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Posts Tagged ‘buttock fat injections’

Avoiding Fat Emboli in Fat Injection Buttock Augmentation

Monday, July 20th, 2015


Fat Injection Indianapolis Dr Barry EppleyButtock enlargement by fat injections (aka the Brazilian Butt Lift) is the most popular method for this procedure. The dual benefit of the body contouring effect from the liposuction harvest to obtain the fat needed for injection is one of its most appealing attributes besides its non-implant method. But it is not a complication free procedure and there are risks of infection, fat necrosis and oil cysts as well as the uncertainty of how much of the far will actually take.

Death from buttock injections is most commonly associated with the injection of silicone oil and other unapproved materials. Intravascular injection of the materials with pulmonary emboli is the usual identified cause of the fatal outcome. But such adverse events with fat injections from BBL is far more rare.

In the July 2015 issue of the journal Plastic and Reconstructive Surgery the paper entitled ‘Deaths Caused by Gluteal Lipoinjection : What Are We Doing Wrong?’ In this paper from South America the authors polled Mexican and Coliumbian plastic surgeons for deaths from fat injection buttock augmentation. Between these two countries a total of 64 deaths were reported from liposuction with 13 specific deaths related to buttock fat injections. All deaths occurred wither during surgery or within the first 24 hours after surgery. Autopsy results from some of the patients showed very evident fat pieces/particles in the lungs. The authors conclude that injecting fat into the deep muscle planes of the gluteal muscles was the source of the fat emboli and its subsequent morbidity.

Deep Gluteal; vessels in Fat Injection Buttock AugmentationThe goal of injecting fat into the buttocks is to achieve maximum fat survival. One of the techniques to help achieve that end is to place some of the injected at into the muscles. The greater number of blood vessels in the buttock muscles compared to that of the subcutaneous fat is believed to result in improved fat survival. However deep in the gluteal muscles are the subpiriformis and supraprirformis channels were larger blood vessels exist.

What this paper alerts plastic surgeons to is that, while injecting fat into the buttocks can be beneficial for fat survival, it should be done only in the superficial part of the gluteus muscle just after piercing its fascia lining. Deep fat injections runs the risk of inadvertently piercing the large gluteal vessels with risk of lethal fat embolism..

Dr. Barry Eppley

Indianapolis, Indiana

The Success of the Brazilian Butt Lift

Monday, May 18th, 2015


Buttock Fat Injections Dr Barry Eppley IndianapolisButtock augmentation is most commonly done today using fat injections. (aka Brazilian Butt Lift or BBL) It is popular because it not only offers a natural method of buttock enlargement but has a concomitant benefit of body contouring through the liposuction fat harvesting. Many good buttock augmentation results from this procedure are the result of the combination of both effects and no just the fat grafting itself. Waistline narrowing and buttock enlargement together can create a powerful change in the lower trunk/pelvic region.

This combination of waist and hip change has long been regarded as attractive in many cultures around the world. A waist-hip ratio of 0.7 in females is the aesthetic ideal and may be achievable with a BBL surgical approach. The question is how effective is this procedure in reaching this aesthetic ideal and how successful is the fat that is injected maintained.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, the article entitled ‘Gluteoplasty with Autologous Fat Tissue: Experience with 106 Consecutive Cases’. In this paper the authors looked at 106 consecutive female patients who underwent a BBL procedure over a three year period. One key inclusion factor is that they could not have a weight change greater than 10% during the follow-up period. The degree of satisfaction (patient and surgeon) was assessed on a scale of 1 to 4  with four being the highest rating. The average age of the patients was 33 years old and the average amount of fat injected into the buttocks was 505ccs. No patients experienced any medical complications. Five patients (4%) developed a seroma in the liposuction harvest area. The vast majority of the patients (103 out of 106, 97%) has high satisfaction ratings of 3 and 4. Only one patient (1%) reported aesthetically troubling fat volume loss months after the procedure. Two patients (2%)  had revision procedures for excessive gluteal fullness at the sides of the buttocks.

