Buttock augmentation by injectable fat grafting, also known as the Brazilian butt Lift, is one of the most sought after body contouring procedures in the United States and in many other countries as well. It rivals in number of procedures performed that of more traditional body plastic surgery procedures such as breast augmentation and tummy tucks.
The one critical difference between this form of buttock augmentation and the other body plastic surgeries is that there is a relatively high incidence of major complications associated with it. These have been both fatal and non-fatal pulmonary fat embolisms reported with fat grafting to the buttocks. Of almost 200,00 cases of buttock fat grafting performed in the past five years, 25 deaths have occurred. The number of non-fatal complications was much higher. Such a high rate of complications merited an analysis of how to make the procedure safer.
In the October 2017 issue of the journal Aesthetic Surgery Journal an article was published entitled ‘Making Fat Transfer to Buttocks Safer’. In this paper a Task Force identified that either contributed to an increased risks of complications as well as those that were protective for it. The fundamental concept is to avoid entrance of the fat into the deep gluteal veins which are remarkably large and easier to inadvertently inject fat that one would think. These include the following principles:
1) Don’t injecting fat deep into the gluteal muscles
2) Use large injection cannulas to keep the injection pressure lower
3) Angle the injection cannulas more parallel rather than downward to avoid injecting too deep
4) Inject from above the buttocks rather than from below to create an injection angle that avoids the deep gluteal vessels
5) Maintain three-dimensional awareness of where the tip of the injection cannula may be
6 )Only inject when the cannula is moving
7)Have a high index of suspicion of pulmonary fat embolism in patients that are medically unstable either during or after surgery
8) Be aware of the anatomy of the deep gluteal vessels and mark the patient before surgery as to their location
9) Discuss before surgery the risk of pulmonary embolism and its management
Buttock augmentation by fat grafting can be a safe procedure when these techniques are used that are known to avoid getting fat into the deep gluteal veins.
Dr. Barry Eppley
Indianapolis, Indiana