How do plastic surgeons know how deep to inject fat? I’m getting BBL done in September.

Question

I’m really excited but also very nervous as I hear about the high mortality rate. I’ve read in most cases happens with people performing this surgery with non plastic surgeons but that it has also happened to board certified plastic surgeons (inadvertently). My question is; how do plastic surgeons know how deep to inject fat in order to avoid hitting a vein? Do you really know where veins are? Or is this a matter of “luck”? Thank you.

Donovan Rosas, MD · Answer

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.
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.
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.

Jaime S. Schwartz, MD, FACS · Answer

A good candidate has enough fat available for transfer in the procedure. The amount of fat that can be transferred in a BBL depends on how much fat the patient has to harvest and the amount of space there is to move the fat into. It is recommended for the patient to have a BMI of 30 or less. If you are too thin, a Brazilian Butt Lift may not be possible.

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well.. based in your question its difficult to evaluate you if the case dont have a case.its recommend get a consultation in person with a plastic surgeon to evaluate you.

Emmanuel De La Cruz, MD · Answer

Hello Nayelleee,
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, 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. Autopsies of the deceased patients reveal a number of commonalities, such as: fat in and beneath the gluteal muscles, damage to the superior or inferior gluteal vein, and massive fat embolism (blood clot) in the heart and/or lungs. Given these findings, it is critical that prospective patients discuss the risks of undergoing a BBL with their surgeon before pursuing the procedure. 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.

How do plastic surgeons know how deep to inject fat? I’m getting BBL done in September.

Answers (4)

Answer: LIMITING INJECTIONS TO THE SUPERFICIAL PLANES.

Answer: LIMITING INJECTIONS TO THE SUPERFICIAL PLANES.

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Everything you need to know about Brazilian Butt Lift

Our mission is to create a world where every investment in modern beauty is Worth It.

How do plastic surgeons know how deep to inject fat? I’m getting BBL done in September.

Answers (4)

Answer: LIMITING INJECTIONS TO THE SUPERFICIAL PLANES.

Answer: LIMITING INJECTIONS TO THE SUPERFICIAL PLANES.

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Recommended reading

Everything you need to know about Brazilian Butt Lift

Our mission is to create a world where every investment in modern beauty is Worth It.