NEW YORK, NY (August 2, 2018)– Recent deaths and serious complications associated with the popular Brazilian Buttock Lift Procedure (BBL) have prompted 5 of the world’s top plastic and cosmetic surgery-related organizations to come together to form an Inter-Society Gluteal Fat Grafting Task Force. The Task Force was formed to examine the causes behind these tragic incidences to try to prevent them from occurring through a variety of physician and patient safety education measures, including unprecedented research. The American Society for Aesthetic Plastic Surgery (The Aesthetic Society), the American Society of Plastic Surgeons, (ASPS) the International Society of Aesthetic Plastic Surgery (ISAPS), the International Society of Plastic and Regenerative Surgeons (IPRES), and the International Federation for Adipose Therapeutics and Science (IFATS), have all recognized that the death rate for BBL Procedures, (approximately 1/3,000) is the highest for any aesthetic procedure and accordingly, action must be taken now in order to prevent further tragedies from occurring.
“We believe that it is essential for our organizations to come together to address the complication and death rate associated with an increasingly popular aesthetic procedure in order to change the course of these adverse events as much as is possible in the name of patient safety,” states W. Grant Stevens, MD, President of the American Society for Aesthetic Plastic Surgery.
In 2017, there were three deaths in the state of Florida alone from the BBL procedure. Consequently, the Task Force is ramping up its efforts to conduct further research and spread the word about best practices for the procedure to all physicians worldwide, regardless of their area(s) of expertise.
To-date, the societies have reviewed autopsy reports that have made it evident that all deceased BBL patients have had specific findings in common, including:
- Fat in the gluteal muscles
- Fat beneath the muscles
- Damage to the superior or inferior gluteal vein
- Massive fat emboli in the heart and/or lungs
Further, the Task Force has identified factors that added additional risk to the procedure as well as those that proved to be protective and/or preventative. These findings have led to the adoption of the following recommendations:
- Avoid injecting fat into the deep muscle. No deaths have occurred with fat found only in the subcutaneous plane, (under skin but over muscle)
- Avoid gluteal veins and the sciatic nerve. Fat should only be grafted into the superficial planes with the subcutaneous space considered safest.
- Use a >4.1 mm single hole injection cannula and instrumentation that offers control, avoiding bendable cannulas and mobile luer connections. Vibrating cannulas may provide additional tactile feedback.
- Avoid downward angulation of the cannula.
- Position patient and place incisions to create a path that will avoid deep muscle injections.
- Maintain constant three-dimensional awareness of the cannula tip.
- Only inject when the cannula is in motion to avoid high pressure bolus injections.
- Consider pulmonary fat embolism in unstable intra- and post-operative patients.
- Review gluteal vascular anatomy and draw landmarks to identify and avoid injection into the pedicle.
- Include risk of fat embolism and surgical alternatives in the informed consent process.
“These guidelines should be adhered to by anyone performing the BBL procedure in order to curtail complications as much as is possible,” states Dr. Stevens.
Additional research is being conducted in the form of more anatomic studies via cadaver labs, injectable dye studies with ultrasound and fiberoptic equipment, cannula testing, injection depth testing and specific site injection testing. Once those results are finalized, a comprehensive set of guidelines for the procedure will be submitted for publication in the major clinical journals.
For any patients interested in the procedure, they should be advised to research board-certified plastic surgeons in their area that specialize in BBL and should ask to see before-and-after photos and ask for patient references.
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