As can be seen in this study, BBL surgery has a high satisfaction rate with a very low incidence of any major problems. The autologous nature of the procedure is undoubtably the reason for few complications. Their experience shows that such fact injections are sustainable and not prone to a high rate of resorption after surgery. The one aesthetic problem that they did encounter infrequently was too much lateral fullness. This can be avoided by drawing a line laterally between the anterior and posterior hip area and not injecting in front of this line.

Buttock Augmentation results left side view. DR Barry Eppley IndianapolisThe authors point out that removal of excessive fat from the lumbosacral region is an important factor in obtaining a good buttock shape and must be done in every patient. This is the importance of performing the procedure in the prone position prior to the fat grafting.

Fat grafting to the buttocks is known to have a lower rate of resorption than that which occurs in the face. The exact reason is not known but may be a function of a larger muscle mass and higher volumes of fat injected. As a result, BBL surgery usually has better results and higher patient satisfaction than facial fat grafting. The fat redistribution effect is also more likely to achieve a pronounced recontouring than just fat grafting alone.

It is important to point out that no patients in this study was injected with mega volumes of fat (1,000ccs or greater) nor ws there an attempt to balloon out the buttocks to very large proportions. The success in this study’s patients may not translate to high volume buttock fat injections.

Dr. Barry Eppley

Indianapolis, Indiana

Fat vs. Implants for Buttock Augmentation

Monday, January 20th, 2014


While implants offer a permanent buttock augmentation effect, they are associated with a much longer recovery period. One must be very selective in choosing patients for implants while one can be a lot more lax about who opts for fat grafting. If there is an equivocal choice between fat or implants for buttock augmentation, I would always choose fat as it has fewer risks and complications. (aka the Brazilian Butt Lift) Fat grafting patients need liposuction to another part of their body to get the fat and get the added bonus of some body contouring effects from doing so. Recovery from fat grafting is also much shorter.

Buttock Fat Injections Dr Barry Eppley IndianapolisBut many times fat grafting is not enough to make enough of a difference in buttock size or to meet a patient’s expectations. Some patients don’t have adequate fat to meet the buttock size they want to achieve. If someone is looking for a dramatic or head-turning type of buttock augmentation effect, this is not going to occur from most cases of fat grafting.

Buttock Implants Indianapolis Dr Barry EppleyWhen it comes to volume retention, implants are very predictable. Just like breast implants, what you put in is what you get. This is clearly not the case with fat grafting.  And unlike days of old, buttock implants have improved. The growing demand for buttock implants has to led to new designs and material modifications. They are a lot softer and come in a variety of sizes (volume) and projections. Lower profile buttock implants have a more tapered profile which is really critical with intramuscular placement. In addition, the improved base width-to-volume ratio allows for a more proportional outcome rather than looking like a gumdrop placed on top of the buttocks.

The key question with buttock implants which is not an issue with fat grafting, is the anatomic location of the augmentation. Fat injections are placed both into the muscle and on top of it. (subcutaneous) Buttock implants, however, must be placed into either one location or the other. While some surgeons may debate the advantages of one location over the other, there are some considerable differences between the two.

An intramuscular location offers a lower risk of complications but is surgically more difficult to do, has a longer recovery and is limited as to what size augmentation can be achieved. (usually no greater than 350ccs.  A subfascial location (above the muscle) offers greater implant size insertions and less recovery but a greater risk of infection, seromas and implant visibility.

The popularity of buttock augmentation has not only led to more procedures being done but an evolving widespread experience with the techniques to do it. Fat grafting and implants offer a range of options that each patient must consider carefully and determine by proper education what is best for themselves and their buttock reshaping objectives.

Dr. Barry Eppley

Indianapolis, Indiana

Brazilian Butt Lift in Thin Patients

Saturday, July 27th, 2013


The success of buttock augmentation by fat injection depends, first and foremost, on having enough fat to harvest. If not enough volume of fat is available, it does not matter how well it survives as the buttock result will be inadequate. This has made the use of buttock fat grafting in thin patients historically not possible. Harvesting fat traditionally relies on the patient having well defined fat deposits that are easily visible and palpable. Such localized fat deposits do not exist in most thinner patients.

