Striving for Improved Safety and Efficacy in Brazilian Butt Lift (BBL)
Anatomically-shaped buttocks contribute to the overall aesthetic balance of the body when appropriately aligned with a sculpted torso and contoured breast profile. Surgical decisions for enhancement or reduction at any of these regions are based on the patient’s ideal image of herself as well as her age, height, weight, ethnic considerations.
Buttock augmentation can be accomplished with a number of alternative procedures that include, but not limited, by the insertion of gluteal buttock silicone implants, increasing the bulk of the gluteal muscles by exercise or radio-frequency stimulation, and fat grafting.
In 2017, the Aesthetic (Plastic) Surgery Education and Research Foundation (ASERF) formed a Gluteal Fat Grafting Task Force that reported gluteal fat grafting (aka Brazilian Butt Lift) to be a high-risk procedure and recommended specific surgical techniques to decrease the risk of fatal pulmonary fat embolism (PFE). The task force determined that the mortality rate for BBL ranged from 1 in 2250 to 1 in 6214. The major societies (ASERF, American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, International Society of Aesthetic Plastic Surgery, and the American Association for the Accreditation of Ambulatory Surgical Facilities) began a systematic education campaign to inform their members of the inherent risk of performing BBL surgery and what techniques and equipment could be used to minimize these risks. Subsequent anatomic studies confirmed their recommendations of the Task Force and showed the unique anatomy of the buttock region with prominent vessels that increases the risk of disastrous results from fat injections in the buttock very different from fat injections in faces or breasts.
Task Force Recommendations
- Subcutaneous fat grafting only with avoidance of injecting into or below muscles
- Use of wider than 4.0mm diameter, single-hole, non-flexible cannula
- Avoidance of downward injections and only inject when cannula is in motion
- Proper position of the patient to avoid deep or muscle injections
- Review gluteal vascular anatomy
- Include the risk of fat embolism and give surgical alternatives in the informed consent
As a consequence of the educational campaigns and research findings, improvements in technique and anatomical awareness of muscular and submuscular presence of large vessels have resulted in increased safety and efficacy for BBL surgery. Despite these improvements in the last three years, members of the plastic surgery societies acknowledge that much more needs to be done to establish adoptive uniform guidelines about safety issues from larger meta-analyses of unbiased survey data and the use of safe precautions and judgment with individual plastic surgeons.
Dr. Sasaki will provide you with evidence-based information about each of these procedures and guide you to safe and effective options.