The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review and Recommendations

Abstract

Superficial gluteal lipofilling (SGL) is a fat grafting procedure that is performed to correct a trochanteric depression and buttock deflation. Brazilian Butt Lift (BBL) is gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in Brazilian Butt Lift (BBL) was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of using intraoperative ultrasound scan has been demonstrated in guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicised risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management.

Challenges with medical tourism

“…Detailed recommendations for the safety of aesthetic procedures and in particular for the prevention and management of infectious complications, have been issued by national authorities and scientific societies [9 ▪▪ ,32]. Such recommendations were preceded by highly publicized fatalities in patients undergoing cosmetic procedures abroad [32]. Recommendations also raised the issue of insurance, and particularly the need to cover such procedures [32].…”

“…Such recommendations were preceded by highly publicized fatalities in patients undergoing cosmetic procedures abroad [32]. Recommendations also raised the issue of insurance, and particularly the need to cover such procedures [32].…”

“…All (eight) patients with complications after cosmetic surgery referred to a hospital in Ireland and two out of three patients with complications after cosmetic ]. A recent review of 20 articles reporting complications cared for in the United States after cosmetic surgery abroad, found that the mean duration of treatment was consistently longer than two months (some cases required treatment for up to one year), high rates of hospitalization (36.8%), and high rates of surgical management ( 51 Patients with complications following cosmetic procedures should be cared by certified surgeons in strictly regulated healthcare settings [32]. Detailed recommendations for the safety of aesthetic procedures and in particular for the prevention and management of infectious complications, have been issued by national authorities and scientific societies [9 && ,32].…”

“…Patients with complications following cosmetic procedures should be cared by certified surgeons in strictly regulated healthcare settings [32]. Detailed recommendations for the safety of aesthetic procedures and in particular for the prevention and management of infectious complications, have been issued by national authorities and scientific societies [9 ▪▪ ,32]. Such recommendations were preceded by highly publicized fatalities in patients undergoing cosmetic procedures abroad [32].…”

Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting

“…In order to reduce the incidence of fatal and nonfatal pulmonary fat embolisms, the American Society of Plastic Surgeons (ASPS) [ 6 , 7 ] and several authors recommend limiting the fat transfer to the subcutaneous plane [ 6 , 8 , 9 ], where fewer and smaller vessels are located [ 6 , 8 , 9 ]. However, a systematic review found it did not reduce the complication rate significantly in comparison to the injection into the intramuscular and subcutaneous planes ( p = 0.059) [ 10 ].…”