Does ultrasound monitoring for BBL make it safer?

Ultrasound-guided BBL is an additional safety step. The ultrasound allows you to see the area (plane) in which you are injecting fat to ensure the fat stays above the muscle. Placing the fat under or in the muscle can create complications. Not every surgeon uses it as it requires training. At the moment The Florida Board of Medicine mandates the use of an ultrasound for BBLs performed in the state of Florida.

There is very little conclusive evidence clearly defining risk factors for the BBL procedure. It is assumed that the risk of fat embolism is related to improper injecting techniques injecting deep into the gluteus muscle. This was at one time considered standard of care because grafting fat into muscle gave better fats survival percentages and improved results. The procedure was at one time reported as having a fatality incidence of one in 3000. That is approximately the same risk as driving an automobile by an average driver for three years.
The main area of concern is the gluteal vein which is deep to the gluteus muscle anatomically. Plastic surgeons who follow safety recommendations by the American Board of plastic surgery should have far lower incidences of this complication.
Many of the fatalities that happened especially in Florida were in the hands of a handful of rogue providers. there were two surgeons neither one who was trained or board certified in plastic surgery who had combined nine fatalities. those doctors are no longer providing these procedures. providers such as those will skew statistics making the procedure seem more dangerous than it may actually be if patients choose properly trained and experienced surgeons.
Using proper surgical technique and purposefully avoiding dangerous situations should make the procedure much safer. There are currently no evidence that correlates surgical technique including the use of ultrasound with improved outcomes that I am aware of.
While serious medical complications grab the headlines and cause great anxiety for a number of people the incidence is still fairly small when the procedure is done properly. In my opinion patients should be more concerned about being left disfigured by plastic surgeons who lack skill and experience than of medical complications though obviously both should be taken seriously and risks minimized whenever possible.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe. This includes plastic surgeons.
Results are permanent and more or less irreversible.
In the end patients have to make their own decisions as do surgeons in regards to what is appropriate and what is not.
My recommendation is for patients to select the most talented and experienced surgeons based on having multiple in person consultations with local board-certified plastic surgeons in their community.
I do not recommend people travel long distances for elective surgical procedures and recommend having in person consultations instead of virtual consultations.
During in person consultations ask each provider about techniques and how they perform the procedure. Also ask each provider to show their entire collection of before and after pictures especially of patients with similar body characteristics to your own.
Seeing a handful of pre-selected pictures is insufficient to get a clear understanding of what average results look like in the hands of each provider.
Different plastic surgeons also have very different views on what is attractive and appropriate when it comes to the female figure.
There is unfortunately far too many providers creating absurd body contours that are unnatural and unforgiving to correct once done.
An experienced plastic surgeon should have no difficulty showing you a minimum of 50 sets of before and after pictures for this fairly common procedure. Highly experienced surgice will have hundreds or even thousands of before and after pictures for this procedure.
I also recommend reading all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
Continue having consultations until you feel comfortable with having selected the most appropriate provider for your needs.
All surgeons take the potential risk of serious complications seriously and the current standard of care is to incorporate the safety measures described by the American Board of plastic surgery. Florida is unique in it’s a requirement to use ultrasound guidance for the procedure. It is not clear if this actually makes the procedure safer. Government agencies are notorious for failure to react in time followed by overreacting. I question if Florida rules should be the standard of care. time will tell.
Best,
Mats Hagstrom MD