Key points
- Buttock fat grafting is a rapidly growing body contouring operation, but there have been reports that its death rate is considerably higher than that of other cosmetic surgeries, so its safety has been discussed continually [1, 4].
- The main risk associated with death is fat embolism, in which injected fat enters the blood vessels and blocks the blood vessels of the lungs [2].
- The death rate, once reported as one in 3,000, appeared as one in 15,000 in recent surveys, but these are survey data from outside Korea [2].
- It has been pointed out that fat embolism is difficult to prevent completely, so the surgical plan and emergency preparedness need to be checked thoroughly [3].
What is buttock fat grafting?
Buttock fat grafting is surgery that refines the volume and shape of the buttocks by transferring fat obtained through liposuction from areas such as the abdomen or waist, and it is also known as a Brazilian butt lift (BBL). With growing interest in the shape of the buttocks in recent years, demand has increased, and methods for systematically assessing the anatomy of the buttocks have also been developed [5]. A 2023 review introduced buttock fat grafting as the fastest-growing body contouring operation and examined efforts to improve its safety [4].
The two main methods of buttock augmentation are fat grafting and implant placement, and a 2018 review assessed both as having clear limitations [1]. It stated that methods using implants also have a number of problems, so neither is an easy choice [1].
Why is safety a particular concern?
A 2018 review stated that the death rate of buttock augmentation using your own fat appears to be considerably higher than that of other cosmetic surgeries [1]. Because of these concerns, the operation has been effectively banned in some countries [2].
According to a 2021 review comparing it with tummy tuck (abdominoplasty), most deaths after a tummy tuck were due to deep vein thrombosis (blood clots in the deep veins) and pulmonary embolism (blockage of the blood vessels in the lungs), whereas deaths after buttock fat grafting were associated with pulmonary fat embolism occurring during the procedure [2]. Fat embolism is a condition in which injected fat enters the blood vessels, travels to the lungs, and blocks the vessels there. For this reason, the depth at which fat is injected and the instruments used to inject it have been discussed as important to safety.
How have reported death rates changed?
At the center of safety concerns about buttock fat grafting was a report of a death rate of one in 3,000 [2]. More recent surveys have since shown a death rate of one in 15,000, and the review stated that, in terms of death rate alone, it appears to be at a level similar to a tummy tuck [2].
However, these figures come from an analysis of a survey by the foundation of an aesthetic plastic surgery society and data from a US accrediting organization for outpatient surgery facilities [2]. Survey data can have limitations depending on how far the responses reach, and the same figures cannot be applied directly to Korean patients. These reports mean that the risk has been reported to be lower, not that the risk has disappeared.
Efforts to reduce the risk
The authors of a 2021 review considered that improvements in the understanding of dynamic anatomy, in surgical instruments, and in technique could greatly reduce pulmonary fat embolism during surgery [2]. Professional societies and surgeons are developing surgical guidelines based on the theoretical causes of fat embolism [1]. A 2023 review also summarized various efforts to improve the safety of this operation [4].
If fat embolism occurs
Macroscopic fat embolism, in which pieces of fat large enough to be seen with the naked eye block blood vessels, has a high death rate and has received considerable attention in plastic surgery [3]. Although much has been written about prevention, it has been pointed out that it is difficult to prevent completely because both technical and human factors are involved [3].
Similar to a pulmonary embolism caused by a large blood clot, macroscopic fat embolism can cause heart and lung function to deteriorate rapidly [3]. A 2020 review proposed a sequence of steps for responding, based on experience in treating pulmonary embolism, and examined the possible use of extracorporeal membrane oxygenation (ECMO, a form of heart and lung support), but stated that the evidence on treatment itself is lacking [3]. This is why prevention and emergency preparedness are both important.
What to check during your consultation
Buttock fat grafting is surgery that calls for as much understanding of the risks as it does expectations for the results. It is a good idea to ask about the following in detail, and if you still have concerns after hearing the explanation, not to rush your decision. The risks and results vary from person to person depending on your body type and health.
- The depth at which fat will be injected and the instruments used
- The volume of fat transferred in one session and the length of the operation
- The equipment and transfer arrangements in place for emergencies during surgery
- Options other than fat grafting and the limitations of each
Frequently asked questions
- Is buttock fat grafting a dangerous operation?
- A 2018 review stated that the death rate of buttock fat grafting appears to be considerably higher than that of other cosmetic surgeries [1]. In recent surveys outside Korea, the death rate was one in 15,000, lower than in earlier reports [2]. Even so, you should make your decision with a clear understanding that, although rare, life-threatening complications can occur.
- Can fat embolism be prevented in advance?
- There is a view that improvements in the understanding of anatomy, in instruments, and in technique can greatly reduce fat embolism [2]. However, it has been pointed out that because technical and human factors are involved, it is difficult to prevent completely [3]. It is therefore a good idea to check both the prevention plan and the emergency response system.
- Are buttock implants safer?
- A 2018 review assessed buttock augmentation with implants as also having a number of problems [1]. The sources for this article do not include figures that directly compare the safety of the two methods. Because each method carries different types of risk, it is a good idea to compare them through an examination.
References
- Shah B. Complications in Gluteal Augmentation. Clin Plast Surg. 2018.PubMed 29519486DOI
- Del Vecchio DA, Wall SJ Jr, Mendieta CG, et al. Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plast Reconstr Surg. 2021.PubMed 34847113DOI
- Lari A, Abdulshakoor A, Zogheib E, et al. How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options. Aesthet Surg J. 2020.PubMed 31606739DOI
- Pazmiño P, Del Vecchio D. Safety in Gluteal Augmentation. Clin Plast Surg. 2023.PubMed 37704319DOI
- Mendieta CG, Sood A. Classification System for Gluteal Evaluation: Revisited. Clin Plast Surg. 2018.PubMed 29519485DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.