Brazilian Butt Lift (BBL)—liposculpture in conjunction with autologous fat injection to the buttocks—is one of the most popular, likely the fastest-growing, and certainly the most controversial cosmetic surgical operative procedure in the United States. However, this seemingly simple procedure’s popularity has come with notoriety. This lecture will describe the history of BBL from its inception to the present day, will examine the response of international surgical groups to the high death rate associated with intramuscular and submuscular injection of fat in the gluteal area, will discuss ongoing and constantly changing regulatory responses to the procedure’s real and imagined safety issues, and will make suggestions as to how surgeons can ensure their patients’ safety and can navigate and shape the regulatory environment. The lecture will focus on patient safety and update surgeons on recent changes in the US regulatory environment as regards BBL surgery.