One of the most popular new surgeries is the Brazilian Butt Lift (BBL). In this operation fat is harvested from the waist and abdomen, purified, and re-injected into the buttocks. (If you want to see what that looks like click here) Most patients assume that this is a very safe operation, but the operation has a serious possibly fatal complication. The reinjected fat can be injected directly into a vein, and this fat can then travel with the blood flow to the lungs where it can foul the entire circulation. This is called a fat embolus and this can prove fatal.
The research arm of the Aesthetic Society, (The Education and Research Foundation) has formed a task force to study Fat Embolism in BBL. There findings will soon be published in their peer reviewed journal. (I will update you soon)
Some of the Task force findings are available now. Of the ~100,00 BBL surgeries in the US we suspect that there have been 23 Embolism deaths – a rate of 0.023%. While this rate is very low, the data was very raw and unreliable. The Task Force reviewed the data of 612 member surgeons who performed nearly 20,000- BBLs. They reported a 0.016% fatal embolism rate. However a recent survey of 18,000 surgeries tabulated to a 0.029% embolism rate.
Several technical factors have been identified by the task force. The use of deep muscular injections into the deep Gluteus Muscles are associated with a higher embolism rate.The use of small bore reinfection needles resulted in a high injection pressures. This has also been associated with a higher embolization rate. This would seem logical as the deep muscles contain more large veins, and small bore reinfection cannula could easily enter these veins resulting in a direct intravascular fat injection.
In our own practice we want the patients to understand that BBL is not a low risk surgery that BBLs have a real fatality rate. The rate is still very low (between 0.016% – 0.029 %), but not zero. We have made several changes in our operative technique to lower this risk even more. We now use a state of the art very large vibrating basket probe for re-injection and we avoid deep muscular fat injections, thus keeping the chances for intravascular injections as low as possible. We continue to have very satisfied patients with wonderful results. We have been successful in avoiding fat embolisms and we constantly strive for safety in cosmetic surgery.
Take home points.
- Fat embolism is a complication of BBLs
- The rate nationally is probably 0.02% fatality
- Intravenous fat injection is probably the cause
- Large bore vibrating basket canulla-s reduce the chance
- Deep intramuscular injections are avoided