“Your butt is very tight,” Karra Janatiss says. The 32-year-old owner of Doll House Consultants, a recovery care service, is describing the physiological challenges of a “Brazilian butt lift” or BBL, one of the fastest-growing categories of elective surgery.
“Picture a balloon. When you blow it up, it expands,” she says. “It feels like a burning, throbbing, aching pain. My clients—they can’t bend, they can’t lift. They can’t get in and out of bed and use the bathroom on their own. You’re swollen for six to 12 months.”
Janatiss, petite and curvy, with glossy black hair and a tattoo of a rosary encircling her left hand, is among a legion of caretakers dedicated to healing BBL patients. The operation itself involves transferring fat from other parts of the body (usually the stomach, but sometimes the back or thighs) into the hips and buttocks. Post-op recovery services is an entirely new industry that has sprung up around tending to the brave women (and the occasional man) who put their bodies through a long, agonizing, and bloody journey to achieve the perfectly Instagrammable peach.
Today, Janatiss is in the kind of hotel room she usually works in, tending to her 22-year-old client Aaliyah, who has just finished showering. Aaliyah is a model-tall Chicagoan with her braided hair wrapped up in a high bun. (Aaliyah’s last name is being withheld for privacy reasons.) A red three-wick candle burns on top of the TV console and the bedside tables are crowded with supplies: Cheerios, hair scrunchies, Neosporin, and cocoa butter lotion. Janatiss has cooked for and bathed Aaliyah, ferried her to follow-up appointments, and taken her on excruciating and slow walks down the hotel hallway to ensure her blood continues to circulate through her bruised body.
Outside of Aaliyah’s hotel room, the sky is a naked blue. It is the perfect day to unfurl a towel at South Beach and soak up the sun on the edge of the glassy Atlantic. The air is a balmy, sexy 75 degrees, just warm enough to melt the edges of a frozen cocktail. But Aaliyah isn’t in Miami to do Miami—at least, not that part. She’s here because Miami, city of micro bikinis and eternal summer, is the U.S.’s cosmetic surgery capital, with eight plastic surgeons per every 100,000 residents as of 2018, and likewise the tender, beating heart of the post-op care industry.
“My clients—they can’t bend, they can’t lift. They can’t get in and out of bed and use the bathroom on their own. You’re swollen for six to 12 months.”
Janatiss, big brown eyes wide over her black surgical mask, spins Aaliyah around to point out her surgical incisions. There are small pocks of darkened skin on her back, stomach, and just below her tailbone. Dangling from her hip is a drainage bag to collect the anesthetic Lidocaine. Janatiss pulls her client to the center of the room. For BBL patients, compression garments called “fajas” are an important part of post-op care: They stimulate lymphatic drainage, knit new fat together with old, and minimize swelling. With gloved hands, Janatiss works a black faja over Aaliyah’s legs as generic Lifetime TV drones in the background.
Even a week after her surgery, getting Aaliyah into the faja was a slow and painful process. Though some fajas are more like a waist trainer, Aaliyah’s is a full-body suit. “It feels like somebody is pressing on your burn,” Aaliyah says, eyes skyward and lips locked in a grimace, one pink-nailed hand spread to cover her naked chest.
For many, BBLs are the surgical route to the iconic hourglass silhouette: a waist dwarfed by ample hips and the kind of round, firm ass best described as “juicy.” That kind of figure, natural or augmented, is flaunted in music videos and Instagram posts by some of today’s biggest stars: Megan Thee Stallion, Kim Kardashian, Cardi B. Online brands, like Fashion Nova (which counts both Meg and Cardi among its collaborators), have dedicated their marketing to those curves, and rappers have praised them (21 Savage bragged that all his bitches have BBLs on his Metro Boomin collab “Runnin’”). The BBL as a cheat code to sex appeal may be a 1960s invention, credited to Brazilian plastic surgeon Ivan Pitanguy, but its popularity is a somewhat recent phenomenon: Sir Mix-a-Lot’s lament from his 1992 hit “Baby Got Back” that popular culture dictated that “flat butts are the thing” is hardly recognizable 30 years later.
