‘A 38 year-old ex-Miss Argentina has died from complications after undergoing plastic surgery on her buttocks. Solange Magnano, who won the crown in 1994, died of a pulmonary embolism three days after having a gluteoplasty done in Buenos Aires. Close friend Roberto Piazza said the procedure involved injections and the liquid “went to her lungs and brain”.

For many, this tragic story points to the inherent dangers of cosmetic surgery and that someone risked everything she had in life for a more firmer behind. On the one hand, that is truth to that perception.  Surgery of any kind always involves some risk and the potential for deep vein thrombosis (DVT) and pulmonary embolus (PE) has a big prevention emphasis in surgery these days. On the other hand, however, there is an underlying issue of probable poor and inappropriate medical judgment which has more to do with this mortality than just chance alone.

DVT is a not uncommon condition that occurs when a blood clot forms in one of the large veins, usually in the lower legs. PE is a complication of DVT which develops when a blood clot breaks loose and ends up in the lungs, creating a potential life-threatening condition. Up to one million Americans suffer from a DVT each year with estimates of several hundred thousand deaths resulting from a breakaway PE. This is more deaths than that which occurs from breast cancer and AIDS combined.

DVT-related PE is now the most common cause of preventable hospital death. As a result, there has been a huge initiative nationally for its prevention. Recognizing that the slowing of blood flow in the large veins in the leg can lead to a clot, it is standard and expected practice that prevention using mechanical squeezing devices on the legs are used in all surgeries of consequence.  Higher risk surgeries include orthopedic and general surgery…plastic surgery would not be considered in an increased risk category. But many plastic surgeons, including myself, use them on every surgery anyway.

But Miss Argentina did not die from a DVT-related PE. Rather, she died from a PE that appears to have come directly from what was injected into her buttocks.

Buttock enhancement, also known as gluteoplasty, are cosmetic procedures for improving the size and shape of the buttocks. The most common method is known as the Brazilian Butt Lift, which has been developed and popularized by plastic surgeons in South America. While the Northern Hemisphere may prize a smaller buttocks, down south a rounder and more fuller derriere is preferred. This is achieved most commonly by fat injections…liposuctioning fat from one area and transferring it by injection to another. Implants can also be used but the use of your own natural fat has obvious appeal.

When I first read this story I thought this woman died from a PE caused by a fat embolus from having had a Brazilian Butt Lift. It is rare but fat emboli have been reported to occur from liposuction and fat injections. But when pictures showed how thin she was, It struck me that there was no way she had enough fat to even do that procedure. It soon become obvious, and by reading other reports, that she had a foreign material, a ‘liquid substance’, injected into her buttocks. One source has indicated that it was a liquid that contained PMMA particles.

PMMA particles are microscopically small plastic beads. That have been put together with collagen and other liquid materials to make injectable filling materials for soft tissue augmentation.  Because the bead component of the filler never goes away, there can be some permanency of the result. One such material, known as Artecoll, is an FDA-approved injectable filler for use in the face…but never in the buttocks. If this is in fact what was used in this patient, or some similar beaded concept, then the development of an injection-related PE starts to make sense. With many thousands of beads and clumps of beads injected, it would be very easy for some of them to get into the larger veins in the buttock…and transported right upward through the heart into the lungs. Such a risk is negligible in the face where such materials were developed and intended to be used.

Was the death of the ex-Miss Argentina preventable? By not doing the surgery… for sure. But if the surgery had been done with proper methods and materials (or not done at all if there was not enough fat to be used), the risk of such an outcome would have been no higher than a similar fate occurring from an accident while driving to work everyday. In South America, this is known as a horrendous tragedy. In the United States, such misuse of implantable materials is known as malpractice and loss of one’s medical license.   

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Enhancing the Shape and Size of the Buttocks with Butt Implants (Gluteoplasty) in Indianapolis by Dr Barry Eppley

For those women, and rarely for a few men, the desire for a larger more shapely buttocks is more prevalent today than ever in the history of plastic surgery. This buttock enhancement trend is undoubtably fueled by fashion style issues such as the well known ‘J-Lo Butt’ and the northern influence by immigration of Hispanic and South American cultures, which is a larger buttock with no crease underneath. (known as the Brazilian buttocks) As a result, buttock size increase can be done with either implants or fat injections. I will talk here only about the use of buttock or gluteal implants for buttock enhancement or medically known as, implant gluteoplasty.

Buttock implants or gluteal implants are semisolid, rubbery silicone implants that have several basic shapes and sizes for the buttock area. They are not liquid filled nor should any surgeon ever use those type of implants for anything other than the breast. The buttock implants are fairly soft and flexible and don’t feel that much different from dense buttock tissue. The main plastic surgery issue with buttock implants is the surgical technique by which they placed. This has been controversial over the years. Should the buttock implant go into the gluteal muscles (intramuscular) or on top of them? (subfascial) While some controversy probably still exists, I think the best technique is that advocated by plastic surgeon Dr Gonzalez in Brazil. He probably has the world’s largest buttock implant experience and I was privileged to work with one his disciples, Dr. Jose Flores, in Indianapolis for several months.

Through a midline incision in the upper buttocks crease, a pocket is carefully developed in the gluteus maximus muscle. The pocket is developed with an instrument staying within carefully determined markings done prior to surgery with the patient standing. The size and shape of the buttock implant (round or oval) is determined prior to surgery during the initial consultation based on the size and shape of the buttocks and what area of the buttock needs to be increased in size the most. The buttock implant is then slipped into this carefully made pocket. No type of compression garments is needed after surgery. Walking and sitting are allowed after 24 hrs. Sleeping should be done on the patient’s side for 1 week and driving is allowed after 7 days. Working out and running should not be resumed for at least one month after surgery.

I have found buttock implant surgery to be very gratifying for most patients, However, be aware that buttock implant surgery is painful and some sufficient recovery time is needed. The most common complication of buttock implant surgery is fluid collection (seroma) around the implant which may require drainage.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www/ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis