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In the danger zone: Brazilian butt lift

Article-In the danger zone: Brazilian butt lift

A task force representing plastic surgery societies is urging practitioners to reevaluate performing gluteal fat injections (Brazilian butt lift). This comes on the heels of new recommendations for making gluteal fat injections safer due to concerns about deaths from the procedure.

The multi-society Gluteal Fat Grafting Task Force chaired by Dan Mills, M.D., J. Peter Rubin, M.D., and Renato Saltz, M.D., reports that every surgeon performing the Brazilian butt lift should “immediately” reevaluate the way he or she does it.

All autopsies of deceased [Brazilian butt lift] patients have had four things in common, according to the statement: “fat in the gluteal muscles; fat beneath the muscles; damage to the superior or inferior gluteal vein; and massive fat emboli in the heart and/or lungs.”

Their findings indicate that surgeons injected more deeply than intended because none of the postmortem cases of death had fat in the subcutaneous space, only, they write.

Dr. YounDetroit, Mich., based plastic surgeon Anthony Youn, M.D., who is not part of the task force, points to these taskforce recommendations for avoiding complications related to the procedure:

1. “Stay as far away from the gluteal veins and sciatic nerve as possible. Fat should only be grafted into the superficial planes.”

2. “Concentrate on the position of the cannula tip throughout every stroke to ensure there is no unintended deeper pass….”

3. “Use access incisions that best allow a superficial trajectory for each part of the buttock; avoid deep angulation of the cannula….” Make sure the cannula tip remains superficial.

4. “Use instrumentation that offers control of the cannula….”

5. Injections should only be done while the cannula is in motion.

6. “The risk of death should be discussed with every BBL patient.”

Sometimes, Dr. Youn says, other procedures work well to enhance the buttocks.

“In many patients, contouring the periphery of the abdomen, using liposuction or non-invasive fat reducing methods, can provide a reframing of the buttocks that may be sufficient to make patients happy. Many doctors are also injecting Sculptra off-label for buttock enhancement,” he says.

When talking with patients about the Brazilian butt lift, Dr. Youn says he explains the surgery and the risks involved, especially with larger grafted volumes, and makes sure the patient is aware and agrees to proceed if he and the patient both deem it safe and necessary.

“Currently the mortality rate for this operation is unacceptably high, and I praise [the American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery and International Society of Aesthetic Plastic Surgeons] on taking the initiative to tackle this issue head on, providing plastic surgeons suggestions on making this procedure as safe as possible. However, I do believe that if we can make our patients happy without having this surgery performed, that should be considered,” Dr. Youn says.

According to the advisory, The Inter-Society Gluteal Fat Grafting Task Force represents the American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgeons. The International Society of Plastic and Regenerative Surgeons and the International Federation for Adipose Therapeutics and Science provide scientific support.

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