Brazilian Butt Lift. I read about deaths related to fat embolism. Is this procedure dangerous?

Question

I want to get a Brazilian done so badly but I’ve read some scary things about how patients have died during this surgery because of the fat embolism. Is this procedure dangerous?

Ricardo L. Rodriguez, MD · Answer

hello Ava,It is great that you are taking the time to learn more about these risks. There have been a number of deaths from PFE (pulmonary fat embolism), and it is a fact that this procedure carries the highest mortality rate compared to any other cosmetic surgery procedure.  As a patient, your first obligation towards safety is to make sure your surgeon is Board Certified by the American Board of Plastic Surgery , and that the surgical facility is properly accredited. However, even board certified plastic surgeons have had mortalities. So it is incumbent upon you to ask your surgeon to explain how he performs the procedure.   As others have noted, our national society, the ASPS , has been actively investigating the issue. An inter-society Gluteal Fat Grafting Task Force team was formed over a year ago which included 19 Plastic Surgeons worldwide.  Earlier this year and over the summer we (yes, I am a member) issued some preliminary guidance for surgeons to inject only in the subcutaneous regions when injecting into the buttocks. The subcutaneous space is the area immediately below the skin and above the gluteus muscles.  We know with certainty that ALL of the reported deaths did have fat injected into the gluteus muscles.  This is why the Task Force made the recommendation to inject into the buttocks only subcutaneously.
Gluteal Fat Injection is technically a "blind procedure" because you cannot see thru the skin.The only way to ensure that you are not injecting in to the intramuscular plane is to put your cannula tip right up the skin when you inject and inject only small amount while retracting the cannula. Continuous injection methods or pump driven injection methods run the danger of injecting throughout the path of the cannula without knowing what plane (subcutaneous or intramuscular) the path is in.  For this reason, I believe that injecting small amounts in each injection pass manually is the safest technique. 
On the Task Force, we have been discussing these issues and studying autopsy report of the fatalities. Most recently, the ASPS , ASAPS, ISAPS,  IFATS,  and ISPRES societies have conducted two sessions of anatomic cadaver dissections in Miami over the summer months.  We injected fat and monitored it's pathway.  The report will take some time to produce, but much information about safety has been gleaned.
I am not at liberty to share the results of the sessions , but I will tell you that most all of  what I wrote in my December 2017 blog post listed linked below remains highly relevant. I encourage you to keep researching the topic , ask questions, and continue staying informed.I do believe that this procedure can be performed safely and with excellent results if your surgeon can ensure that he is injecting only in the subcutaneous space. Best of luck. Ricardo L Rodriguez MD

Mathew A. Plant, MD, FRCSC · Answer

When done incorrectly BBL can definitely be unsafe with a death rate around 1:3000. When done by a board-certified plastic surgeon with the fat injected only into the subcutaneous space, not the muscle, and using the cannula angles recommended by the ASAPS/ISAPS then it is much safer. Discuss your concerns in person with your surgeon before you proceed to make sure you are comfortable. Best of luck!

Emmanuel De La Cruz, MD · Answer

Hello AvaMassi,
It’s a pleasure to answer your questions! As with every surgery, there are some risks associated with Brazilian Butt Lift (BBL) surgery, such as fat embolism, numbness, and infection, among others. However, an experienced and specially trained plastic surgeon can help diminish those risks significantly. Actually, there is a low mortality rate for BBL of approximately 1 in 3,000, according to statistics issued by the American Society of Plastic Surgeons in March 2018. Research has uncovered a correlation between the fatalities, suggesting that death occurred during cases in which a plastic surgeon injected beyond the subcutaneous fat layer. The importance of selecting a meticulous plastic surgeon with the ability to safely perform the surgery cannot be overstated. Limiting injections to the superficial planes (namely, the subcutaneous space) may be an effective way to minimize the risk of harm. Moreover, careful control of the cannula (the surgical instrument used to transfer fat), as well as cautious placement of access incisions, can help ensure a superficial trajectory for the fat transfer that occurs as far away from the gluteal veins and sciatic nerve as possible. Hope this is helpful! Dr. De La Cruz.

Bennett Yang, MD · Answer

Hello and thank you for the question. All surgery carries some risk. Brazilian butt lifts are one of my most common procedures. When done correctly, it is a very safe procedure with low risk and complications. Unfortunately, there have been well publicized cases of death from this procedure. ALL of the deaths were done in cosmetic surgery clinics located in florida. These cases all had a common feature; not being performed by a fully licensed and board certified plastic surgeon. Over the last 18 months, there were 6 reported deaths in this area. In comparison, outside this area, the ENTIRE USA had NONE. These clinics advertise extremely low prices and get a lot of volume of patients who want to find the cheapest deal in town. Do your homework. Research the doctor doing your surgery. Go on several consultations and go with the person you feel is most competent and will pay attention to your goals and has realistic honest expectations. Best to you. @bennettyangmd

Derby Sang Caputo, MD · Answer

The BBL or fat transfer is one of the most commonly performed surgeries these days.  Even though you mentioned bad stories about it this doesn't mean that under well trained and experienced Plastic Surgeon the risks are very very low.  I hope you can do a consultation with a certified doctor that can help you with the surgery process. Best of luck.

Adolfo Sesto, MD · Answer

Hi. Is not dangerous in the hands of a capable, responsible, highed skilled and experienced plastic surgeon, because there is a protocol to follow to prevent this issue, eventhoug the possibility always exist.International Member of the American Society of Plastic Surgeons (ASPS)
Member of the International Society of Aesthetic Plastic Surgery (ISAPS)
Member of the International Confedaration of Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

Andrew Gear, MD · Answer

Every surgical procedure has risk. There has been a recent correlation between fat embolism and death in BBLs when the fat is injected in the deep planes beneath the gluteus maximus muscle. Our society now recommends staying in the superficial plane above the muscle only which is what I do. When people chase an aggressive, unnatural bubble butt appearance, surgeons often place a lot of excess fat beneath the muscle and while this can be dramatic, it sets in motion the potential for death.

David L. Robbins, MD, FACS · Answer

Fat transfer to the buttocks is a safe procedure.  However, just as with any surgical procedure, there are risks that need to be discussed with your surgeon.  Fat embolism occurs when the fat is injected too deep and the fat enters a deep blood vessel and travels to the lungs.  The fat should be injected in a superficial plane in the buttocks to avoid this potential complication.  Dr. David Robbins

Brazilian Butt Lift. I read about deaths related to fat embolism. Is this procedure dangerous?

Answers (8)

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