What is the safest injection technique for BBL?

Question

I'm planning to get a BBL and am trying to educate myself as I'm very scared of a PFE. I'm reading there are 3 injection techniques (Coleman, assisted injection and safe gluteal ft injection). I'm wondering what the general consensus is from surgeons on what they find the safest technique is? My PS said she does hers manually so she can feel where the fat is placed (assuming Coleman from my research) and said it's the safest way. I'm finding a lot of conflicting information online on this.

George Marosan, MD · Answer

Thank you for your question. A BBL procedure is both a technical and artistic operation involving harvesting and shaping of the torso 360 degrees and fat transfer to the buttocks (subcutaneous fat compartment only, between skin and muscle fascia) for shaping and enhancement. This forum is too limited to go into this subject in detail.Dr. Coleman should be credited for being a pioneer and advance the science of fat grafting. The Coleman technique is not appropriate for fat transfer to large areas such as the buttocks. Syringe technique is possible, but cumbersome and time consuming. I used to do it, but abandoned it years ago. I use a 4 mm stiff, curved and non-bendable cannula to inject the fat. The fat is collected into a closed container (no air exposure), minimally washed, the fluid removed and the fat is pumped through a pump. The resistance is set low, so if any resistance is met, the fat injection stops automatically. This is very important. EVL is a system which uses an expanded basket cannula and a pump to propel the fat to be injected.Recently, ultrasound guidance was introduced, but most practices do not use this.It is important to find a surgeon who follow the guidelines put forth by the American Society for Aesthetic Plastic Surgery (ASAPS) in this regard. The study quoted by many as 1:3,000 death from BBL is false. It is not a study, it was based on a survey with many erroneous assumptions. One surgeon included in the survey had nine death out of ten patients he has ever done! That is an outlier, or a misprint. Real studies are in the process of being published (not only in the US, but world wide) that point to 1:13,000 death in BBL. This is less then tummy tucks at 1:10,000! No one questions tummy tucks or want to ban it!All operations have risks, that is why it is imperative to choose a surgeon who understands the principles and has the correct acceptable technique to carry a BBL safely. Good luck.

Matthew J. Nykiel, MD · Answer

Hello and great question. I appreciate the time you are spending researching this procedure. My name is Dr. Matthew J. Nykiel. I am a Board Certified Plastic Surgeon, a Fellowship Trained Cosmetic Surgeon, and a Breast Augmentation Specialist
The safest technique would be above the muscle injections. The is the safest way to preform fat transfer.
I would definitely recommend doing an in person consultation with a board certified plastic surgeon who specializes in this procedure and who can suggest what is needed. I hope that helps! Best of luck!

Kenneth Hughes, MD · Answer

Hello, thank you for your question. The result is really a function of how aggressively the surgeon will liposuction and transfer. Most patients get an immense benefit with maximal liposuction of the abdomen, sides, and back to obtain the smallest waist possible and then maximal fat transfer to the buttocks and hips. One incision is all the is required to inject the fat into the buttocks.  However if the buttocks is larger and/or the the anatomy requires additional incisions, more incisions may be necessary.

Emmanuel Mallol Cotes, MD · Answer

Thank you for your question. To provide a valid medical opinion I will need to see pictures of you body from different angles. I would suggest to be treated by board certified plastic surgeon with experience in this procedure, to get the best desired results.
Respectfully,Dr. Emmanuel Mallol Cotes.-

Zoran Potparic, MD · Answer

It appears that safest technique regarding incidence of fat embolism is injection in the subcutaneous plane; that is a fat layer between skin and buttock muscles, practically the same layer where fat is aspirated from abdomen, flanks and back. Few plastic surgery papers that came out recently quote 10-14 fold lower incidence of fat embolism with this technique than when fat is injected into multiple layers including muscles and between the muscles. The fact that largest blood vessels in this area are between and inside the muscles makes this plane the most dangerous when it comes to fat injections and fat embolism. It is now the law in State of Florida that fat grafts can be injected only into subcutaneous fat tissue of buttocks and hips. Hope this helps..

Kamran Azad, MD · Answer

You ask an important question. As with any surgery there are risks, but there are ways to minimize those risks. With a BBL, it is important for the surgeon to focus on the plane of injection, only injecting into subcutaneous superficial plane, no intramuscular injections, as all the big arteries and veins are underneath the muscle.
There are many opinions on technique, but I personally use an EVL (Expansion Vibration Lipofilling) technique using the basket cannula. I find the syringes to be unstable while injecting the fat, as the cannula can move. Additionally the surgeon’s thumb on the syringe is controlling the amount of fat being injected into the buttocks. With EVL, the basket cannula is steady and hooked up to a pump to control the amount of fat being injected, leaving the surgeon’s focus on where the tip of the cannula is. I personally also use a bent cannula that I point up to ensure I am staying subcutaneous, staying superficial.Kamran Azad MD, Board Certified Plastic Surgeon

Dallas Buchanan, MD · Answer

Thank you for your questions. This is a hotly debated topic and the real answer is that nobody really has definitive data to state anything, we are all just making statements based on opinion and technical things which are comfortable for us and deliver good results in our hands. The bottom line is that the safety profile of this operation is associated with damage to the large gluteal veins and then a fat embolism from the grafting. It is understood that grafting fat into the muscle increases the risk of this so that is obviously to be avoided. That being said, in a cadaver study where they asked surgeons to only graft above the muscle, it was found that about half of the time we think we are all above the muscle, we are not. Probably the only technique out there that really proves where the fat is being grafted is to place the fat under ultrasound guidance and this is something that some practices have started doing. I think that in the end, there is no assurance of safety for this operation. It has a quoted death rate of 1 in 3,000 and I think that before you proceed with surgery, you have to be willing to accept that risk. If that is too high for you, then the answer is do not have the procedure.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Daniel Barrett, MD · Answer

Dear TTdreamer84,
every surgeon has a preferred technique. It is very important to add fat above the muscle in order to avoid complications. 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

Andrew Gear, MD · Answer

There’s a lot of confusion and misuse of semantics as stealth advertising tools when it comes to fat grafting. The Coleman technique is not actually an injection technique as it is so much a technique that processes the fat in a specific way. The key safety issue with a BBL is to stay above the gluteus maximus muscle. That’s the key element. People have died from fat embolism‘s using manual techniques so that in and of itself is not a guarantee of safety.  In addition, over injecting fat in the pursuit of some pornographic bubble but is also a recipe for danger. The increased pressures can cause the fats allegiance to vessels and placed deep to the muscle. There are automated systems out there that can be safely use. I use the Wells Johnson system that regulates pressure. If pressure peaks, the injection pump automatically stops. I believe this is an added safety feature. Again, this procedure is and can be dangerous and requires a lot of experience and skill with its execution.

Manuel Belen, MD - Account Suspended · Answer

Hello,
  
Thank you for sharing the information, it is a pleasure for me to answer your question.
  
It is difficult to evaluate the options without seeing photos,
It is advisable to consult with a certified plastic surgeon, for a good evaluation, to provide you with all the information you need to know about the appropriate recommendations, so that you can achieve the desired goals in your body.
  
I hope this answer will help you
  
My best wishes for you...

What is the safest injection technique for BBL?

Answers (10)

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