Orbitozygomatic injuries are among the most common fractures encountered by the plastic surgeon. Appropriate management depends on an accurate diagnosis, focusing on the physical examination and data from computed tomography scans. One must pay particular attention to the orbital component of this injury, as it is from this that so much of the morbidity relating to these fractures is incurred. As with all facial fractures, accurate reduction is paramount to a successful outcome. As many buttresses as are necessary should be visualized to ensure an anatomic reduction. The amount and location of fixation depend on the fracture anatomy.A successful outcome may be expected if these basic principles are followed.

Background Brazilian Butt Lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. Unfortunately, by 2017, the surgery was associated with the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation. Objectives The purpose of this study was to explore the factors involved in making South Florida an outlier, as it relates to BBL mortality. Methods The anatomical findings of the gluteal dissections in 11 post-BBL surgery autopsies (22 hemi-buttocks) were assessed for commonalities. The authors examined the records of patients who died from BBL-related Fat Emboli to determine commonalities. Results All cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality in these cases involved the location of where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume budget clinics located in South Florida. Short surgical times of approximately 90 minutes, appeared to be the norm for these cases. Conclusions South Florida has experienced 25 BBL related fat emboli deaths from 2010-2022, however 14 of those deaths have taken place after the Aesthetic Surgery Education and Research Foundation (ASERF) guidelines and the Florida Board of Medicine BBL “subcutaneous-only” rule. The working environment at the clinics and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.

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Background Advances in gluteal fat grafting have improved our understanding of the regional anatomy and technical nuances to diminish risk. To date, there are no anatomical studies identifying presence or absence of buttock fat compartments. Objectives The authors performed a cadaveric study to identify and characterize the deep subcutaneous gluteal fat compartments to further our understanding of the nuanced differences between the deep subcutaneous and the superficial subcutaneous fat layers. Methods A cadaveric study was performed to identify the fat compartments. Iliac artery and vein latex injection prepared 4 fresh (N = 8 hemibuttock) hydrated cadaver dissections. Preliminary work identified the likely position of deep gluteal fat compartments. The cannula was positioned under ultrasound guidance in between the superficial and deep gluteal. Cadaveric buttocks were infiltrated using the static (SIME) technique with dyed human fat, dyed apple sauce, and dyed saline in an attempt to identify the gluteal deep subcutaneous fat compartments Results Dissection identified and characterized 7 discrete deep gluteal fat compartments. These include 3 medial fat compartments (superior, middle, and inferior); a central fat compartment; and 3 lateral (superior, middle, and inferior) deep fat compartments. Conclusions We present our findings of 7 deep gluteal fat compartments that have distinct boundaries and maintain injected contents separate from each other above the gluteal muscle fascia. These compartments can be selectively expanded for buttock augmentation. Knowledge of these compartments enables surgeons to perform gluteal augmentation using static infiltration, under ultrasound guidance in the deep subcutaneous fat layer using autologous fat, while optimizing aesthetic considerations.