Many women seek a procedure that will provide fullness and lifting to their buttocks. Although implants have long been available to add volume to the buttocks, they have not achieved widespread acceptance. This is probably because of the difficult recovery and the relatively high rate of complications associated with buttock implants.
Gluteal fat reinjection – more commonly known as “The Brazilian Butt Lift” – has become far more popular for buttock augmentation than the use of silicone implants and, for the most part, was considered to be quite safe. This procedure utilizes a patient’s own fat which is extracted from other areas of their body using liposuction and reinjected not only in the fatty tissue of the buttock, but also into the underlying muscle. It was felt that injecting the fat directly into the muscle would provide for a greater “take” and less absorption of the graft because of the increased blood supply to the muscle.
Fat reinjection, in general, has enjoyed a huge increase in popularity. I must confess, I have never shared the general enthusiasm of many other cosmetic surgeons. Largely used for filling of facial laxity, numerous cases of irregularity and reabsorption following the procedure have been reported. Much of the fat is absorbed by the body leading to the need for multiple injections and, at least in my opinion, relatively unpredictable results.
However, in the case of buttock reinjection, it was a case of either using the fat or discarding it. For that reason, several years ago we began offering the procedure to patients requesting it. We always cautioned patients of the relatively high risk of reabsorption, and, indeed, this was often the case. However, patients did seem to be pleased with the results, at least in the short term. Unfortunately, we did not have enough long term followup to know whether the results held up over the long term in a significant number of patients.
From the start, there were anecdotal reports of deaths due to embolization of fat. Embolization refers to globules of fat being transported in the venous blood system to the heart, lungs or brain. At first, these reports were attributed to surgery being performed by inexperienced or unqualified individuals. Unfortunately, it has turned out to be a far more serious issue. Deaths have been reported following the Brazilian Butt Lift surgery performed by well qualified surgeons. Actually, the estimated death rate following this procedure far exceeds that of any other cosmetic surgery generally performed.
Current theory suggests that the problem is the result of injecting fat into the muscle. As stated above, the muscle is very vascular and, if one of the many large veins is penetrated, fat can actually be directly injected into the blood stream. Surgeons who accept this theory are recommending avoiding injecting fat into the muscle and are injecting smaller amounts of fat only into the fatty tissue of the buttock. While there is a significant amount of logic in this theory, it is still unproven.
For this reason, we have decided that the safest alternative is to avoid this procedure until, if and when, it is proven to be as safe as any other cosmetic surgery. As we always advise our patients, cosmetic surgery is elective and safety is our most important consideration.