BBL - any advice for intramuscular fat transfer?

Question

Hello! During a consult with a board-certified plastic surgeon, the dr said he would transfer the fat into the muscle, as opposed to the subcutaneous layer under the skin (most common way as there is less risk) i dont know of anyone that has done the fat transfer into the muscle. Things i need to know / advice ???

Morad Askari, MD, MBA · Answer

I would strongly advise AGAINST getting a fat transfer intramuscular for a BBL. The risks outweighed the benefits. Placing the fat inside or under the muscle for a BBL can create serious complications like a fat embolism. Fat embolism is when a fat cell travels inside your blood system and blocks circulation. If one of them gets into larger blood vessels leading to the heart or lungs, it can cause life-threatening complications. The buttock has large blood vessels increasing the risk of fat embolism.

Alan Gonzalez, MD, FACS · Answer

Hello @MR2212, thank you for your question. It would be best to seek out several specialists and listen to other options. In my opinion, this is something completely new to me; I had never heard of the technique of transferring fat to muscle. In fact, fat would not be able to enter the bloodstream. In the muscle the fat is between cells so which means it cannot integrated. For more information and recommendations, it is prudent to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Finny George, MD · Answer

Hi, thank you for sharing your question. I would advise against this method of fat transfer as it has the highest risk of fat embolism.

Alexander Hamers, MD · Answer

Hello @MR2212. There are worldwide recommendations from the Task force for Safety in Gluteal Fat Grafting to reduce the risks in BBL surgeries. Fat embolism during surgery can happen when there is injury to deep veins. They are deep to the gluteal muscle fascia. So buttocks lipoinjection should be performed carefully and it should be avoided to inject into the muscle. There are also other tools and techniques to reduce the risks like ultrasound mapping, special patient positioning during the surgery, canullas that are resistant to bend during injections. I hope this answer can help you. 
Kind regardsAlexander T. Hamers MD

Daniel Barrett, MD · Answer

Dear MR2212,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

Cagil Meric Erenoglu, MD · Answer

Intramuscular fat transfer is avoided because of the fat embolism risk. I would recommend you to have an ultrasonic safe bbl, where the fat is given subcutaneously.

Darryl J. Blinski, MD · Answer

That is below the standard or recommend techniques here in USA! No BBL should have intra muscular injections. Maybe you mis understood him? Best to recall this surgeon for an explanation.

Arian Mowlavi, MD, FACS (license on probation) · Answer

The safest approach to adding fat to your buttocks would be through our Safe California Ultrasound Buttock Augmentation (SCUBA) that uses ultrasound technology to directly visualize the surrounding structures. SCUBA allows for the safe transfer of fat by minimizing risk of a potentially detrimental fat emboli and/or inserting into your areas of injections. Additionally, using our propriety fat grafting cannula, we are able to directly visualize placement of fat such that entry into the gluteal muscle is avoided. This is because fat emboli have been associated with intramuscular fat grafting of the gluteus muscle. Avoidance of intramuscular fat grafting has been identified as the number 1 minimizing factor for fat emboli. As such, using our propriety fat cannula, we are able to avoid any fat graft transfer into the gluteus muscle and prior injection sites.

Mats Hagstrom, MD (license on probation) · Answer

Admitting that you graft fat in the gluteus muscle is a bit like announcing that you’re a Republican if you live in San Francisco.
It’s frowned upon and unpopular.
Still San Francisco has a substantial number of conservative residence who live in hiding.
In reality grafting fat in the subtitaneous plane or in the gluteus muscle not so much of a black-and-white concept it’s more of shades of gray.
Even providers who claim they don’t graft in the muscle are most likely ending up with some fat in the superficial layer of the gluteus muscle because the subcutaneous fat layer is usually insufficient and quite thin. Likewise the contours were working on are curved and the instruments are straight. The high risk area for fat embolism is believed to be the gluteal vein which is deep to the main muscle. Plastic surgeons who specifically graft fat deep into the muscle are most likely the ones who are at highest risk for developing a fat embolism.
A few years back there were a series of fatalities from this procedure from patients developing fat embolism‘s.
In particular there were two rogue players in Florida neither were board certified in plastic surgery and combined they had 10 fatalities.
There were also a large number of fatalities in Columbia.
The American Society of plastic surgeons calculated to fatality rate for this procedure was one in 3000. No question that the majority of plastic surgeons were probably doing safety procedures with low risk while those who are careless we’re probably putting patients at greater risk.
Still, the American Society of plastic surgeons released a series of recommendations for surgeons performing this procedure and one of those recommendations was to not graft in the muscle.
No one has ever demonstrated that carefully grafting in the superficial part of the muscle ads or reduces risk and there has been very little evidence of fat embolism‘s being a current problem with the BBL procedure which continues to be one of the most popular cosmetic surgery procedures performed.
Wether earlier risk statistics were overestimated, where a result of Rogue players or grafting fat in the gluteus muscle is as dangerous as it was described is uncertain.
There are also other safety variables that can be taken into consideration. One of these is properly using tumecsent solution for its vasoconstrictive properties in the area being grafted, using blunt cannus of appropriate size etc. etc.
In the end each patient chooses providers based on their own criteria. The reason fat was historically grafted in the muscle was because it gave better results.
I question if all plastic surgeons are avoiding the muscle completely and most likely lots of plastic surgeons are grafting some fat in the muscle during the procedure whether intentional or not.
Still, all plastic surgeons are aware of the risk of the complications and I believe are cognizant of being careful. None of us ever want to see that complication in any of our or any of our colleagues patients.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe. For that reason I believe patients should have multiple in person consultations with a number of providers to help find the most talented and experienced provider in their community. During consultations ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in. For fat transfer procedures make sure after pictures are always at least three months from the date of surgery. Early fat grafting results can look very impressive but do not represent final results. simply seeing a handful of pre-selected pictures which most likely represent the best results of each provider‘s career is insufficient to get a clear understanding of an average results look like in the hands of each provider.
This is why patients need to push providers to open up their portfolio and show as many pictures as possible. ask the provider to show as many pictures as possible of patients with similar body characteristics to your own. Also ask the provider to show examples of excellent, average unless than outcomes.
An experienced surgeon should have no difficulty showing you a minimum of 50 sets of before and after pictures. Highly experienced surgeons will have hundreds or even thousands of before and after pictures for this procedure.
When looking at Liposuction results look carefully for any evidence of contour irregularities. Ask the surgeon what areas were treated and what areas were not treated and look carefully at the transition zones between treated and untreated areas.
The concept of how the BBL should be performed also varies great really from surgeon to surgeon. some providers deliver what seems like a cartoon caricature excessively large buttocks with purposeful liposuction of the thigh in order to make the buttocks look larger. This “lollipop look” is unnatural in my opinion highly undesirable. Final results should emphasize a smooth continuous S-curve from the armpit to the knees. 
When in doubt I recommend having more consultations.
Best,
Mats Hagstrom MD

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!The BBL is a safe and reliable operative procedure if the fat is injected into the deep subcutaneous tissues. If the fascia is penetrated and fat is injected into the gluteal muscle, there is increased risk of fat embolism to the lungs. In our practice, we utilize ultrasound instrumentation to directly visualize the area to ensure that the fascia is not penetrated during the procedure.I cannot recommend fat injection into the buttock musculature. Best wishes...

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