While thin patients may never have large amounts of fat that can be extracted, more fat can be had when liposuction cannulas are used that have multi-hole tracks. This allows a more even level of fat removal that what can be achieved with cannulas that have just single holes on one side of the cannula tip. Having a larger number of holes that can encircle the cannula, up to 12 in total now exist, a more even removal of fat can be done and more fat can be obtained. This is especially useful in patients with thinner fat layers over large body surface areas.

Since smaller amounts of fat can be obtained in thinner patients, it is critically important how they are injected as well. To help optimize fat survival, the consideration of ‘supercharging’ the fat with a PRP additive can be done. PRP, or platelet-rich plasma, is a natural extract of one’s blood that contains platelets. Platelets are powerhouses of potent growth factors and other cytokines that have a strong influence on wound healing. Numerous studies have shown the benefits of combining PRP with fat in laboratory conditions and it is presumed such effects translate into a real clinical effect. While the amount of PRP compared to fat volume is small in most large volume fat transfers, it has more importance in smaller volume procedures.

When injecting fat into the buttocks, it is important that the fibrous bands between the muscle and the skin are not excessively released. Over release of these bands can cause the contour of the buttocks to drop or sag. Small injection cannulas should be used and the fat placed in small 1cc or 2cc ‘droplets’ both into the muscle as well as between the muscle and skin.

While buttock augmentation by fat will never completely replace the use of implants in thin patients, these technical developments make fat grafting for some who can accept less than their perception of an ideal result possible.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Brazilian Butt Lift in Thinner Women

Sunday, April 15th, 2012

Background: The size and shape of the buttocks is an important part of the aesthetics of one’s body. The importance of size and shape varies amongst different cultures and ethnic groups. This has led to the popularity of buttock augmentation procedures, using either the insertion of an intramuscular implant or fat injections. Fat injections, known as the Brazilian Butt Lift, is the more popular due to its use of one’s own body tissues and the generous availability of donor material in most patients.

But regardless of one’s ethnic or racial background, a completely flat buttocks is not viewed as aesthetically desireable. Such a flat buttocks, and sometimes even an indented one, is prone to occur in those that are thin and lean. To no surprise, a thinner overall fat distribution in one’s body can lead to minimal fat over the buttocks as well. While the gluteal muscles are not small, much of buttock volume comes from the amount of fat between the skin and the muscles.

In the thinner woman who desires a buttock augmentation, specifically a Brazilian Butt Lift technique, the lack of sizeable donor material is a limiting factor. For very thin women, this procedure is an impossibility and an implant is the only treatment option. But moderately lean to average-size women may have a fat injection buttock technique if they recognize that the buttock size obtained will be more modest and always less than they ideally desire.

Case Study: This 31 year-old female had long been bothered by her flat buttocks. She had tried to build up her buttock size through different exercises but without success. She did have some excess fat on her stomach and around her waistline and wondered if this would be enough for a Brazilian Butt Lift. On feeling her stomach and flanks, it was felt that maybe a liter of fat aspirate could be obtained but not much more. She wanted to proceed with surgery as she did not want to have synthetic implants.

Under general anesthesia she first underwent liposuction harvest of the entire abdomen and flank regions in the supine position. A total of 1,150cc of aspirate was obtained after initial Hunstad infiltration. She was then turned over into the prone position where additional liposuction was done across the top of the buttocks, in the sacral triangle and below the buttocks in the infragluteal fold. This brought the fat aspirate to 1,275ccs.

The fat aspirate was processed by passing it through a sieve and draining off the excess fluid. This brought the concentrated fat amount to 450cc. Using an injection cannula, 225cc of the concentrated fat was injected into each buttock. The injection amount combined with surrounding buttock liposuction fat reduction gave her a visible amount of buttock enhancement.

