Practice Advisory on Gluteal Fat Grafting

Abstract

On January 31, 2018, The Multi-Society Task Force for Safety in Gluteal Fat Grafting released a Practice Advisory regarding gluteal fat grafting. The Task Force was assembled in the wake of several highly publicized patient deaths involving Brazilian Butt Lift ("BBL”) and produced a second practice advisory in August 2019. In 2021 the ASAPS President commissioned a Working Group on BBL Patient Safety, charging the Group to address new guidelines affecting safety and welfare of BBL patients. The “Practice Advisory on Gluteal Fat Grafting” is the first advisory developed since the Working Group was formed. In addition to surgical technique as a major cause of fatal complications of BBL, the Working Group focused on micro-economic trends of operative time and regional BBL pricing and considered fatigue and distraction in formulating the current guidelines. In Florida the majority of BBL deaths occur at the end of the week. Such a non-normalized distribution most likely represents the result of fatigue and/or distraction, which has been linked to surgical mortality in multiple published communications. In addition, mortality is likely due to uncertainty or lack of documentation as to the correct plane of fat injection. Therefore, the newest and most compelling recommendations from these guidelines include the use of ultrasound-guided documentation of cannula placement prior to and during fat injection, and the limitation of 3 BBL cases as a maximum amount of total operative cases per day. The authors thank members of the Task Force for the insights they brought to this process.

Adipose Tissue Transfer in Dynamic Definition Liposculpture Part II. The Lower Limb: Gastrocnemius, Vastus Medialis, Vastus Lateralis, and Rectus Femoris Muscles

“…24,25 In addition, the newest recommendations for gluteal adipose grafting (after the 2018 practice advisory from the Multi-Society Task Force for Safety in Gluteal Fat Grafting) include the use of ultrasoundguided documentation of cannula placement before and during fat injection and the limitation of three BBL cases as a maximum amount of total operative cases per day. 26 To our knowledge, there has not been any fatality or pulmonary fat embolism reported in the medical literature after IM fat grafting in a muscle other than the gluteus major, [27][28][29][30][31] or any case report of ACS following aesthetic procedures of the lower limb. [32][33][34] Animal studies have shown that IM fat grafts have no association with long-/ short-term events of fat embolism after autologous fat transplantation, which further supports the special case of the gluteus major muscle.…”

A New Classification for Adipose-derived Stromal-cell Systems

“…Preferring the desired fat size will not only create the desired result, but also allow for regeneration in the superficial area. 16 …”

“…Preferring the desired fat size will not only create the desired result, but also allow for regeneration in the superficial area. 16 In order for the fat graft to be successful in radiation injury and burn reconstruction, two basic problems must be solved. These are high pressure and vascular insufficiency.…”

Body Contouring and VASER Technology, the Fourth Dimension

“…The procedure has been made even safer with the advent of handheld high-definition ultrasound, which gives a visual on the anatomical location, and depth of the transferred fat into the buttocks, thus avoiding the gluteal muscles and reducing risks of embolus and vascular origin complications [38][39][40][41].…”