BBL surgery: Di dark side of Brazilian butt lift boom

Wen Alice Webb go for a non-surgical Brazilian butt lift (BBL) – one procedure wey involve injection of plenty dermal filler inside her bum-bum – for one pop-up clinic inside a rented beauty salon one morning for September 2024, she expect say e go finish in time for afternoon school run.

But Alice, 33, no return home.

Di mother of five die less dan 24 hours afta she do di treatment, and become di first pesin for di UK wey dey known to don die sake of non-surgical BBL procedure. Dem go hold her inquest between September and November to establish di cause of her death.

Her tori don become major point for serious debate about Britain aesthetics industry wey dey boom, wia cosmetic injectables now dey available evriwia, from High Street beauty salons to rented office spaces and hotel rooms.

Over di past two years, I don investigate dis industry, going undercover to find out wetin really dey happun behind clinic doors.

I dey see practitioners wey dey willing to inject hundreds of millilitres of filler into my body from makeshift treatment rooms in office blocks. Dem offer me prescription-only medicines without proper consultations and sell weight-loss injections wey no get label ontop social media.

I don tok to dozens of women wey don tell me about di serious pain dem experience wey dey caused by cosmetic injections wey bin dey marketed as pain-free and low-risk, and di resulting infections wey leave dem for hospital.

Di cosmetic accreditation service Save Face say dem don see plenty cases of serious harm wey dey linked to cosmetic procedures - including one patient wey now no fit close her eyes sake of one eyelid surgery wey no go well, and anoda one wey get wound for intestines during a liposuction procedure.

"E dey so horrific like say e sound like some sort of horror feem, but dis na di procedures wey dem dey carry out on our high streets," na so Save Face director Ashton Collins tok.

Di UK na one of Europe least-regulated markets for cosmetic injectables. Unlike many European kontris, anybodi fit legally train to inject dermal fillers and offer treatments to members of di public.

Now ministers for Scotland and England say dem dey tighten regulation of dis multi-billion pound industry. But dis wan go work? And wetin make, more dan a decade afta sabi pipo warn say dermal fillers na a "crisis waiting to happun", patients still dey exposed to preventable harm?

From di Kardashians to di High Street

For June 2024 Joanne (wey only want make we use her first name) bin go for a non-surgical BBL procedure for one pop-up clinic for one flat for Essex becos she consider say e dey less risky pass to fly go Turkey for a surgical BBL – dis na bifor Alice die.

"I just want peachy bum," na so Joanne, a mum of two from South Wales tok. "I for turn and run away". Shortly afta treatment, wia dem inject her wit 1 litre (1.8 pints) of filler, she end up for hospital wit sepsis. Two years on, she say she still get scars on her thighs and buttock from di treatment.

Cosmetic injectables bin once dey associated wit wealthy, middle-aged clients wey dey seek subtle anti-ageing treatments, but di industry don undergo a dramatic transformation over di past decade.

Treatments such as dermal fillers – injectable gels, dem usually make from hyaluronic acid, wey dem dey use to add volume and shape – and Botox now dey marketed to a much younger audience and dem dey promote am as routine beauty treatments rather dan medical procedures.

Ashton Collins of Save Face believe say social media and reality television don play major role to drive dat change: "Di Kardashians, Love Island and social media make am fashionable for younger women to get bigger lips, cheeks and frozen faces."

At di same time, injectable treatments don become increasingly widely available and often dey offered from beauty salons - wey fit make dem appear similar to routine beauty services, according to Collins.

"Pipo fit do dia nails or eyebrows and see dis treatments as an extension of dat," she tok. "If you dey under 35, e dey very likely say you see dis treatments as beauty treatments rather dan sometin medical."

Di result, Collins argue, na say di consumers often focus on convenience, popularity and price rather pass safety credentials.

"We repeatedly find say pipo no know say Botox na a prescription-only medicine. Dem no know say dem gatz dey assessed by a healthcare professional," she tok.

All dis don help to fuel di extraordinary growth across di sector. But Collins say e also create di conditions for unsafe practitioners to thrive.

"Di way dis treatments dey presented on social media dey remove much of di perception of risk," she tok.

Striking growth

Di scale of dat market still dey unclear as e no get a central register of practitioners and no official database wey dey track di sector growth.

Dr Alexander Zargaran, an NHS plastic surgeon and researcher for University College London, plan to quantify one of di largest parts of di market: Botox.

Im analysis identify nearly 20,000 practitioners wey dey operate across di UK in 2025, compared wit just over 3,500 identified as recently as 2023.

