Gluteal augmentation, also referred to as the Brazilian butt lift (BBL), has seen an intense increase in popularity, with more than a 3200% increase from the early 2000s to 2015. At the same time, it accounts for a significantly higher mortality rate compared to other cosmetic procedures—1 in 3448 versus 1 in 55,000. Many of these deaths are associated with lung embolism due to muscular and submuscular grafting. The goals of this chapter are threefold: From the Oslo Plastic Surgery Clinic, this chapter first focuses on patient assessment and safety-oriented procedures for gluteal augmentation as told from the perspective of the Oslo study experience. We also delve further into the concerning issue of the mortality rate of gluteal augmentation by providing a review of the current international data on mortality rates and complications. And importantly, we offer safety guidelines pre-, per-, and postoperatively to address these serious concerns for your own practice. This includes assessing the patient as an appropriate candidate and setting up realistic expectations, exercising moderation in fat volume, avoiding dangerous grafting and incision methods, and encouraging strict postoperative mobilization.