What is the difference in results for BBL for fat layered into the muscle vs injected into the superficial layer only?

Question

I consulted with a doctor who prefers not to inject into the muscle due to the risk of fat embolism. Will it give similar results?

Dallas Buchanan, MD · Answer

Thank you for your question. This is an awesome question and something that is debated in cosmetic surgery circles. There are some out there who continue intra-muscular injections because the theory is that the muscle has better blood supply than the subq tissue, and thus better fat survival. The counter to that is that intra-muscular injections have a larger risk of damaging the deep blood vessels and increasing the risk of fat embolism, complications, and possibly even death. While that sounds scary, there are multiple reports of deaths from BBLs in this country and it is something that all PS professional societies are actively investigating. Bottom line for me, improved results are not worth risking safety. I do not think it is wise to proceed with muscle injections in light of recent information. Better to be safe than sorry.Hope this helps!

Daniel Barrett, MD · Answer

Dear nosetake2,injecting fat into the muscle is linked with a higher risk of complications. Most of surgeons transfer fat into the subcutaneous space and they get great results. I would recommend you to consult a board-certified plastic surgeon with experience in BBL procedure.Daniel Barrett, MD, MHA, MS
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

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 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.
With regards to your specific question, it is difficult to quantify the difference definitively but there is a decrease in graft viability/take when placed in the subcutaneous plane. The vascularity of the muscle and the subsequent graft viability are directly related. However, as I described above, so too are the risks.
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.

Stephen W. Gordon, MD · Answer

While it is true that fat injections into the deep gluteal blood vessels is hazardous, this complication can be avoided if the surgeon is aware of the pertinent anatomy and exercises good surgical judgement as he or she injects fat into the muscle.  The results are better because augmenting muscle gives improved fat retention, and better contours.

Millicent Odunze Geers, MD, MPH · Answer

The difference quite frankly is the possibility of DEATH. Intramuscular fat injection increases the risk of fat embolism, which is the injection of fat into the deep blood vessels that travels to the lungs and can cause instant death. Great results can be achieved with superficial fat injection only. There's no need to take an avoidable increased risk for a COSMETIC, ELECTIVE procedure. When considering a plastic surgeon for BBL, prioritize your safety first, and also review her/his before and after photos. Beware of any surgeon who shows you "after" photos of the patient still on the operating room table. This is not indicative of a long-term result. It simply shows how you look at the end of the procedure. Best of luck.

What is the difference in results for BBL for fat layered into the muscle vs injected into the superficial layer only?

Answers (6)

Answer: Where to inject fat for BBL. Superficial fat or muscle.

Answer: Where to inject fat for BBL. Superficial fat or muscle.

Answer: The Difference Is Increased Risk Of Death

Answer: The Difference Is Increased Risk Of Death

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What is the difference in results for BBL for fat layered into the muscle vs injected into the superficial layer only?

Answers (6)

Answer: Where to inject fat for BBL. Superficial fat or muscle.

Answer: Where to inject fat for BBL. Superficial fat or muscle.

Answer: The Difference Is Increased Risk Of Death

Answer: The Difference Is Increased Risk Of Death

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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.