The Numbers, As the CDC Actually Reported Them

Between 2009 and 2022, 93 U.S. citizens died after undergoing cosmetic surgery in the Dominican Republic. That figure isn't a social-media rumor or a plaintiff's-attorney press release — it comes directly from the Centers for Disease Control and Prevention, published January 25, 2024 in the Morbidity and Mortality Weekly Report (MMWR Vol. 73, No. 3, pages 62–65), under the title "Deaths of U.S. Citizens Undergoing Cosmetic Surgery — Dominican Republic, 2009–2022." CDC investigators built the count from consular death reports and Dominican medical examiner records spanning thirteen years, and the trend line inside that number is the part that should actually change how you plan a trip.

Deaths averaged 4.1 per year between 2009 and 2018. Then, starting in 2019, the average more than tripled to 13.0 deaths per year through 2022, peaking at 17 deaths in a single year, 2020. That spike lines up almost exactly with the mainstreaming of the Brazilian Butt Lift (BBL) — gluteal fat grafting marketed heavily on social media, bundled into "surgery vacation" packages, and financed on payment plans that made it newly accessible to a much larger pool of travelers, including a growing number of Black American women.

What a Closer Look Revealed

CDC investigators pulled full case files for 24 decedents from 2019–2020 and were able to obtain autopsy findings for 20 of them. The cause-of-death breakdown was concentrated almost entirely around two mechanisms: fat embolism accounted for 11 cases (55%), and pulmonary venous thromboembolism (a blood clot traveling to the lungs) accounted for 7 more (35%). Hemorrhagic shock and sepsis each accounted for one case (5% apiece). In plain terms: roughly 9 out of 10 of the deaths CDC could fully investigate were caused by something entering the bloodstream during or after surgery and blocking blood flow to the lungs or heart.

The procedures involved were consistent, too. Liposuction was present in 100% of the reviewed cases, gluteal fat transfer (BBL) in 92%, abdominoplasty (tummy tuck) in 58%, and breast augmentation in 46%. And here's the detail that matters most for anyone planning a trip: every single one of the 24 decedents with available surgical records had undergone multiple procedures in one operation — a mean of three, ranging from two to four. Nobody in this data set died after a single, isolated procedure performed on its own.

What Actually Goes Wrong, Medically

Fat embolism and venous thromboembolism aren't exotic or mysterious complications — they're well-documented risks of the exact procedures at the center of this data. During liposuction and fat grafting, a surgeon is moving fat between parts of the body, sometimes injecting it back in to build volume in the buttocks. If that fat is injected into or near a vein rather than into surrounding muscle tissue, it can enter the bloodstream and travel to the lungs, where it blocks blood flow — a fat embolism. Long surgeries, prolonged immobility on the operating table, and the body's own clotting response to major surgical trauma raise the separate risk of a blood clot doing the same thing.

Both risks exist no matter where a procedure is performed, including in the United States. What changes the odds is what happens if something starts going wrong mid-procedure or in recovery: whether there's a cardiac and pulmonary monitor running, whether a blood bank and emergency medications are on hand, whether the recovery team is staffed and trained to catch a crashing patient in the first minutes rather than the first hour, and whether there's a real path to an ICU-level facility if things escalate. A well-run, well-equipped facility can catch and treat an embolism before it's fatal. An under-resourced one, with the goal of moving to the next surgery of the day, is where the same complication becomes a death.

Why Doing More In One Trip Is the Real Risk Multiplier

The "every decedent had multiple procedures" finding isn't a coincidence, and the Dominican Republic's own Ministry of Health has said as much. In 2019 — the same year the death rate began climbing — the Dominican MOH issued its own safety and quality recommendations for cosmetic surgeons, including surgeon training and licensure requirements, mandatory cardiac and pulmonary evaluations before surgery, and a hard cap: no more than two major procedures scheduled in a single operation.

