How dangerous is liposuction and fat transfer to the hips?

Question

I’m 19 years old, healthy weight, I’m looking to get liposuction of my abdomine and flanks and fat transfer to my hips only. What are potential risks? And why are some procedures fatal? Is age a factor? I’m really nervous...

Ryan Neinstein, MD, FRCSC · Answer

As someone who basically only performs liposuction and also sits on the american board of plastic surgery safety committee I can tell you that yes large volume fat transfer is not safe enough in my opinion to be practiced as often as it is. The main issue is fat emboli which can cause immediate death. I do perform fat transfers but I only do low or small volume for contour where safety can be maximized

Afshin Farzadmehr, MD · Answer

Based on my experience of performing liposuction and fat transfer procedure to buttocks and specifically on hips to give those curves in the area of "dents" in my hands and my techniques in over 18 years I have never had a single adverse event or bad outcome in over 3000 patients.  This procedure is HIGHLY experience based for safety and aesthetically beautiful results as it is an art to get fantastic work.

Jason Emer, MD · Answer

There is a risk with every procedure, but you minimize the risk by seeing a board-certified doctor who specializes in high definition liposuction and fat transfer. For best results, I recommend a hi definition procedure like VASER liposuction. I use VASER HI DEF with ThermiRF and fat grafting to get the most fat removal, skin tightening, contour and definition. This combination will give you the most toned result, if you're a candidate. I recommend getting a formal evaluation with a hi definition physique expert. Best, Dr. Emer

Robert M. Tornambe, MD · Answer

queenpeaches  At 19 years old, your first option is diet and exercise, not liposuction. If that fails, liposuction with fat transfer to the hips is a reasonably safe procedure when performed by a board-certified plastic surgeon. Fat transfer to the hips does not carry as many serious complications as fat transfer to the buttocks. Be certain to consult with a board-certified plastic surgeon to explore all options. Good luck.

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.
At 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 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 1:3000-1:6000 (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.

Carolina Restrepo, MD · Answer

Thank you for your question.  Combination procedures are safe and very effective in the right hands.  The surgeon has to be an expert in each procedure and must have a lot of experience in performing them. You definitely have to choose your surgeon correctly and make sure that he/she has the training and experience to meet your goals with absolute safety.  Don’t settle for less than a Board Certified Plastic Surgeon with specialized expertise in this procedure.

Joshua A. Halpern, MD, PA · Answer

Unfortunately there are no pictures. Some surgeons feel strongly that when injecting fat one should inject the fat superficial to the muscles. When injecting fat into the buttocks they feel that injections of fat even into the superficial muscle can increase the risk of fat getting into the bloodstream and migrating into the heart and/or lungs which could be fatal. In addition they feel that fat should be injected through larger cannula so as to minimize the risks of entering into a blood vessel. Please note that not every surgeon agrees with these statements. In addition, apart from making sure that the patient is a good surgical candidate for surgery, one would like to use a liposuction technique that minimizes bleeding. I incorporate the SAFE technique (that Dr. S Wall invented). In addition I strongly recommend that the surgery be performed by a Board Certified Plastic Surgeon and in an accredited surgical facility. I hope you find this information useful. Please watch the enclosed video.

Navanjun S. Grewal, MD · Answer

Hello and thank you for your question.

If you are healthy and go with a qualified surgeon for your surgery should be little/no complications.  There is risk associated with surgery, but it is highly unlikely for there to be major complications.  
Fat grafting to the hip and or buttocks is very common and very safe.  
Best of luck to you,
Dr. Grewal 
Beverly Hills, CA

Daniel Krochmal, MD, FACS · Answer

Thank you for your question.There are risks with any procedure.  There have been some fatalities with fat grafting to the buttocks, and that has caused the plastic surgery community to take a very good look at why this is happening.  Much has to do with the anatomy of the vessels, the equipment used to place the fat, the location where the fat is placed, and the knowledge of the person injecting the fat (I recommend only doing this with a board certified plastic surgeon in an accredited facility).I believe fat grafting to the hips can be done very safely.  It's far away from the vessels of concern for the fatal complications that are associated with fat grafting of the actual buttocks (but even that can be done safely if the current recommendations are followed!).It's best to have a consult with several plastic surgeons in your area to discuss your options.Best,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

Karol A. Gutowski, MD, FACS · Answer

There is a risk with every procedure, including liposuction and fat transfer. While the risk is very low when the procedure is done properly in an accredited facility, there is some risk. See link below for more information.

How dangerous is liposuction and fat transfer to the hips?

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