Why don’t doctors use ultrasound to minimise risk during a Brazilian butt lift?

There are some surgeons using ultrasound to evaluate depth of injection during fat grafting this is not mainstream, and may never become widely used. There are some new cannulas being developed to differentiate between injecting into fat and muscle, but these are in the early stages. For experienced injectors, an ultrasound is not required to ensure safe depth of injection, which is subcutaneous.Watch this brief video for more information.Best wishes,Dr.Bruno

Thank you for your question.
The problem with intra muscular and intra vascular injections could be solved with use of intra operative ultrasound as you have suggested. There are however practical problems with this approach at this time. A surgeon who is well aware of the anatomy and stays above the muscle will avoid this problem without additional modalities. In the future, however, intra operative ultrasound may become a useful addition to the procedure. All The Best !

During a Brazilian Butt Lift operation, using ultrasound to make sure that you do not inject the fat too far is an idea that has practical limitations, as it would have to be in real time to really safeguard this. It's important that the surgeon plans the operation anatomically to ensure they don't go deep under the muscle. 

That's a great question!It's something that's being looked at for the future in order to avoid injections into the blood vessels within the muscle. Please always consult with a board certified plastic surgeon.All the best,Moises Salama MD, board certified plastic surgeon

Thank you for the question. To minimize the complications new guidelines have been issued. One of the recommendations is to inject only in subcutaneously using larger cannula. US can be used however person injecting has to be trained. It is best to consult with a a board certified plastic surgeon. Good luck.

This is a great question! Recently, the media and news outlets have stirred up some concerns regarding the BBL procedure. It is true that outdated techniques have led some surgeons to inject fact into the deep fascia and gluteal muscles, which in turn can cause fat to travel to the heart and lungs. This is where the problems occur. Newer and safer guidelines recommend only injecting fat into the subcutaneous layer and strictly avoiding the muscles. There are many different techniques that can be used to ensure that fat is only being injected into the subcutaneous layer, such as, choice of instruments and cannulas. An ultrasound machine could definitely be utilized, however the knowledge, acceptance utilization of the new guidelines may be enough to make the BBL procedure as safe as possible.Please check out this video dedicated strictly to safe BBL techniques and the new associations dedicated to spreading these new and safe guidelines.Please discuss any other questions or concerns with your Board Certified plastic surgeon and their care team.

Great question! Your demonstrates that you understand the core challenge surgeons face in performing gluteal fat transfer.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.
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. 
Relatively speaking, the subcutaneous plane is the "safe" plane. It is unclear how the relative risk falls with subcutaneous injection vs. intramuscular injection (however, in all likelihood, it is less).With regards to your specific question, some surgeons do use ultrasound to identify and avoid vessels at risk for inadvertent cannulation and injection. This can also help prevent injury to the vessel which has also been proposed as a passive mechanism for emboli (i.e. if the vessel is injured...there is a low pressure system within which contrasts with the high pressure environment of a gluteus filled in some cases to capacity).Ultimately, this may become a universally accepted protocol. However, cost and logistics are probably a limiting factor for employing US routinely in these cases.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Hello and thank you for your question. While ultrasound could further minimize risk during a Brazilian butt lift (BBL) procedure, a skilled and board-certified plastic surgeon should be able to achieve safe and successful results without using advanced imaging. Additionally, adding ultrasound to a BBL would drive up the cost of the procedure for an unnecessary reason. Some plastic surgeons may perform BBL while using ultrasound, but it is uncommon and not typically necessary.
If you have any questions about BBL or want to find out if it’s right for you, schedule a consultation with a plastic surgeon. Make sure they are board-certified before moving forward. Hope this helps! Michael Eisemann M.D.
Plastic Surgeon
Houston, Texas

I am not sure if the utility of US has been tested or not. Even if it worked to help safety, it would add significant time to the OR/anesthesia fees meaning the cost of surgery would go up. It is my experience that many patients choose their surgeon by cost which is why it is still very popular for patients to travel to Miami and out of the country to have a BBL. If board certified PS here in the US raised out prices any more, my guess is more patients would choose to travel to the cheaper locations. It is very dangerous to have your BBL in Miami or out of the country - the death rate is much higher than the 1/3000 here in the US. Most of the US deaths contribution to the 3000 are out of Miami. 

BBL is performed with ultrasound to assure proper placement of the fat graft. If you are a good candidate for a Brazilian Butt Lift (BBL), the optimal outcomes are achieved with: 1) use of VASER liposuction to harvest the fat, 2) a closed looped system such as Puregraft to process the fat, and 3) strategic micro-packet transplant technique. These three processes have demonstrated over 95% fat graft take. This means that your results will be stable as long as you maintain your weight. As an official VASER trainer, I am routinely referred unhappy BBL patients. One of the most common reasons for disgruntled BBL patients is that patients are not able to accurately communicate their desired buttocks goals to their surgeons.  A buttocks assessment tool can be an invaluable tool to communicate to your surgeon the exact buttocks size and shape you are desiring. A Skype or Facetime consultation with a BBL specialist can help you get an accurate recommendation and pricing. 
Respectfully,
Arian Mowlavi MD,FACS
Realself 100 Hall of Fame Inductee