"We know say di industry dey grow," Zargaran tok. While some of dis increase reflect more comprehensive mapping of practitioners advertising online and through social media, the scale of the growth in just two years remains striking.

Some of di sector growth dey driven by non-medical practitioners, as Zargaran research suggest - according to im study, di proportion of non-medical aestheticians double from 12% to 24.8% between 2023 and 2025.

Di study also find say Botox treatments dey more widely available in di most deprived communities.

Practitioner density dey more dan six times higher in di most deprived areas compared with di least deprived. But at di same time, pipo for di i most deprived areas get less access to medically qualified practitioners.

And dis lead us to wider kwesion: if di UK now get tens of thousands of cosmetic injectors wey dey operate across di kontri, somebodi suppose dey responsible to dey regulate dem?

A lighter touch?

Under current laws across di UK, anybody fit legally undertake training, buy dermal filler products and offer treatments to members of di public.

While doctors, nurses and dentists dey regulated by professional bodies wit power to torchlight complaints and impose sanctions, di same statutory regulator for non-medical aesthetic practitioners no dey.

For Austria, by contrast, botulinum toxin and dermal filler treatments dey classified as medical procedures and dey typically reserved for doctors. In France, non-medical practitioners dey prohibited from administering injectable cosmetic treatments.

Andrew Rankin, chief executive of di Joint Council for Cosmetic Practitioners (JCCP), say di UK lighter-touch approach reflect wider regulatory culture wey historically take consumer choice and economic growth more serious.

"We get an inclusive philosophy to economic activity wia govment dey try to find di balance between public safety as dem dey maintain an innovative and effective economy," e tok.

For 2023, wen di govment bin consult on a licensing scheme for England, some respondents warn say any new regulation go need to dey proportionate.

While dem get broad support for improving safety, raise concerns about di potential impact on small businesses, wey make up much of di sector, and di risk wey overly restrictive rules fit limit consumer choice or drive parts of di industry underground.

But di current situation across di UK fit make am difficult for consumers to assess qualifications, understand di training a practitioner don receive and know wia to turn wen treatments go wrong, Zargaran tok.

"If you be medical professional, you go don go through certain types of training, including di important principles of consent, carrying out procedures, follow-up and recognising complications," e add.

More dan 10 years ago, di govment commission one independent review of di cosmetic interventions industry following di PIP breast implant scandal, wia thousands of women receive implants made with silicone wey bin no dey approved for medical use.

Di review, wey den-NHS Medical Director Professor Sir Bruce Keogh lead, examine di wider cosmetic sector, including dermal fillers, Botox and oda non-surgical procedures.

E warn say pipo wey dey undergo non-surgical cosmetic procedures get "no more protection and redress pass pesin wey dey buy ballpoint pen or a toothbrush" and conclude say : "Na our view say dermal fillers na a crisis wey dey wait to happun."

Di review call for practitioner licensing, stronger training requirements and tighter controls over who suppose dey allowed to perform cosmetic procedures.

Sake of di Keogh Review, di govment introduce system of voluntary self-regulation. Organisations such as di JCCP bin dey established to set standards and encourage practitioners to join accredited registers.

But Rankin say dis approach bin no work and many practitioners remain entirely outside voluntary schemes: "Wetin be dey underestimated na di extent to which, in a self-regulatory framework, practitioners bin no dey interested in meeting those standards."

Di enforcement problem

Four days after undergoing a liquid BBL for one Essex clinic in October 2023, dem rush 28-year-old Louise Moller from Bolton go hospital wit sepsis.

She call her mama, Janet Taylor, from A&E: "Mum, I think I go die," she tok.

To stop di sepsis from spreading thru her body, surgeons remove large areas of dead tissue from her left bum-bum.

Janet report di incident and di practitioner wey carry out di procedure - Ricky Sawyer, one popular rogue injector wey also perform di non-surgical BBL wey leave Joanne wit sepsis - to police.

But becos di procedure happun for Essex while Louise live for Greater Manchester, she say dem tell her say di case go need to pass between forces.

Wen BBC News approach Greater Manchester Police (GMP) and Essex Police about dis for 2025, di two of dem say responsibility for di investigation lie wit di oda force.

We contact GMP for dis article but dem no respond. Essex Police say: "We understand di frustration for dis case," but insist again say responsibility dey wit GMP.

For Collins, Louise experience show wider failure of enforcement. "Pipo assume say pesin must dey wey go dey regulate dis practitioners and hold dem accountable wen tins go wrong," she tok. "Very often dat no be di case."

