BBL and best and safest place to put the fat: Into the muscle? Below the muscle? In the superficial fat? Confused.

I have been performing this procedure safely for 15+ years and the new data emerging about the increased mortality rates is disturbing. It is good to see patients doing their homework and researching this procedure and asking questions.
Fat injections should be made into the subcutaneous space, which is the area above the muscles, and avoid injecting deep into the muscle. Pulmonary Fat Embolism (PFE) occurs when a vein wall is injured during the injection process thus allowing fat to enter the vessel. The most dangerous area is where the inferior and superior gluteal veins emerge from the pelvis to the gluteal muscles. This area must be avoided.
No, if the surgeon is experienced and using the correct processing and re-injecting techniques the results will not be lumpy. Correct injection methods are essential to achieve a uniform, smooth, natural appearance to the buttocks.
To minimize risk, be sure to:
Choose a Board Certified Plastic Surgeon (American Board of Plastic Surgery)Have Your Surgery Performed in an Accredited Surgery Center ((AAAASF, JHCHO)Ask Your Surgeon about Injection Technique DetailsUse IV Sedation with Tumescent Solution instead of General AnesthesiaPlease rigorously vet the credentials of both the Surgeon and the Surgical Facility. The web reference for an in-depth post I published recently to help BBL patients understand the recent media coverage of BBL mortalities because asking all of the right questions can help ensure you're choosing the right surgeon to trust your life with.
Best wishes!

Great Question.It seems like you are doing your research.Recent evidence seems to suggest that BBL has a higher complication rate than most other elective aesthetic procedures. The Aesthetic Society of Board Certified Plastic Surgeons is embarking on research to make the procedure safer.Here are the latest recommendations to make the procedure safer:1) Transfer the fat to the fat above the muscle.2) Avoid injecting into the muscle. Big vessels can be injured deep to the muscle.3) Use cannulas at least 40 mm in diameter when transferring the fat.4) The surgeon needs to have experience with the anatomy.5) Proper positioning and incision placement is key to avoiding injury.6) The surgeon needs to inject fat in a continuous fashion.My advice is to find a Board Certified Plastic Surgeon who has experience and is following these guidelines. Place the fat where the fat belongs- in the fat above the muscle.Good Luck and congratulations on doing your research.

The available experience/evidence on fat transfer to buttocks suggests that the safest approach is injection into the subcutaneous layer rather than deeply into the muscle.  Deeper injections into the muscle appear to have a higher risk for more serious bleeding and embolic complications.

Hi, thanks for your question. The plane for the placement of the fat can be in the subcutaneous tissue, as well as in the muscular plane, both with advantages and disadvantages.The muscular plane is the most effective so that the fat lasts due to its vascularization rate, but in the same way it can increase the possibility of causing a pulmonary thromboembolism. In the superficial subcutaneous plane the loss rate is slightly higher between 30 to 40%, but it is much safer, just as the muscular plane will present a considerable increase in the shape and projection of the gluteus.
Jimenez Toribio, MDPlastic surgeon