For a BBL, how likely is it that a top board certified surgeon can accidentally pierce through one of your arteries?

Thanks for your question.This complication is extremely unlikely. Extensive surgical experience will help minimize these significant complications.Please always consult with a board certified plastic surgeon.
Take care,
Moises Salama M.D., Board Certified Plastic Surgeon

A board certified plastic surgeon is well trained to do this procedure while minimizing the risks, including piercing an artery while injecting fat. How they do this is by only injecting fat under the skin and above the muscle. By injecting fat superficially and not injecting under the muscle, you are more likely to avoid those arteries. Additionally, blunt cannulas are used to inject the fat, which makes it less likely to pierce or cut anything. 

So the deaths that have occurred due to BBLs have been due to traumatic injury to large veins located deep in the muscles of the buttocks.  Board certification is very important, but so is proper training. There are plenty of board certified surgeons who do not have good training which results in more serious and more prevalent complications. The american society of plastic surgeons really stressed board certification (which is important) but experience and proper training are equally as important. Many of the complications which have occurred in places like Miami are from the same surgeons or same groups of surgeons. That being said, complications are possible in anyone. I utilize techniques to minimize the risk for the patient as much as possible. In my opinion, you're not performing good surgery if it's not safe surgery. Best,~Dr. Sieber

There have been several deaths in the past associated with BBL procedures.  These cases have been carefully reviewed by the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).  Autopsies have shown that, in these cases, the large veins deep in the gluteal muscles were pierced causing fat to be released into the circulatory system and resulting in fat emboli to lodge in the lungs.  At the time it was felt that injecting fat deep in the muscle may result in better viability of the injected fat cells.  Due to this issue the ASPS and ASAPS have advised their board certified members to avoid injecting the fat deep into the gluteal muscle and to avoid the known areas where these large veins and arteries are located.  They have also advised to using larger bore, blunt tipped cannulas to inject the fat which should further reduce this risk of piercing a blood vessel.   Although, no surgeon can guarantee zero risks with any surgery, a well trained, board certified, plastic surgeon should be able to easily follow these reasonable guidelines and minimize the risk of fat emboli.  Best wishes, Dr. Lepore.