Danger risks with having BBL?

Question

I’m going to have this done in November I’m just choosing my surgeon and am quite scared about having something done as I’m worried about any of the implications. Has anything gone wrong for anyone?

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 (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.

Luis A. Mejia, MD · Answer

Hello thank you for your question and provided information as well.., based on your question, the first thing is that if you do not have basic pathology and you are in good health, and most importantly if it is the studies indicated by your certified plastic surgeon, everything goes ok, I do not see why you had any problem.but my recommendation is that you consult everything concerning your plastic surgeon.

Erika Sato, MD, FACS · Answer

The BBL can be very dangerous. There is a 1/3000 death rate here in the US and 7% death rate our of the country (DR/South America/Mexico etc). Death is caused by a fat embolus. I love this procedure...I do it often...and have had little to no complications and definitely NO death. Do your homework. Find a board certified PS that does a large number of this procedure and follows all the safety guidelines in place by the task force (ASPS).

Douglas Taranow, DO, FACOS · Answer

Dear Holly,YES.   There are much higher risks with doing a BBL than almost any other cosmetic procedure out there.  Any surgeon who tells you differently is either lying or does not read any articles.  The BBL has similar risks of bleeding, infection, asymmetry, blood clots...etc as all other procedures.  It does have an unusually high rate of fat embolus  (fat ending up in a blood vessel) not seen in any other procedure and also fat necrosis (fat that does not survive and is absorbed by the body).  These emboli have only been reported with injection of the fat into the muscle of the buttocks.  This is the major reason why myself (and many other surgeons) only inject the fat into the subcutaneous fat already found in the buttocks.Good luck with your research.Dr T

Steven Wallach, MD · Answer

There are always risks wirh surgery. While they can  not be completely avoided, ,I think going to an experienced surgeon will help minimize the risks. Good luck.

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