Do Doctors know when they are injecting fat for a bbl if its the fat layer or muscle?

Question

I workout a lot and I have build muscle in my buttocks I don't have much fat in my buttocks. I'm afraid the doctor is going to inject fat on my muscle instead of my fat layer.

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well.. based in your question There are different techniques, only that the plastic surgeon must have a lot of experience because there are parts that are grafted in one area and another part that is grafted in another area for projection, it is advisable that when choosing the plastic surgeon have more experience in that part.

Roger Tsai, MD · Answer

Great question!  A surgeon experienced in this procedure will know where the fat is being placed.  Our plastic surgery society also recommends that fat should not be placed into muscle and only placed in the layer above the muscle in the fatty tissue plane.  It is best to have an in person consultation with a few plastic surgeons and go with the one you are most comfortable with.  Looking at their photos will give you an idea of the potential results.Best of luck and hope this information helps!- Dr. Roger Tsai  @DrRogerTsaiBoard Certified Plastic Surgeon

Eugene Kim, MD · Answer

It is not recommended to inject fat into the buttocks.  However there's no way to know for sure where the fat is actually injected.  It is important to see a plastic surgeon who is experienced with this type of surgery and is familiar with the anatomy.  There are many techniques use to help minimize the chances of injected fat intramuscularly.

Carolina Restrepo, MD · Answer

Thanks for your question. With Brazilian butt lift we transfer fat from one area of the body to the other.  These fat cells are transferred in microinjections throughout multiple planes in the buttock tissue so that they can gain new blood supply and live in their new home, providing increased volume and shape to the buttocks.  You definitely have to choose your surgeon correctly and make sure that he/she has the training and experience to meet your goals with absolute safety.  Best is a Board Certified Plastic Surgeon with specialized expertise in this procedure.

William Bruno, MD · Answer

If your plastic surgeon is experienced with fat grafting techniques he or she will know at what depth/layer to inject the fat. Watch this brief video for more information.Best wishes,Dr.Bruno

Kenneth Hughes, MD · Answer

The fat is injected above the gluteus muscles and superficially under the skin into the fat and surrounding tissue of the buttocks.  I do NOT inject fat into the muscle to all but eliminate the risk for fat embolus and death (although this rate is most probably not zero).  Precise placement of the fat is necessary to help reduce the risk for fat pooling and resulting fat necrosis and/or infection.

Daniel Barrett, MD · Answer

Dear BabyLove8,Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area.If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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.
BBL/gluteal lipoaugmentation demonstrates a dramatically higher risk profile than other surgeries. The Aesthetic Surgery and Educational and Research Fund has convened 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 and aspiration prior to injection. Using a supra-gluteal approach to minimize the risk of inadvertent intravascular injection has also been proposed. While this will likely impact graft viability negatively, it will also lower the risk of a serious complication.
According to AAASF data the risk of death from BBL will range from 1:3000 (subcutaneous grafting should reduce this risk relative to intramuscular grafting). By comparison the risk of fatal complication from abdominoplasty is 1:13,000. It is unclear how the relative risk falls with subcutaneous injection vs. intramuscular injection (however, in all likelihood, it is less).
No result is worth risking one's life for. I find that the patients who focus not on the volumization but rather the contouring benefits of the liposuction are happier than those whose sole goal is size. Relatively speaking, the subcutaneous plane is the "safe" plane.
With regards to your specific question, an experienced practitioner should have a sense of where they are at all times. That being said, inadvertent intramuscular injection is being considered as a root cause for problems.
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.

Michael J. Denk, MD, FACS · Answer

Fat is injected into the subcutaneous space during a BBL, and not into the muscle. The correct location for fat grafting is important for both good results and patient safety. Be sure to seek a consultation with a board certified plastic surgeon who is experienced in liposuction, fat grafting and BBL. Best of luck.

Mats Hagstrom, MD (license on probation) · Answer

when grafting fat we use our knowledge of anatomy in combination with instinct and experience to make a decision of what layer or how to inject the fat. There have been many autopsy is done on patients who have died from fat embolism's after BBL's  where the operative note states that the fat was only injected in the subcutaneous fat layer and not into the muscle when in reality injected fat was found in the gluteus muscle. When it comes to decreasing the chance of a fat embolism it is not merely avoiding injecting into the muscle but not injecting into the deep layers of their gluteus muscles were the large veins are. In reality I believe it's not possible to deliver impressive results are consistent with what many patients are seeking without injecting fat into the muscle layer. Before and after pictures representing the wish pictures of many patients show video volume being doubled, tripled  or even more. If someone's subcutaneous fat layer is 3/4 of an inch then that type of enhancement based on grafting fat only into the fat layers would require  increasing that space by perhaps 400 to 800%. Let's say a reasonable strategy is to double the volume and of that we keep 50% of the injected fat. If the natural fat layer between the skin and gluteus muscle is 3/4 of an inch then you can expect to add  less than half an inch.  This is not enough to maintain consistent high patient satisfaction but it is most likely slightly safer than attempting to gain the results patients are seeking. The bottom line is aggressive results require an aggressive approach which often has higher risks. There are many many factors that go into the decision-making's and approaches to a BBL. There is the need for manual dexterity, aesthetic vision, aesthetic judgment understanding of the art and science of medicine etc. etc.  I cannot emphasize enough the importance of seeking providers with experience and a high ethical standard. It is perhaps the ethical standards and being critical of your own results which serve patients best lead to the very best outcomes consistently. There is always in the back of the mind of each plastic surgeon a decision making process that balances consistent safety and results versus individual results and risks. When following the golden rule or as the lords prayer tells us  in the line "lead us not into temptation" serving each individual patients best needs should come first and foremost and awake assistant what we would want for  ourselves, our friends and family.Perhaps a rambling answer to your question. You can tell when you're injecting deep into the muscle by certain signs such as the muscle contracting when injecting deep.I personally inject into the gluteus muscle. I use all risk minimizing techniques I am aware of and try to balance these with getting results that are consistent with what I believe my patients are seeking. What are field desperately needs is precise anatomic understanding of the gluteal veins.  Further, understanding what angles in relationship to specific anatomical landmarks lead to the highest risk of fat embolism's. It should be possible to inject that into the gluteus muscles at the same time keeping the risks of fat embolism's at an acceptable rate.  It is possible that in the future we will use ultrasound guidance to help us inject fat in a manner that gives the highest level of safety.  Best, Mats Hagstrom M.D.

Do Doctors know when they are injecting fat for a bbl if its the fat layer or muscle?

Answers (11)

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