But the Brazilian butt lift is polarizing. With one of the highest mortality rates among cosmetic procedures, it is a particularly dangerous operation. That “holy shit!”, Instagram-model effect is usually the result of multiple BBLs. And then there are the complex cultural dynamics. For decades, at least, the bigger lips and butts that some Black and brown women had were denigrated, hypersexualized, policed, and ostracized. Now that they’ve been popularized, as writer Crystal Martin noted in The Cut, “the cultural and social value of BBL flowed from Black women to white women, and it has been entirely commodified. Anybody can have a big butt for a price.” Yet, she writes, “the distortion of its proportions” of Black features is more of a “Frankenstein’s monster” than actual representation. And it is often Black women who pay for and then are “punished” with ridicule for pursuing that exaggeration of Blackness, as Martin puts it, through dangerous surgery.
Nevertheless, every year, thousands of women like Aaliyah bear the bodily pain and financial burden (anywhere between $5,000 and $20,000 per procedure), along with potential social scrutiny, to pursue that big butt for a price. And a throng of recovery care workers are now there to help them.
Aaliyah found her Brazilian butt lift surgeon the same way she found Janatiss: social media. If the public conversation about BBLs can be fraught and laden with judgments, an online ecosystem of mostly private cosmetic surgery pages, called “Sx” pages in a riff on “Rx,” provides a safe and supportive space for women who are researching the operation.
This particular subset of cosmetic surgery patients call themselves “dolls.” Largely a community of Black and brown women, they run quasi-anonymous Instagram accounts, Facebook pages, and massive WhatsApp chats. The networks are part gossip blog (like surgery-centric versions of The Shade Room) and part whisper network (calling out dodgy doctors instead of shitty men). “Dolls” itself is a winking embrace of the “plastic” in plastic surgery, an echo of Lil’ Kim and Nicki Minaj referring to themselves as “Barbie,” and by extension a rejection of the hush-hush style of cosmetic surgery executed in private to achieve natural-looking results. In doll parlance, Aaliyah is officially a Fisher Doll because her surgeon’s name is Dr. Fisher.
Being a doll is about more than becoming an amateur cosmetic surgery researcher; it’s also an attitude. Dolls are women who luxuriate in their bodies. Women who wear bikinis and prance around their palatial apartments, their XXL hips twitching for emphasis with every bouncy step. Women who’ve mastered the art of over-the-shoulder posing for maximum focus on the two perfect globes of her ass. To be a doll is to be in demand, an object of envy and desire and attention, expensive in a literal and a spiritual sense.
But they’re also nurses, servers, teachers, administrative assistants, retail workers, students, and stay-at-home mothers who saved up enough money to change their appearance in order to participate in this culture of opulence.
The BBL’s popularity, according to a survey by the International Society of Aesthetic Plastic Surgery, has exploded, increasing by 77.6 percent between 2015 and 2019.
“I don’t even want to say it,” said a doll named Nellie (whose last name is being withheld for privacy reasons), one week after her first BBL. “But my boyfriend said, ‘You look the same [now after surgery], like you do in your Instagram pictures.’ I was like, ‘Babe, those are angles. I’m tired of angles. I want to look like the real thing in real life.’”
To reach that glamorous final form, some spend years consuming surgery community material before they book their first appointment. They swap horror stories and memes and pair up when their appointments align, becoming “surgery sisters.” They also meticulously document their progress, whether they’re swollen and leaky immediately post-op or twirling in front of the mirror in lingerie.
And they pursue BBLs in spite of their documented dangers: with one death per 3,000 procedures performed, it’s been dubbed the riskiest cosmetic procedure, in part due to opportunistic surgeons who rush through as many procedures as possible, as well as the difficult nature of the operation itself. It’s hard to accurately inject fat into the buttocks, and fat shot into muscle or a blood vessel can easily cause a deadly embolism.
Dolls are just one part of a larger cultural shift. Elective plastic surgery is more popular than ever, partly because costs have risen at a lower rate than that of inflation over the last 20 years. Since cosmetic procedures are typically out-of-pocket, medical practitioners set competitive prices. The taboo around surgery has also diminished in our bare-it-all, confessional social climate and celebrities have spoken publicly about getting work done.
While noninvasive procedures like Botox remain the most prevalent, healing-intensive surgeries are trendy and highly visible. In 2020, the American Society of Plastic Surgeons, which accounts for about 85 percent of U.S. cosmetic procedures, estimated that board-certified plastic surgeons performed approximately 22,000 BBLs, 99,000 tummy tucks, 193,00 breast augmentations, and 211,000 liposuctions. (Most of these numbers are lower than the 2019 statistics—possibly thanks to the pandemic.) The BBL’s popularity, according to a survey by the International Society of Aesthetic Plastic Surgery, has exploded, increasing by 77.6 percent between 2015 and 2019.
