Terrified of getting a BBL. What is the risk of death from a fat embolism?

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.
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.

Thank you for this great question. Recent compiled data has shown that the death rate from the BBL procedure is the highest of any cosmetic procedure. The death rate has been published at 1 in 3,000. The deaths are from fat embolism when trauma to the gluteal veins and a pressure gradient causes fat to enter the bloodstream. Many surgeons think the solution is to just stay superficial to the muscle and while this is true from a safety standpoint, cadaver studies have shown that whether or not surgeons think they are injecting deep to or superficial to the muscle, on examination, all those surgeons had fat that was into or deep to the muscle. So it is easier to do than you think. The bottom line is this is a risky procedure and you have to gauge the risk vs the benefit. A great start is to make absolutely sure you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery and thoroughly discuss the risks and benefits of any procedure.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery