one-physician-to-one-patient ratio during every phase of a BBL, from the start of anesthesia through extubation. Once a surgeon has started your BBL, they may not start another procedure on another patient (LegalClarity).
Why it exists: A surgeon splitting attention between two operating tables can't give either patient full focus.
How to check: Ask: "Will my surgeon stay with me through my whole procedure, or do they rotate between rooms?" You want the first one.
Rule 6: Is the office registered with the state – and is the surgeon's license active?
What the law says: Physician offices performing this level of surgery must register with the Florida Department of Health. The office gets an on-site inspection before registration, then at least one inspection a year afterward – and those can be unannounced (LegalClarity).
Why it exists: Registration puts the office under real oversight – inspectors review patient records and safety practices. An unregistered office is operating outside the system built to protect you.
How to check: Ask the clinic: "Is this office registered with the Department of Health?" Then verify the surgeon yourself: per the Florida Healthcare Law Firm's licensing guide, check a physician through the Florida Department of Health's own licensing system (its Medical Quality Assurance portal) – not a business website or directory. Search by name or license number, then confirm the listing matches – name, profession, license number, and current status.
Who is (and isn't) a good candidate for a BBL?
The law requires your surgeon to examine you in person no later than the day before surgery – and that exam is where candidacy gets decided. Be honest about your health history, medications, and whether you smoke. Generally, candidates need enough donor fat, good overall health, and a stable weight. People with certain heart or lung conditions, uncontrolled health problems, or unrealistic expectations usually aren't good candidates.
No one can clear you over the phone – the in-person visit is your chance to ask everything on this list, and your surgeon's chance to say honestly whether a BBL is right for you.
Want to talk through your options at Renew Me?
If you're considering a BBL, bring this checklist to your consult and ask every question on it – Renew Me Plastic Surgery welcomes those questions. Call (786) 957-1777 to schedule a consultation with Dr. Paul Boulos at 730 NW 107th Ave, Suite #117, Miami, FL 33172.
Sources
https://www.flsenate.gov/laws/statutes/2023/458.328
https://www.medestheticsmag.com/research/injectables/article/22880571/floridas-plastic-surgery-bill-is-a-game-changer-for-bbls
https://legalclarity.org/what-are-floridas-liposuction-limits/
https://floridahealthcarelawfirm.com/florida-state-license-lookup/
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