Plastic Surgery Task Force Recommendations and Standard of Care on BBLs per ASPS
The Plastic Surgery Task Force on the Brazilian buttlift advised doctors to:
- 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 than can be placed in the subcutaneous layer the surgeon should consider staging the procedure rather than injecting deeply.
- 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.
- 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.
- Use instrumentation that offers control of the cannula; avoid bendable cannulas and mobile luer connections. Vibrating injection cannulas may provide additional tactile feedback.
- Injection should only be done while the cannula is in motion in order to avoid high pressure bolus injections.
Dr. Kenneth Hughes of Hughes Plastic Surgery in Los Angeles and Beverly Hills designed these maneuvers almost 8 years ago to help minimize the risk of fat emboli and death. Dr. Kenneth Hughes refers to this as a subdermal injection technique in which fat is injected with large cannulae directly under the skin, visualizing the tip of the cannula at all times.
Dr. Kenneth Hughes has performed 2500 BBLs since that time without a death from fat embolus or fat embolus of any kind. It is important to realize that even if fat emboli are not fatal they can produce many other complications due to the inability of the lungs to deliver the oxygen the body needs to critical organs like the brain, kidneys, and heart.
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