That cap exists because combining procedures compounds every individual risk. More time under anesthesia means more time for a clot to form. More surgical sites mean more blood loss and more fat manipulation, which means more chances for fat to reach a vein. And the entire economic model of a "surgery vacation" — fly in, get the full package done in one trip because you're only making the trip once, fly home a few days later — is built around doing as much as possible in the shortest possible window. That structure is a risk factor in itself, independent of any single country, clinic, or surgeon's individual skill.

Red Flags to Check Before You Book Anything

This isn't a call to avoid cosmetic surgery abroad altogether — it's a call to ask the questions that actually change your odds, before you put down a deposit:

  • Verify the surgeon's board certification independently. Ask for their credential with the Dominican medical board and check whether they hold certification recognized by a body like the International Society of Aesthetic Plastic Surgery (ISAPS) — and confirm it yourself rather than taking a clinic's word for it.
  • Confirm the facility's license and accreditation status with the Dominican Ministry of Public Health, and ask directly whether the facility has ICU-level capability and a written emergency transfer plan to a full hospital.
  • Ask exactly how many major procedures are being scheduled in one operation, and treat any package that bundles three or more as a red flag, not a bonus. The Dominican MOH's own guidance caps it at two.
  • Ask what monitoring is used during and after surgery — cardiac monitoring, pulse oximetry, and a documented recovery-room staffing plan, not just "someone will check on you."
  • Get pre-op clearance from your own doctor at home, including a real conversation about your personal cardiac, pulmonary, and clotting risk factors before you ever board a plane.
  • Build in real recovery time before your flight home. Long-haul immobility right after major surgery is itself a clotting risk; ask your surgeon, in writing, what they consider a safe window.
  • Be skeptical of any price that seems to reward doing more. If it's cheaper per procedure to add a third or fourth one, that pricing structure is nudging you toward exactly the pattern this data flags as most dangerous.

A Word on Liability — Please Read This Before Anything Else

This article is journalism and general safety information. It is not medical advice, a diagnosis, or a treatment recommendation, and it is not a substitute for a consultation with a licensed physician who knows your personal health history. Every patient's individual risk profile is different, and only a qualified medical professional evaluating you directly can advise on whether any specific procedure, surgeon, or facility is appropriate for you. Black Travel Now does not endorse, recommend, or receive compensation from any specific surgeon, clinic, or hospital in the Dominican Republic or anywhere else, and nothing in this piece should be read as legal or medical guidance. If you are considering cosmetic surgery abroad, talk to your own doctor first.

Protecting Yourself If You Move Forward

If you've done the vetting above and decide to move forward, two practical safety nets matter more than almost anything else in the fine print: travel or medical-travel insurance that specifically includes medical evacuation coverage (a standard travel policy usually does not cover a medical complication from an elective procedure, so you have to look for policies written for medical tourism specifically), and using accreditation-verification resources or vetted referral services to confirm a facility's standing before you book — rather than relying on a clinic's own marketing or a single influencer's testimonial. Neither of these is a substitute for the vetting steps above, but they're the difference between a manageable emergency and a catastrophic one if something does go wrong far from home.

This Isn't About Fear. It's About Coming Home.

None of this is written to shame anyone who has had or is considering a BBL abroad. The reasons people make this choice are real and rational: U.S. cosmetic surgery prices are often two to four times higher than prices abroad, many U.S. surgeons have long waitlists or won't perform the procedure at all due to its risk profile, and financing options abroad can make an otherwise unreachable procedure suddenly possible. None of that makes anyone reckless or foolish for considering it.

What this data means is that the choice deserves the same seriousness as any other major surgery — because that's exactly what it is. If you've already booked a trip, use this piece as a checklist to ask harder questions of your provider, not as a reason to panic. If you're still deciding, let the real numbers — not the horror stories and not the influencer glow-ups, but the CDC's own thirteen years of data — inform the choice you make. And if, after reading this, you decide the risk isn't one you're willing to take right now, that is just as valid a decision as choosing to move forward informed. Either way, the goal is the same one every episode of this series comes back to: however you get there, get home safely, to the people who love you.