Can blood clots be prevented with BBL?

Question

Kenneth Hughes, MD · Answer

Your surgeon should know all of your risk factors for blood clots, be able to stratify your risk, and manage you accordingly.   If you have more than one risk factor for blood clots other than having a BBL and lipo surgery, you may need Lovenox or something similar.   If you are a patient who is high risk for blood clots, you may want to consider if you want to do the surgery. DVT, a blood clot in the deeper venous systems of the body, most commonly the legs, can put you at risk for PE, a blood clot that has moved or embolized from these deeper venous systems and has become wedged in the pulmonary vasculature, sometimes causing respiratory distress.
Early ambulation, shorter surgeries, venous compression devices prior to induction of general anesthesia, and anticoagulation in the appropriate candidates help manage this risk.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Donovan Rosas, MD · Answer

The risks of BBL are similar to those of liposuction with one significant difference...Emboli. However, these are clots but rather fat.
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.
At the recent American Society of Plastic Surgeons Hot Topics (2016), data from AAAASF (ambulatory surgical certifying body) was presented, suggesting that BBL/gluteal lipoaugmentation demonstrates a dramatically higher risk profile than other surgeries. The Aesthetic Surgery and Educational and Research Fund is convening 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, 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.
With regards to your specific question, according to AAASF data the risk of death from BBL will range from 1:3000 to 1:6000 (subcutaneous grafting will reduce this risk relative to intramuscular grafting). By comparison the risk of fatal complication from abdominoplasty is 1:13,000. Thus the risk is quite high relative to other aesthetic procedures (so much so, that this issue is being carefully examined by the governing bodies of aesthetic plastic surgery).The risk of blood clot and subsequent pulmonary embolus, while still a concern is not nearly as significant as the risk of fat embolus. Blood clots can be avoided by risk stratification. Patients at higher risk may require Lovenox for anticoagulation. SCD (compression devices) are also important to counter the loss of vascular tone associated with the induction of general anesthesia.
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.

William Bruno, MD · Answer

The risk of developing a blood clot during a BBL is fairly low, between 1-2%. Most surgeons will use compression stockings and sequential compression devices. If you are at higher risk you may need anticoagulation as well. You should also be aware of fat emboli, which is a clot made of fat which can occur during this surgery if fat is injected into a vein which could travel to the lungs. Watch this brief video for more information.Best wishes,Dr.Bruno

Can blood clots be prevented with BBL?

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Can blood clots be prevented with BBL?

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