I want a BBL with highest survival rate, should fat be injected into subcutaneous space or in muscle?

BBL can be a very dangerous procedure if the fat is injected into the muscle.  Our plastic surgery society recommends that the fat be injected above the muscle to prevent fat embolism.  Currently it has the highest death rate of all the plastic surgery procedures that are performed so make sure you see a board certified plastic surgeon who is experienced with this operation.

Fat embolus is a very serious and known complication of fat transfer/BBL (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 survival, this does come with a significant increase in risk to patient survival. 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 (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, it 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.

Hello BrittE92,
I understand your concerns. As with every surgery, there are some risks associated with Brazilian Butt Lift (BBL), such as fat embolism, numbness, and infection, among others. Research conducted by the American Society of Plastic Surgeons (ASPS) has uncovered that fat embolism (blood clot) in the heart and/or lungs occur in cases in which a plastic surgeon inject beyond the subcutaneous fat layer (in and beneath the gluteal muscles). However, an experienced and specially trained plastic surgeon can help diminish those risks significantly. Moreover, BBL final results can be permanent. Usually, a highly skilled and experienced plastic surgeon will achieve around 65% to 85% survival rate of the fat cells, and the rest will be harmlessly reabsorbed by the body. BBL patients can actively contribute on the success of the procedure and longevity of the results by following their surgeon’s recovery recommendations. I typically suggest my patients avoiding cigarettes and heavy drinking because these habits reduce circulation throughout the body, leading to the degradation of new cells. Another fundamental measure is wearing specialized compression garments around the clock (except for showering) during six months, to reduce swelling and help their skin contract smoothly to their new body’s contours. Additionally, at least ten lymphatic drainage massage sessions are required, starting 24 hours after the procedure, to eliminate excess lymph fluid, alleviate swelling and discomfort, and also prevent complications such as seromas (fluid collection) and contour irregularities (indentations, and/or fibrosis). In my experience, patients who successfully avoid sitting or putting pressure on their buttocks or stretching for the first 8 weeks after their surgery are much more likely to have long-lasting results than patients who fail to follow this advice. Hope this is helpful! Dr. De La Cruz.