How does the doctor know where they are injecting the fat during a BBL? Especially if they don't use an ultrasound?

Question

I understand that injecting into the muscle/under the muscle is highly dangerous. My question is - is there anyway that the doctor knows with certainty which area they’re injecting to? I’ve heard of some using ultrasounds but what if they don’t use one? How do they guide themselves and prevent the cannula to enter the muscle? Is it possible or an ultrasound is needed for that technique?

Finny George, MD · Answer

Hi, thank you for sharing your question. While using an ultrasound may be helpful, it is not a necessity. And it is only as good as the person who is using it. Like others procedures that are relatively "blind", the feel of the tissues and palpation of the cannula is a big part of doing these safely. Muscle feels entirely different than subcutaneous tissue. The skill level and experience of your surgeon will guide them. I hope this helps.

Daniel Barrett, MD · Answer

Dear arii_harris,
in case of fat transfer, it is safer to inject fat above the muscle. Knowledge of human anatomy and good surgical training prevents surgeons from injecting fat into the muscles. Finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kenneth Hughes, MD · Answer

The traditional methods of transfer of fat into the gluteal muscles have been abandoned in favor of fat transfer though large cannula to areas directly VISIBLE beneath the skin to reduce the risk of fatal fat emboli and patient deaths. You do not need an ultrasound.

Bryan Curtis, MD · Answer

During a Brazilian butt lift (BBL), the doctor typically follows specific anatomical landmarks to determine where to inject the fat. While ultrasound can be used in some cases to assist with the procedure, it’s not always necessary. The key steps include: 1. Marking: The surgeon marks the areas on the buttocks and surrounding areas where they intend to inject fat. This is typically done when the patient is in a standing or lying position. 2. Experience and Skill: Experienced plastic surgeons rely on their knowledge of human anatomy and their surgical skills to guide them. They are trained to understand the structure of the buttocks and can identify the safest and most effective areas for fat injection.3. Visual and Tactile Feedback: Surgeons may use visual and tactile feedback during the procedure. They can feel the layers of tissue and the position of the cannula (the thin tube used to inject the fat) to ensure precise placement.4. Patient’s Desired Outcome: The surgeon considers the patient’s aesthetic goals, discussing them before the procedure. This helps guide the fat injection in a way that achieves the desired shape and volume.It’s essential to choose a board-certified plastic surgeon experienced in performing BBL procedures, as they have the expertise to ensure the fat is injected into the right areas for a safe and desirable outcome.

Darryl J. Blinski, MD · Answer

Great question! US only gives an idea of the location of the injecting cannula tip. It is a non definitive tests that is only as good as the person using this device. The best way is only inject if patient in jack knife prone position on the operating table, use a 4-5 mm injecting cannula, feel & see the tip of the injecting cannula at ALL times, inject in a retro grade fashion VERY VERY VERY slowly. Just because a clinic or surgeon says they use an US device very hard to always believe them!

Mats Hagstrom, MD (license on probation) · Answer

Doctors know what tissue plane you’re working in during fat transfer simply from clinical experience and competence. It’s exactly the same for the liposuction part of the procedure. How does the doctor know they’re not suctioning out muscle?

The high-risk area for a BBL it’s considered the gluteal vein which is on the deep side of a fairly thick muscle.

It’s pretty easy to differentiate what tissue plan you’re working in but even if the surgeon wants to graft in the superficial aspect of the muscle is most likely is still not presenting a significant risk compared to the purposeful deep muscle grafting that was standard of care in the past.

The risk of fat embolism is not a black or white simple graft in the muscle or not in the muscle situation.

Even the statistics to determine this complication was increased with this procedure was highly skewed based on a small number of individuals who had insufficient training and were rogue players but cumulatively had the majority of deaths.

I’ll plastic surgeons take patient risk very seriously and nobody wants to have a fatality or serious complication on their hands after surgery.

Even the most low character questionable providers don’t want to complications.

You’ll find that safety is paramount among physicians as a fairly universal concept.

In my opinion what patients should be concerned about isn’t serious complications but bad aesthetic items. The life implications that having a poorly done procedure can happen can be devastating and this is avoidable by thoroughly vetting providers before committing to having procedures.
By thoroughly choosing providers through thorough in person consultations exclusively patients will have a chance to speak to each provider about all of their concerns including complications.

That way you’ll get the first hand account and I went to provider approaches this procedure and the topic at hand.

Best,

Mats Hagstrom MD

James Fernau, MD, FACS - Account Suspended · Answer

Hello, and thanks for your question. We go through highly extensive training in order to prevent complications from a BBL procedure. Some physicians may use ultrasounds, however, they are not needed. You must see a board-certified physician with extensive experience for your procedure. Best of luck to you!

Sincerely, James Fernau, MD 
FACS Aesthetic Surgery Certified, American Board of Plastic Surgery Certified, American Board of Otolaryngology/Head & Neck Surgery Member: American Society of Plastic Surgery (ASPS) American Society of Aesthetic Plastic Surgery (ASAPS) International Society of Aesthetic Plastic Surgery (ISAPS) American Academy of Facial Plastic Reconstructive Surgery (AAFPRS) American Academy of Otolaryngology/Head & Neck Surgery (AAOHNS) American Society for Laser Medicine and Surgery (ASLMS) The Rhinoplasty Society

How does the doctor know where they are injecting the fat during a BBL? Especially if they don't use an ultrasound?

Answers (7)

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