That’s a lot of surgery—and, thus, a lot of recovery.
“When I got out of high school, I wanted to be a nurse,” Janatiss, who started Doll House Consultants in 2016, told me. “But I don’t like dealing with death. Once I got into the hospital, I said, ‘I don’t think this is for me.’ I like to build bonds with people. So, what better way than building bonds with my clients, while they recover from something they chose to do that made them feel better about themselves?”
Janatiss, like any good post-op recovery worker, is a natural caregiver. (She reached out the night before our interview with detailed parking instructions and a shortlist of nearby restaurants for lunch.) And she also has an intimate understanding of what her clients are going through since she got her own Miami BBL a year before starting her business: “I know it feels like you got hit by a truck!” In fact, many BBL recovery workers have had the operation themselves.
In addition to outpatient caregivers, like Janatiss, the post-op industry also encompasses car services that provide airport pickups, and rides to and from surgery. There are Airbnb hosts who outfit their rentals specifically for post-op guests, physical therapists who focus on lymphatic drainage, and retailers that stock compression garments and special pillows designed to help one’s ass retain its new, fuller shape. Some of these niche businesses arose out of the challenges dolls face in seeking ad-hoc accommodations: Recovery care workers relayed stories of hotels and ride-share drivers refusing services to post-op dolls.
“[Surgeons] used to provide aftercare and keep patients in the hospital after having the surgery performed. Now, they completely leave out post-op care and leave it up to their patients.”
Rose Menos is a post-op car service owner in New York City, where she ferries clients for her company Post-Op Rides NYC to appointments in a gleaming black Mercedes SUV, charging $100 to $150 per ride. The Mercedes is outfitted with a custom mattress strapped into the back seat to keep passengers, who must lie on their stomach to avoid putting pressure on their swollen posterior, as stable as possible. She keeps glass bottles of Aquapanna and ginger candies on hand for post-op nausea and dons a baby pink surgical mask whenever a client enters her car.
“It’s the difference between Fashion Nova and Chanel,” Menos said, while we waited in her car on a narrow Bronx street for Nellie, the BBL patient who we’d just ferried to her clinic for a special post-op massage. “There’s nothing wrong with either. You can go quantity with a lesser price point, with a little bit less quality to be quite honest. Or you can do something a little bit more substantial, but charge people for it.”
While some dolls choose a personal caregiver to take care of them in a hotel room, others opt for dorm-style recovery houses, which cost less but still crank up the opulent aesthetic. On Instagram, virtual tours for post-op recovery houses showcase an endless procession of white leather couches, marble floors, crystal chandeliers, and turquoise backyard pools.
Recovery houses look glamorous and social media-ready, but the surgery community’s denizens do their part to reveal the unvarnished realities of surgery, too. Stumble on a lymphatic masseuse’s page or make your way onto faja TikTok and it might be hard to process the mélange: blood, vomit, swelling, and bikini shots. According to recovery care workers, getting graphic on social media is an effective way to educate prospective clients about the recovery process. That’s why some post-opt care accounts regularly post photos of rust-brown, drainage-stained sheets and video clips of Lidocaine spurting from open incisions, which they alternate with photos of former clients healed and glowing.
“Word of mouth is the most powerful form of marketing,” said Shomara Garcia, the 33-year-old founder of Muñeca Private Care Recovery Services and a licensed massage therapist. Garcia learned how to attract clients at her last job running social media for a Miami plastic surgeon’s office. “I recovered one client, then she led me to her grandma, her aunt, her mom, her sister, her cousin—I felt like I’ve covered everyone in that entire family! It’s easy to grow from there.”
The dolls who travel to Miami, according to recovery workers, are often traveling for the (comparatively) affordable price point. One Texas doll said she made the trip from Texas to Florida because the procedures she wanted—a tummy tuck and liposuction on her flanks and upper arms—cost double, about $20,000, in Dallas. (The busiest time of year is when refunds start rolling in after tax season.) “Surgery is very affordable now,” Garcia said. “Back in the day, I’m talking about 15, 20 years ago, [surgeons] used to provide aftercare and keep patients in the hospital after having the surgery performed. Now, they completely leave out post-op care and leave it up to their patients.”
