The Australasian Society of Aesthetic Plastic Surgeons has supported the warning issued by the International Society of Aesthetic Plastic Surgeons (ISAPS) that extreme caution needs to be taken when performing the Brazilian Butt Lift (BBL) procedure.
The unusually high mortality rate from this cosmetic procedure is estimated to be as high as 1:3000, greater than any other cosmetic surgery.
The cause of mortality is uniformly fatal fat embolism due to fat entering the venous circulation associated with injury to the gluteal veins. In every patient who has died, at autopsy, fat was seen within the gluteal muscle.
In response, the Multi-Society Task Force for Safety in Gluteal Fat Grafting (ASAPS, ASPS, ISAPS, IFATS, ISPRES), representing board-certified plastic surgeons around the world, recently released a practice advisory. Additionally, the Task Force is conducting anatomic studies to develop specific technical safety guidelines.
Since the release of the practice advisory, deaths from this procedure continue to be reported. Importantly, however, in no case of death has fat been found only in the subcutaneous plane.
The Task Force has therefore concluded that:
- Fat should never be placed in the muscle. Fat should only be placed in the subcutaneous tissue.
- If the desired outcome might require another procedure, then manage the patient’s expectations and discuss the possibility of staging (as often done with fat injections, hair transplants, etc.)
- It is easy to unintentionally enter the muscle during the subcutaneous injection.
- Therefore, stay mentally focused, alert, and aware of the cannula tip at every moment; be vigilant about following the intended trajectory with each stroke and feel the cannula tip through the skin. Consider positioning that can favour superficial approaches, such as table jackknife. Use cannulas that are resistant to bending during injection and recognise that Luer connectors can loosen and bend during surgery.
- The risk of death should be discussed in your informed consent process, along with alternative procedures (such as gluteal implants or autologous flap augmentation).
- No published series of Brazilian Butt Lifts done with intramuscular injections is large enough to demonstrate it can be done without the risk of fat embolism.
- The subcutaneous plane has not been linked to pulmonary fat embolism. Until and unless data emerges that intramuscular injections can be done safely, the subcutaneous plane should remain the standard.
- Fat injected into the subcutaneous space cannot cross the superficial gluteal fascia and migrate into the muscle; therefore, any intramuscular fat found at autopsy can be concluded to be the result of injection into the muscle.
“The Brazilian Butt Lift is by far the most dangerous cosmetic procedure a Surgeon can perform. As Surgeons, we have a duty of care to patients to ensure their safety. If you cannot do this, you should refrain from offering this procedure,” Dr Somia said.
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