Who we don't work with: security exclusions at BBL
In body contouring surgery, knowing when to say no is also part of safety. At Cirumed Clinic Marbella, Dr. Alexander Aslani sets clear boundaries before accepting any offers. a surgery like BBLliposculpture or large-volume body remodeling.
These exclusions do not mean that surgery is technically impossible. They mean that, for certain patients, the risk is not justified. This article explains the most common cases in which we can refuse an operation and why that decision protects the patient.
Important: This information does not replace a medical evaluation. Each case should be studied individually in a consultation.
Quick facts
Reason: Some patients are not candidates for safety reasons.
Main factors: diabetes, coagulation disorders, certain psychiatric conditions, age, high BMI, and non-absorbable buttock fillers.
Key rule: Most cases are evaluated individually, but non-absorbable gluteal fillers are a absolute contraindication for a BBL with fat transfer.
Objective: to prevent complications that are difficult to control during large-volume surgeries.
⚡ The essentials — what you need to know
Dr. Aslani may refuse surgery when the risk does not outweigh the benefit.
Exclusions are not a judgment about the person, but a medical decision about a specific surgery.
Diabetes, clotting disorders, advanced age, high BMI, or certain psychiatric treatments may change the safety profile.
Non-absorbable gluteal fillers prevent BBL procedures using the patient's own fat, due to the risk of triggering silent infections.
A clinic that doesn't operate on everyone is prioritizing safety over the surgical schedule.
Who shouldn't get a BBL?
Not everyone is a good candidate for a BBL or large-volume body contouring surgery. At Cirumed, Dr. Aslani may decline patients with diabetes, clotting disorders, certain psychiatric conditions, age near or over 60, a high BMI, or non-absorbable buttock fillers. This decision aims to reduce serious risks and is always made after an individual evaluation.
Saying no is also a sign of safety
One of the clearest signs of safe surgical practice is knowing which patients should not undergo surgery. At Cirumed, we reject requests every week, not because the surgery cannot be performed technically, but because the risk is not justified for that particular patient.
In major surgeries like BBL, 360 Liposuction, or combined body contouring, the goal isn't to operate on everyone. The goal is to select the right patients, prevent complications, and offer alternatives when a procedure isn't safe.
Not sure if you qualify for a BBL?
We can review your case individually. If surgery is not safe for you, we will tell you clearly and discuss more suitable alternatives.
Diabetes
Dr. Aslani generally does not accept patients with diabetes for large-volume body contouring surgeries, even when the diabetes is well controlled.
The reason is not only the frequency of complications, but also their severity if a complication arises. In a person with diabetes, an infection, poor wound healing, or a postoperative problem can be more difficult to manage and have a higher risk of escalating.
In extensive surgery, that additional margin of risk is not always justified.
Coagulation disorders
Patients with relevant coagulation disorders, such as Factor V Leiden, von Willebrand disease, or coagulation factor deficiencies, are not usually accepted for large-volume liposuction.
These patients may have been able to undergo minor surgeries in other contexts, but extensive liposuction is not comparable. This type of operation involves significant fluid shifts and places greater demands on the circulatory system.
Therefore, a clotting disorder can raise the risk to a point that we do not consider acceptable.
Significant psychiatric situations
Psychological health is also part of surgical safety. In patients taking more than two psychiatric medications simultaneously, Dr. Aslani usually pauses the procedure or coordinates with the treating physician beforehand.
This is not an automatic exclusion in all cases. It is a relative contraindication: a signal to review the case more carefully.
Transformative surgery can be emotionally draining. Therefore, it's essential to confirm that the timing, expectations, and patient stability are appropriate.
Age: why there is an approximate limit
For BBL and body contouring surgery, Cirumed applies an approximate threshold of around 60 years of age. The reason is that the statistical risk of cardiac arrhythmia and thrombosis increases significantly with age.
This can apply even to seemingly healthy patients. Even if their overall condition is good, age changes the risk profile in long or large-volume surgeries.
The decision is always assessed individually, but this limit exists to protect the patient.
BMI: why we aim to be below 30
As a general guide, Cirumed is looking for a BMI Below 30 for body contouring surgeries. The closer a patient is to this range, the more predictable and safe the procedure tends to be.
Between 30 and 35, a selected case may be studied, usually with additional medical coordination and cardiac evaluation. There is also an important exception in some transgender patients, where BMI may be interpreted differently due to greater muscle mass.
The number is not a closed door in all cases, but it is an important sign to assess risk, anesthesia, recovery and outcome.
Non-absorbable gluteal filler: absolute contraindication
If a patient has non-absorbable gluteal fillers, a BBL with fat transfer is not possible at Cirumed. This is one of the few absolute exclusions.
The problem is that non-absorbable fillers can cause subclinical infections—silent infections without clear symptoms. Inserting cannulas and transferring fat into that area can trigger the problem and turn it into a serious complication.
In these cases, other options can be considered, such as liposuction around the area or body remodeling, but not a BBL with fat in the buttocks.
The experience that changed the rules
This exclusion is not theoretical. Dr. Aslani bases it on direct clinical experience. In previous years, when the risks of non-absorbable gluteal fillers were less well known, patients underwent surgery unaware that the product they received was non-absorbable.
In several of these cases, fat transfer triggered subclinical infections that had not caused any symptoms before the surgery. This experience is why this procedure is now considered an absolute contraindication.
That's why the consultation asks in so much detail about any previous injections in the buttocks, even if the patient believes it was temporary or doesn't remember the product exactly.
Safety dictates the indication
If a significant risk factor exists, we prefer to explain it rather than proceed with surgery that we don't consider appropriate. An honest assessment is also part of the treatment.
Exclusions are not the same as ideal candidate
Being outside of these exclusions does not automatically mean being the ideal candidate for a BBL. They are two different questions.
The exclusions are based on safety considerations: when surgery is not advisable. The ideal candidate is evaluated based on the positive aspects: available fat, stable weight, good general health, realistic goals, and the ability to adhere to postoperative care.
Therefore, this article should be read in conjunction with the guide on who is a good candidate for a BBL. One page explains the safety limits; the other explains the favorable conditions.
Why an exclusion list protects you
It can be frustrating to receive a no. But a clinic that has clear reasons for refusing surgery is putting safety ahead of its agenda.
Every exclusion exists because a potential complication It has been analyzed and the risk has been deemed too high. Operating on everyone who requests it is not a sign of generosity; it may mean that important limits have been removed.
If you are in one of these groups, the right thing to do is to have an honest conversation about safer alternatives.
FAQ
As a general rule, it's not recommended for large-volume body contouring surgeries. This isn't because all well-controlled diabetes necessarily has more complications, but because if a complication does arise, it can be more difficult to manage.
Yes. For BBL and body contouring surgery, there is an approximate age threshold of around 60, because the risk of cardiac arrhythmia and thrombosis increases with age.
No. At Cirumed, it's an absolute contraindication for a BBL with fat transfer. Remodeling around the area can be considered, but fat grafting into the buttocks is not.
Ideally, the BMI should be below 30. Between 30 and 35, selected cases may be considered with additional medical evaluation. In some transgender patients, BMI may be interpreted differently due to greater muscle mass.
Because large-volume surgeries involve significant fluid shifts and increased circulatory demands, a clotting disorder can raise the risk to an unacceptable level.
No. It means that a specific surgery may not be safe for you. In many cases, there are alternatives, and it's important to evaluate them honestly.
Do you want to know if you are a candidate?
Send us your goals and some photos. The Cirumed team will review your case and give you clear guidance on whether a BBL or body contouring surgery is safe for you.