Choosing a cosmetic surgeon can literally be life or death. Around 100 people die from complications related to outpatient cosmetic procedures per year, according to a 2013 report from the National Center for Health Research. In Miami, I peeked into Jolie Plastic Surgery, a nondescript ground-level storefront, where six women waited in gray leather chairs, in a shopping center tucked between two different insurance offices. In 2019, this clinic, its sister location, and then-owner Ismael Labrador were linked to eight patient deaths and numerous serious injuries in a collaborative investigation between USA TODAY and the Naples Daily News.
It can be especially tricky to crack down on doctors like Labrador and the surgeons performing at his clinics because any licensed doctor can legally perform plastic surgery in the United States, whether or not they have specialized training in cosmetic procedures. That leaves the door open for opportunists with a medical license looking to cash in on popular procedures with high out-of-pocket costs. Practitioners like these are the reason the cosmetic surgery social media sphere is home to its own whisper network.
There are even less regulations in the post-op care industry—the presence of scammers and inadequately equipped caretakers is a widely-known reality among workers. Some post-op care workers have licenses and certifications, such as registered nurses, insured chauffeurs, or trained masseuses. But those qualifications are optional, not a legal requirement. “When I first got started, there were only three companies,” Garcia said. “Now the market has been saturated with tons of people who don’t necessarily know what they're doing.”
The women behind one recovery house, the Recovery Retreat, Angel Amour and Saran, invited me to a tour of their facility on the outskirts of Miami. I visited in mid-December. Like many post-op care houses, the Recovery Retreat had Instagrammable touches. There was a palm-shaded pool, a hot tub, and rooms decorated like a Barbie Dreamhouse by way of Dry Ice: white furry pillows on the beds, glittery word art on the walls, silver side tables topped with silver lamps. “There are horror stories, like—they take girls’ money and the girls get nothing in return,” said Angel of the pair’s eagerness to provide good services. “They don’t get the proper care, the proper service, the nutrition—any of it.”
“I have the curves. I have the shape. I can wear a dress and feel confident in it. I can wear jeans and know from the back that it looks nice. I don’t regret it—and I’ll do it again.”
Shortly after my visit, though, an allegation about the Recovery Retreat’s billing practices came to my attention. Kyera Watts, a 32-year-old woman from Atlanta, Georgia, said that she paid $1,600 for a stay at the Recovery Retreat in October 2021, but she canceled her reservation a week in advance after being told she could only stay five of the nine days she’d booked. Watts was promised a refund multiple times in text messages that VICE reviewed.
More than four months later, after everyone associated with the Recovery Retreat stopped answering her calls and texts asking about the refund, Watts’s friends and family members turned to social media, posting comments like “SCAM!” and “Give her back her money!” under the business’s Instagram posts. Though Saran initially responded to Watts’s sister over Instagram DM, Watts has still not received a refund. Saran and Angel did not respond to multiple requests for comment about the situation from VICE following the initial interview and there were no allegations of medical malpractice. The Recovery Retreat’s Instagram account last posted in December 2021, a few weeks after my tour.
In Florida, providers told VICE that surgery centers are only legally required to ensure patients leave their facilities with someone over the age of 18. Other than that, there are no explicit regulations around aftercare for outpatient procedures. But licensing requirements for assisted living facilities have also been used to shut down recovery houses, especially those with unsatisfied customers ready to file complaints. (The Florida Department of Health did not respond to multiple requests for comment about if and how it plans to regulate the recovery care industry.)
“It’s similar to the difference between prescriptions/medications, and homeopathic and herbal treatments,” said Tito Vasquez, an assistant professor of plastic surgery at the Yale School of Medicine and practicing surgeon. “They’re not regulated because the safety profile and the effect is not as significant or severe enough to warrant it. I don’t think that’s ever going to change.”
As long as the beauty ideal—and the glittering lifestyle its fulfillment promises—can be achieved through surgery, some women will find a way to ascend to dollhood. Sometimes, particularly when money is tight, that means navigating a shadowy world of opportunistic doctors and unlicensed post-op care workers, with little more reliable research than a collection of Instagram testimonials. But that isn’t stopping the dolls.
On a Post-Op Rides NYC drive in the backseat of Menos’s Benz, Nellie was flat on her stomach, dressed in sweats with her curly hair pulled into a topknot and freshly aching from an hour-long massage session. “I actually feel like a woman now,” said Nellie, beaming through her seventh day of BBL recovery. “I have the curves. I have the shape. I can wear a dress and feel confident in it. I can wear jeans and know from the back that it looks nice. I don’t regret it—and I’ll do it again.”
Correction: This story has been updated to clarify the roles of two workers.
Katie Way is a staff writer at VICE. Follow her on Twitter.