Leading plastic surgery organizations are issuing a loud warning call about the risks associated with the popular Brazilian Butt Lift.

“[The] procedure … has resulted in a mortality rate that is estimated to be as high as 1:3,000, greater than any other cosmetic surgery,” according to an  American Society of Plastic Surgeons (ASPS) statement. “With the number of procedures doubling in the last five years, we believe it’s imperative to highlight the associated risks, urge the discussion of potential outcomes with patients and conduct further studies to better understand the risks and whether there are surgical techniques that would enable surgeons to perform this procedure safely.”

The ASPS joined with four other surgical organizations to form the Task Force for Safety in Gluteal Fat Grafting.

“Action must be taken now in order to prevent further tragedies from occurring,” says Grant Stevens, MD, FACS, a board certified plastic surgeon, founder of Marina Plastic Surgery in Marina del Rey, CA, and president of American Society for Aesthetic Plastic Surgery (ASAPS/The Aesthetic Society) in a news release. ASAPS is part of the Task Force along with ASPS, The International Society of Aesthetic Plastic Surgery, the International Society of Plastic and Regenerative Surgeons and the International Federation for Adipose Therapeutics and Science. “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 for patient safety.”  

To date, the Task force has reviewed autopsy reports that have made it evident that all deceased BBL patients have had specific findings in common, including:

1. Fat in the gluteal muscles
2. Fat beneath the muscles
3. Damage to the superior or inferior gluteal vein
4. Massive fat emboli in the heart and/or lungs  

The Task Force has identified factors that added additional risk to the procedure as well as those that can be protective and/or preventative. These findings have led to the adoption of the following recommendations: 

1. Avoid injecting fat into the deep muscle. No deaths have occurred with fat found only in the subcutaneous plane.
2. Avoid gluteal veins and the sciatic nerve. Fat should only be grafted into the superficial planes with the subcutaneous space considered safest.
3. 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.
4. Avoid downward angulation of the cannula.
5. Position patient and place incisions to create a path that will avoid deep muscle injections.
6. Maintain constant three-dimensional awareness of the cannula tip.
7. Only inject when the cannula is in motion to avoid high pressure bolus injections.
8. Consider pulmonary fat embolism in unstable intra- and post-operative patients.
9. Review gluteal vascular anatomy and draw landmarks to identify and avoid injection into the pedicle.
10. Include risk of fat embolism and surgical alternatives in the informed consent process. 

“These guidelines should be adhered to by anyone performing the BBL in order to curtail complications as much as is possible,” Dr. Stevens says.   

Additional research is being conducted in the form of more anatomic studies via cadaver labs, injectable dye studies with ultrasound and fiber optic 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 major clinical journals, Dr. Stevens says.