Why is BBL causing deaths?

Question

There has been a lot of deaths overseas and in Florida with BBL patients. My question is...what causes them to die? Is it the lipo or injection part? Is Liposculpture alone safer. I want another BBL round but all these deaths have me confused and scared. I want to be totally informed of all complications that can cause death. I need to be thoroughly educated on the real risks I'm putting my body through.

Donovan Rosas, MD · Answer

Fat embolus is a very serious and known complication of fat transfer (which has been recently spotlighted in the media). While it is true, injection of donor fat into the infra-muscular plane (within the muscle) increases fat viability this does come with a significant increase in risk. There are large vessels deep to and within the muscle which can be inadvertently injected while grafting leading to a fat embolus. The consequences of such a complication are very serious and life threatening.
At the recent American Society of Plastic Surgeons Hot Topics, data from AAAASF (ambulatory surgical certifying body) was presented, suggesting that BBL/gluteal lipoaugmentation demonstrates a dramatically higher risk profile than other surgeries. The Aesthetic Surgery and Educational and Research Fund is convening a task force as well. The hope is that we will have more concrete guidelines for addressing these very serious complications.
That being said, the safest way to avoid fat emboli is to stay in the subcutaneous plane (at the expense of fat viability)and avoid the deeper muscular plane. If grafting of the deep plane is planned, surgeons should consider blunt cannulas, aspiration prior to injection. Using a supra-gluteal approach to minimize the risk of inadvertent intravascular injection has also been proposed.
With regards to your specific question, repeat grafting while often necessary due to inherent resorption rates often produces lower yields. Post operative scarring can limit the amount harvested (if new donor sites are not available). Thus you may want to adjust your expectations somewhat. In summary, the procedure can be safely performed, however, they should be performed by a board certified (ABPS) plastic surgeon with experience. These risks should be discussed as well as the strategies being employed to avoid them.

James E. Hardy, MD · Answer

Hi and thanks for this very important question. The primary reason for this is related to fat embolism where fat is injected into the deep veins and travels to the lungs. There are other things that can cause problems including blood clots that can form and travel to the lungs and infection. It is very important to use a ps with a track record of safety and certified by the American Board of Plastic Surgery. Being operated in the USA is also very important because if there is a complication, you would want to be taken care of in the American health care system to ensure optimal care and follow up with your surgeon. Best of Luck - Dr. Hardy...

Mark A. Schusterman, MD, FACS · Answer

Thank you for your question.  It is hard to say what exactly the deaths are from since I am not privy to the autopsy report.  It could be blood loss due massive liposuction, or it could be due to fat embolization, which is a condition when the fat gets injected into a major vein which then can go to the heart and/or lungs. Experienced board certified plastic surgeons can avoid the complications by their knowledge of anatomy and using correct technique.  Hope this helps.

David A. Sieber, MD, FACS · Answer

Thanks for this super important question! To my knowledge, almost all of the deaths from BBLs are due to clumps of fat getting into the veins deep in the buttock during the buttock augmentation portion of the procedure. What happens is that these clumps of fat travel in the veins from the buttock up into the heart, then the heart pumps them into the lungs which is what causes the patient to die. There is a recent study seeing if there was a correlation between the volume of fat used and deaths. The researchers found that patients have died even with small amounts of fat. This occurs when the fat is injected deep in the buttock where there is a conglomeration of very large veins. The authors recommend using larger cannulas to inject the fat and to only inject the fat superficially, away from these veins. The plastic surgery community is very concerned because of these deaths and is conducting more and more research to figure out to make this operation as safe as possible! Patient safety is our number one goal when it comes to any surgery we perform!~Dr. Sieber

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