Safety Guidelines for BBL

An Inter Society Gluteal Fat Grafting Task Force was formed to analyze the deaths resulting from Brazilian Butt Lift.  After their investigation, they made the following recommendations, which all WAGS members agree to follow: 

1)   Stay as far away from the gluteal veins and sciatic nerve as possible. Fat should only be grafted into the superficial planes, with the subcutaneous space considered safest. If the aesthetic goal requires more fat that can be placed in the subcutaneous layer the surgeon should consider staging the procedure rather than injecting deep.

2)   Concentrate on the position of the cannula tip throughout every stroke to assure there is no unintended deeper pass, particularly in the medial half of the buttock overlying the critical structures.

3)   Use access incisions that best allow a superficial trajectory for each part of the buttock; avoid deep angulation of the cannula; and palpate externally with the non-dominant hand to assure the cannula tip remains superficial.

4)   Use instrumentation that offers control of the cannula; avoid bendable cannulas and mobile luer connections. Vibrating injection cannulas may provide additional tactile feedback.

5)   Injection should only be done while the cannula is in motion in order to avoid high-pressure bolus injections.

6)   The risk of death should be discussed with every prospective BBL patient.

The following are links to helpful articles written by members of the Task Force, with detailed pictures regarding gluteal anatomy and the safe way to perform Brazilian Butt Lift surgeries:

•Staying Safe During Gluteal Fat Transplantation, Plastic and Reconstructive Surgery, January 2018

•Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force; Aesthetic Surgery Journal, July 2017

•Acceptable Risk: Who Decides? Editorial by Foad Nahai, MD, Aesthetic Surgery Journal, July 2017


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