Fatal Complications of Aesthetic Techniques: The Gluteal Region

Abstract

Cosmetic procedures are common and utilize many techniques to obtain aesthetically good outcomes for patient satisfaction with acceptable safety standards. Cosmetic procedures that involve the gluteal region are becoming increasingly popular as various procedures can target the gluteal region such as liposuction, tumescent liposuction, cosmetic filler injections, autologous fat transfer, depot drug delivery, and implants. Complications of cosmetic gluteal procedures can be localized or systemic with systemic complications being responsible for most deaths. These reported systemic complications include sepsis, thromboembolism, fat embolism with or without fat embolism syndrome, macroscopic fat embolism, anesthesia-related and blood volume abnormalities. We herein report 10 deaths due to elective gluteal cosmetic procedures. Autologous fat transfer (fat grafting, lipoinjection) following liposuction resulted in 8 of 10 fatal outcomes of the gluteal aesthetic procedures. A comprehensive discussion of gluteal anatomy, gluteal contouring procedures, and the approach to such cases is presented along with the autopsy findings of the reported cases.

Granulomatous reaction to autologous gluteal fat transfer

“…When compared with gluteal implantation, this procedure improves cosmetic appearance of scars, reduces complications, and has led to increased patient satisfaction with outcomes 1, 2. Common complications with implants and artificial fillers include seromas, capsular contractures, implant migration, wound healing complications, thinning of native tissues, infections, and foreign body responses 3, 5, 6. Lipogranulomas may be an example of foreign body reactions to lipid or oil-like substances, which result from the inability of the body to metabolize exogenous lipids in the tissue interstitium.…”

“…Unfortunately, surgical excision is not always practical depending on the location and extent of the lesion. Other sources conjecture that complications such as these might be prevented by proper technique in the operating room to ensure viability of the fat cells 3 . However, it seems that these complications may be an inherent risk of the procedure.…”

“…Potential risks include common complications such as fat necrosis, seroma formation, and cellulitis 1 . More serious complications have also been reported, including life-threatening infections and potentially fatal fat emboli, especially in gluteal fat transfer 1, 3. The American Society of Plastic Surgeons recently issued a warning identifying gluteal fat grafting as the aesthetic procedure with the highest mortality rate (1 in 3000 procedures) 4 .…”

Assessment of Different Modalities in Gluteoplasty

“…24,34 However, recent recommendations are to limit gluteal fat injection to the subcutaneous plane and to keep continuous motion of the cannula during injection, preventing any bolus deposition of fat. [35][36][37][38][39][40] Implant gluteoplasty patient survey results showed a mean value of 4.25 for overall patient satisfaction (over a scale from 1 to 5). Fat transfer gluteoplasty results showed the mean value of 4.75.…”

Migration of liquid silicone, an emerging contraindication of neuraxial anesthesia

“…Severe health problems have been documented in some cases such as pulmonary embolism, renal failure, tissue necrosis, and even fatalities. (1,5,6) Its wide use in cosmetic procedures is due to its low cost, durability and thermal stability. Contrary to what was expected, and despite the fact that injected solutions are chemically inert, they give rise to different levels of local inflammatory reactions and necrosis.…”