When seen at her three month follow-up, her final result showed a slightly more rounded buttock shape and size. Her overall buttock shape was more pleasing even if it was not dramatically bigger.

An important question when considering the Brazilian Butt Lift is how much fat will end up being injected into the buttocks. As a general rule, expect only 1/3 to ½ at best ending up being the concentrated amount of fat available for injection. This means that one has to have at least a mimimum of 1,000cc to 1,200 available for removal. It is better that 1,500cc to 2,000cc can be harvested. When only 150cc to 250cc of fat is available for each buttock, the patient needs to appreciate that the buttock size gain will be modest. Some improvement will also come from the buttock sculpting obtained by the liposuction. It is the combination of both that creates the final result. In thinner women, the Brazilian Butt Lift is more of an overall buttocks reshaping effort than exclusively an augmentation outcome.

Case Highlights:

1) The results of fat injection buttock augmentation is limited by the size of the donor harvest areas. These come primarilyfrom the abdomen and hip rolls.

2) In thinner women, the enhancement of the buttock is contributed to as much by the surrounding fat reduction as the buttock size achieved by fat injection.

3) The Brazilian Butt Lift in thinner women is better thought as buttock reshaping than buttock augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Buttock Enhancement Through Combination Liposuction And Fat Injections

Tuesday, October 18th, 2011

Enhancement of the buttocks has become enormously popular over the past decade. Most methods of cosmetic buttock surgery are perceived as that of increasing its size through either implants or, more commonlytoday, fat injections. But buttock enhancement is as much about contouring and reshaping as it is about size increase alone. Large poorly-shaped buttocks are far less appealing than slightly smaller ones that have a more desireable shape.

When evaluating the buttocks, it is best to see it as an anatomic structure with different areas as zones that can be modified. There are essentially six aesthetic zones to the buttocks which can be described as follows: zone 1 is the midline lower back/sacral area, zone 2 is the upper lateral region or low flanks often also called the muffin tops, zone 3 is the middle lateral region where the muscle inserts, zone 4 is the low lateral or greater trochanter area, zone 5 is the upper inner thighs, and zone 6 is the amount of buttock projection seen in the side view.

The relevance of these buttock zones is that they all represent areas of either reduction (liposuction) or augmentation. (fat injections) Zones 1 and 2 are the areas of greatest liposuction fat removal while zones 3, 4 and 6 are the primary areas of fat injection augmentation.

Improving buttock shape is more than just injecting a lot of fat all over the entire buttocks. Skillful reshaping by fat removal combined with fat augmentation is a more successful approach. In many patients, it just isn’t possible to place enough fat or have enough of it consistently survive to create a better shape by simple volume addition alone.

In improving the shape of the buttocks the contour of the hips is a key area. Buttock projection can look diminished when the hip and back area has a good thickness of fat. This obscures any appearance of an upper gluteal shelf. When liposuction is done to reduce the hip and back fat, an inward skin retraction occurs. This creates an inward indentation or concavity which can match the curve of the lower of the lower buttocks as it dips inward towards the posterior thigh. By so doing, the illusion of a greatee central buttock projection is created. This can be further enhanced by concurrent fat injections into this central mound. This is a good example of the ‘ying and tang’ approach to increasing any body contour. The combination is always better than either approach alone.

The survival of fat injections in the buttocks is always an issue of concern. While there are numerous methods of processing fat prior to injection, none have been shown to be better than another. Some method of concentration is important to eliminate excess oils and fluids. In the buttocks, unlike many other face and body areas where fat is injected, there is a choice of injecting into the subcutaneous fat layer, the muscle, or both. The buttocks have a large gluteus maximus muscle and most of the fat injected should be into it. This will ensure the most amount of injected fat survival due to the better intramuscular blood supply.

Buttock augmentation is best done through a combination of zonal liposuction reduction and intramuscular fat injections. This is best for those patients that have an excess of fat around the buttocks in the hips, back and waistline.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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