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Recommendations for safer gluteal fat grafting

Amid serious safety concerns associated with gluteal fat grafting, a plastic surgeon task force has investigated the risks and factors that appear to make gluteal fat grafting safer or more dangerous. Based on its findings, the Aesthetic Surgery Education and Research Foundation’s Gluteal Fat Grafting Task Force released new recommendations for making the procedure safer.

The American Society for Aesthetic Plastic Surgery reports member surgeons performed more than 19,000 fat transfers to the buttocks in 2016 — up from 18,487 in 2015.

The problem is the numerous anecdotal and published reports of fatal and nonfatal pulmonary fat embolism associated with gluteal fat grafting. The task force published survey results from 692 plastic surgeons, worldwide, who had performed 198,857 gluteal fat grafting cases. The task force concluded that gluteal fat grafting has a significantly higher mortality rate than any other aesthetic surgical procedure.

Among the survey findings: During their careers, respondents reported 32 fatalities from pulmonary fat emboli and 103 nonfatal pulmonary fat emboli. A total of 3% of the surgeons experienced a patient fatality and 7% indicated they experienced at least one pulmonary fat embolism in a patient. The task force reported 25 U.S. fatalities in the last five years, confirmed through autopsy reports and interviews with surgeons and medical examiners. American Association for Accreditation of Ambulatory Surgery Facilities reported four deaths from 2014 to 2015 from pulmonary fat emboli, according to the abstract.

The practice of injecting into the deep muscle significantly increases the incidence rate of fatal and nonfatal pulmonary fat emboli, according to the abstract.

“Based on this survey, fat injections into the deep muscle, using cannulae smaller than 4 mm, and pointing the injection cannula downwards should be avoided,” the task force concluded.

Other task force recommendations, according to an American Society for Aesthetic Plastic Surgery press release, are:

·       Position patient and place incisions to create a path that will avoid deep muscle injections.

·       Maintain constant three-dimensional awareness of the cannula tip.

·       Only inject when cannula is in motion.

·       Consider pulmonary fat embolism in unstable intra- and postoperative patients.

·       Review gluteal vascular anatomy and draw landmarks to identify and avoid injection into the pedicle.

·       Include risk of fat embolism and surgical alternatives in the informed consent process.

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