Brazilian Butt Lift involving fat transfer to the buttocks had been recently become very popular. As in any surgery, there are risks and complications, especially when combined with fat injection. There had been numerous case reports of fat embolism that have been documented. The possible explanation for these cases may be attributed to the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned.
Figure 1: 4D VASER Hi-Definition Liposuction with Fat Transfer to the Buttock (Before & After Procedure: 6 weeks after surgery) performed by Dr. Emmanuel De La Cruz
What are the risks of Fat Embolism during Brazilian Butt Lift?
Fat embolism with Brazilian Butt Lift is more common in South America (Columbia and Brazil- ~7%) than it is here in the US.
Twenty-five fatalities were confirmed in the United States over the last 5 years through of autopsy reports and interviews with surgeons and medical examiners. Four deaths were reported from 2014 to 2015 from pulmonary fat emboli in AAAASF facilities.
How to Prevent Fat Embolism in Brazilian Butt Lift
1)Knowing the Anatomy of the Perforators of Gluteus muscle is Key to Avoid iatrogenic injury the vessels Cadaveric studies have shown that the area under the gluteus muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the gluteus muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. Cadaveric studies have shown that the angle of fat injection is important in avoiding injury to the gluteal perforators. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.
2)The fat is injected ONLY when the cannula is being withdrawn. This minimizes the risk of vessel puncture.
3)Use of blunt cannula during fat injection. The blunt cannula is used to decrease the likelihood of penetrating a blood vessel.
4)Avoid downward slope injection of fat into the buttock since the likelihood of iatrogenic penetration of the gluteal perforators is higher.
5)Avoid injection of fat into the gluteus muscle. Intramuscular gluteal lipoinjection was found to be associated with mortality caused by gluteal blood vessel damage allowing macroscopic and microscopic fat embolism
Preventing Fat Embolism Syndrome
1)The use of methylprednisolone as a “membrane stabilizer” would reduce the incidence of Fat Embolism Syndrome. Pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78%.
Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon Houston, Texas
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Cardenas, et al. Deaths Cause by Gluteal Lipoinjection: What are We Doing Wrong? Plast Reconstr Surg. 2015 Jul;136(1):58-66. doi: 10.1097
Mofid et al. Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthet Surg J. 2017 Mar 21. doi: 10.1093/asj/sjx004. [Epub ahead of print]
Ramos-Gallardo, et al. Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers. J Invest Surg. 2017 May 9:1-6. doi: 10.1080/08941939.2017.1321703. [Epub ahead of print]
Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroid: A prospective study in high-risk patients. Ann Int Med. 1983;99:438–43.