Many patients want a bigger butt. In addition to volume, operations can smooth out the torso and make the waist look smaller – all-in-one, and with a patient’s own fat. A buttock augmentation with fat grafting, commonly referred to as a Brazilian Butt Lift (BBL), is a surgical procedure in which fat is removed from one area of the body where the patient has too much and strategically placed in the derrière. While the results are fantastic, tragically, the BBL has been under fire as of late due to patient deaths.
The various plastic surgery societies, whose job it is to put patient safety first, formed an Inter-Society Gluteal Fat Grafting Task Force to examine the underlying cause of these deaths; recently they released an advisory statement. On episode 69 of No Spin Live, the esteemed panel weighs in on these guidelines and whether or not a buttock augmentation with fat grafting can be performed safely.
Is a BBL Dangerous?
The BBL has been around for awhile. It’s popularity has grown significantly as aesthetic eyes move from the breasts to the behind. Whether thanks to certain celebrities on social media, or simply changing fashions, there has been an uptick in patients who want a really big backside. This has led to complications.
Buttock augmentation with fat grafting currently has the highest death rate of any procedure at 1 in 3,000. This is simply not acceptable. “Multiple plastic surgery societies have done some great work,” explains Dr. William P. Adams Jr. of Dallas. They’ve come together in order to get to the bottom of what’s causing these deaths. The Inter-Society Gluteal Fat Grafting Task Force recently came out with an advisory for plastic surgeons with very stringent recommendations. The goal is to insure patient safety.
Buttock Augmentation Advisory Recommendations
What the panel discovered is that all of the deaths to date had four things in common:
- fat in the gluteal muscles
- fat beneath the muscles
- damage to the superior or inferior gluteal vein
- massive fat emboli in the heart or lungs
Despite what some stories have said, no patient who had a BBL with fat injected into the subcutaneous fat layer has died. The task force’s recommendation, therefore, is for any surgeon performing a buttock augmentation with fat grafting to only inject the fat superficially, keeping it well away from the muscle. When performed in this manner, a BBL can be a perfectly safe procedure.
Florida Leads the Change
Dr. Jason Pozner of Boca Raton, agrees whole-heartedly with the task force’s recommendation. It’s something that he has talked about a lot with his colleagues on No Spin Live. Florida is really leading the way when it comes to safety and the BBL. “It is illegal to inject fat under the muscle in the state of Florida now,” he shares.
He thinks that this is a reasonable law that makes sense. Florida has been the hot bed for all of these deaths because it is a state where a high percentage of the buttock augmentation with fat grafting procedures are performed. [Surgeons in Florida have known for a couple of years to] keep the fat above the muscle,” explains Pozner. “It’s a safer plane. I am sure that the death rate will plummet if we all do this and stick to these guidelines.” It’s safer, better for patients, and better for plastic surgery.
Nice Results Attainable with Subcutaneous Buttock Fat Grafting
Dr. Joseph Hunstad of Huntersville, North Carolina has been performing buttock fat grafting procedures for many years with no fatalities. When he first heard about the deaths in Florida, he was really taken aback, and thus agrees with the task force guidelines. “Safety first,” says Dr. Hunstad. “You can get some really nice results with subcutaneous injection… and deliver that really nice shape and not have to violate that muscle.”
Plastic surgeons know the anatomy of the buttock muscles. The problem lies with the huge diameter of the inferior gluteal veins. If the fat gets injected into this vein, “it’s a tragedy right there on the table,” details Hunstad. All of the experts agree that plastic surgeons need to do everything in their power to prevent this from happening.
Multiple Fat Grafts to Build Volume
For patients who want a really full backside, Dr. Pozner points out “you can always go back and graft more fat.” The plastic surgeon can easily follow these guidelines, keep the fat above the muscle, and simply build the volume in the buttocks over time. Dr. Hunstad agrees that it’s best to build the derrière in a staged process. Furthermore, he is always upfront with the patient about the potential risks. If patients understand what is at stake with the BBL, they are not going to want to go too far in terms of size.
See an Experienced Surgeon
It is also vital that patients see an experienced plastic surgeon. “I think the more and more experience you get, the safer you become,” says Dr. Hunstad. With each procedure that he performs, he better understands:
- where to put the fat
- amount of pressure
- how much fat to put in
- which instruments are best to use
Start by finding the board certified plastic surgeons in the area. But, as Dr. Pozner points out, Malcom Gladwell’s book “Outliers” showed us that it takes at least 10,000 hours for someone to become proficient in something. When a patient goes to a plastic surgeon, it is vital to ask how many BBL procedures has that surgeon done. “Many of our people are board certified, but they might do hand surgery and only one buttock augmentation a year.” This is a great person to see for a hand fracture, but not necessarily for a buttock augmentation.
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