While Janet try to get justice for her daughter, I go undercover as a client inside a temporary clinic wey dey operate from one office block for di outskirts of London wia Ricky Sawyer still dey operate.

During di appointment, Sawyer offer to inject up to a litre of filler, provide prescription-only medicines without a prescription being issued used and suggest make dem administer local anaesthetic wey prescriber no dey.

Plastic surgeon Dalvi Humzah, wey review di footage, describe dis practices as "shocking" and "very dangerous".

Since our reporting on Sawyer air for February 2025, dem don ban am from practicing based on one legal injunction wey Trafford Council get. E recently appear for court over breaking dis injunction but dem find am not guilty - during im evidence e say e bin no know say e dey dangerous.

While Sawyer no fit practise anywia for England and Wales, e take several years for dis to happun.

And e no just be di practitioners but also di products dey unregulated. Concerns about illegal medicines and counterfeit products don surface repeatedly across di sector in recent years.

A BBC undercover investigation for 2025 find nurses and pharmacists wey dey supply Botox without carrying out di face-to-face consultations wey dey required under professional guidance.

Authorities don also repeatedly warn about unlicensed and counterfeit products entering di UK market.

Police for Northern Ireland seize more dan 700,000 counterfeit and unlicensed medicines for 2023, including Botox products.

For Glasgow, officers later recover thousands of pounds worth of dermal fillers, needles and botulinum toxin products during a raid linked to di aesthetics trade.

Campaigners say enforcement often dey fragmented between councils, police forces, medicines regulators and professional bodies, with no single organisation responsible.

"You fit waka go beauty salons across di kontri and get Botox di same day without eva having a proper consultation with a prescriber," Collins tok. "Dat no suppose dey happun, but e dey happun becos dem get very little enforcement."

Repeated delays

Since 2013, successive govments don gree di case for reform, yet comprehensive regulation repeatedly dey delayed.

A significant step come wit di Health and Care Act 2022, wey give ministers powers to introduce a licensing regime for non-surgical cosmetic procedures for England. In 2025, ministers confam dia intention to introduce a licensing scheme.

A Department of Health and Social Care tok-tok pesin say: "We go soon consult on tough new measures wey go ensure say only qualified healthcare professionals go dey able to perform di highest-risk procedures."

Dem say dem also dey plan a licencsing scheme for wetin dem describe as lower-risk procedures.

Meanwhile, a law dem pass dis year for Scotland go restrict procedures like Botox and injection of dermal fillers to specific settings, such as regulated clinics.

E go also make am illegal to provide procedures to those under 18. A Scottish Govment tok-tok pesin say all dis dey expected to come into effect from September 2027, as well as a local authority licencing scheme for less risky procedures.

Northern Ireland Department of Health says dem "no get current plans" to introduce mandatory regulation of non-surgical cosmetics or to introduce a licencing scheme.

However, dem say dem dey take "decisive action" against di illegal supply, misuse and promotion of medicines like Botox.

Di Welsh Govment say dem dey monitor di implementation of mandatory licencing schemes for acupuncture, dry needling, body piercing, electrolysis, tattooing and semi-permanent makeup and dis "go inform any potential future extension to oda procedures".

Despite di developments for Scotland and England, dem still get to do substantial work bifor any licensing system go become fully operational.

Further legislation dey required, detailed regulations must still dey drafted and local authorities go need di resources necessary to enforce any new framework.

In di meantime, ministers for England don indicate say di highest-risk procedures go dey prioritised under a proposed "red category" of treatments.

Dis dey expected to include non-surgical BBLs, face lifts and filler-based body contouring treatments, wey go alter di shape of areas such as di stomach, thighs or buttocks.

Rankin say dem get a broad agreement say some procedures "really suppose dey restricted to appropriate professionals".

Supporters of reform hope say di proposed licensing scheme go eventually require both practitioners and premises to dey licensed, too.

More dan a decade afta di Keogh Review warn say dermal fillers na a "crisis wey dey wait to happun", campaigners argue say di problem no longer be a lack of warnings.

But even if new rules dey introduced, di challenge go be to ensure say those wey already exist dey enforced.

BBC InDepth na di home on di website and app for di best analysis, with fresh perspectives wey dey challenge assumptions and deep reporting on di biggest issues of di day. Emma Barnett and John Simpson bring dia pick of di most thought-provoking deep reads and analysis, evri Saturday.Sign up for the newsletter here