Study proposes new standards for safely performing 'Brazilian butt lift'

May 16, 2019

May 16, 2019 - A new anatomic study highlights critical technical issues to ensure safe performance of the increasingly popular "Brazilian butt lift" - a procedure using the patient's own fat to augment and improve the appearance of the buttocks. The study appears in the May issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"The study confirms that gluteal fat grafting is safe, only if the injections remain in the subcutaneous tissue," according to Daniel Del Vecchio, MD, a Boston plastic surgeon who developed the protocol and is a leading  global expert in this area. A video commentary by coauthor Rod J. Rohrich, MD, of Dallas Plastic Surgery Institute strongly emphasizes the need to avoid any fat injection into the gluteal muscle itself in order to prevent serious complications.

New Evidence on Safe Injection Technique for Gluteal  Fat Grafting

Fat grafting has become a popular technique of buttock enhancement for patients who want a fuller, shapelier appearance, without the use of implants. In this procedure, fat obtained by liposuction from one part of the body (such as the abdomen) is processed and injected to enhance the gluteal area. According to ASPS statistics, more than 24,000 buttock augmentation with fat grafting procedures were performed in 2018 - an increase of 19 percent over the previous year.

However, there is growing concern about serious complications resulting from this procedure. A 2015 paper in Plastic and Reconstructive Surgery reported a series of 22 deaths in patients undergoing gluteal fat injection in Colombia and Mexico. The deaths were caused by pulmonary embolisms: collections of fat blocking the arteries in the lungs.

In 2018, the ASPS joined with other plastic surgery specialty societies in issuing an urgent warning regarding the "alarming" number of deaths related to gluteal fat augmentation. An advisory issued to plastic surgeons (PDF link) outlined steps to ensure that fat is injected only under the skin - never into the muscle.

To build the evidence base for this recommendation, Drs. Del Vecchio and Rohrich and colleagues performed a cadaver study to evaluate patterns of fat spread in the gluteal area after injection. Four approaches were evaluated, simulating injection techniques that might be used by plastic surgeons performing gluteal fat grafting.

In three of the four injection techniques, the spread of the simulated fat was mainly limited to the subcutaneous area, immediately beneath the skin. Even when small perforations were made in the fascia - the connective tissue layer separating the muscle from the subcutaneous space - there was little or no spread of the simulated fat into the muscle itself.

Even with multiple perforations and high injection pressures, the muscle fascia prevented the simulated fat from crossing into the muscle. The researchers discuss the process of "subcutaneous migration" that keeps injected fat from spreading into or under the gluteal muscle, if injected into the subcutaneous "safe zone."

The findings were different in the fourth scenario, where multiple punctures were made in the gluteal muscle. In this situation, large amounts of proxy fat were found under the muscle - demonstrating that "deep intramuscular migration" had occurred. Once fat has migrated into the submuscular space, damage to the veins in that area could allow fat cells to enter the circulation, with a potential risk of pulmonary embolism.

The experimental study provides an important piece of evidence supporting previous recommendations to ensure the safety of the Brazilian butt lift. The researchers conclude: "These persuasive findings are profound enough to propose a new standard of care: no subfascial or intramuscular injection should be performed, and all injections should be done exclusively into the subcutaneous tissue."

In his video commentary, Dr. Rohrich adds: "If you are considering buttock augmentation procedures, please do so safely. Start today by finding a board-certified plastic surgeon and an accredited facility in your area; bring in a copy of the safety advisory...and discuss the safest way to achieve the results you want."
Click here to read "Subcutaneous Migration: A Dynamic Anatomical Study of Gluteal Fat Grafting"

DOI: 10.1097/PRS.0000000000005521

Dr. Rohrich is Editor-in-Chief of Plastic and Reconstructive Surgery.

Plastic and Reconstructive Surgery® is published in the Lippincott portfolio by Wolters Kluwer.

About Plastic and Reconstructive Surgery

For more than 70 years, Plastic and Reconstructive Surgery® ( has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information, software solutions, and services for the health, tax & accounting, finance, risk & compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer, headquartered in the Netherlands, reported 2017 annual revenues of €4.4 billion. The company serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit, follow us on TwitterFacebookLinkedIn, and YouTube.

Wolters Kluwer Health

Related Fat Articles from Brightsurf:

Fat check: Yale researchers find explanation for stress' damage in brown fat
In their search for what triggers the damaging side-effects caused by acute psychological stress, Yale researchers found an answer by doing a fat check.

Gene network helps to turn white fat into beneficial calorie-burning fat
1.9 billion people in the world are overweight. Of these, 650 million people are obese, which increases the risk of secondary diseases such as cancer.

Celebrity fat shaming has ripple effects on women's implicit anti-fat attitudes
Comparing 20 instances of celebrity fat-shaming with women's implicit attitudes about weight before and after the event, psychologists from McGill University found that instances of celebrity fat-shaming were associated with an increase in women's implicit negative weight-related attitudes.

The dangers of hidden fat: Exercise is your best defense against deep abdominal fat
Researchers analyzed two types of interventions -- lifestyle modification (exercise) and pharmacological (medicine) -- to learn how best to defeat fat lying deep in the belly.

Dietary fat is good? Dietary fat is bad? Coming to consensus
Which is better, a low-fat/high-carbohydrate diet or a high-fat/low-carbohydrate diet -- or is it the type of fat that matters?

New study on obesity: We inherit the dangerous fat from Dad -- and the good fat from Mom
Brown fat cells burn off a lot of calories, whereas an excess of white fat cells make us overweight and ill.

Innovative technique converts white fat to brown fat
Increasing healthy brown fat might help weight management and reduce symptoms of diabetes.

Fat cells control fat cell growth
Researchers from ETH Zurich and EPFL have discovered a new type of fat cell that suppresses the growth of new fat cells.

Dietary fat, changes in fat metabolism may promote prostate cancer metastasis
Researchers at the Cancer Center at Beth Israel Deaconess Medical Center (BIDMC) shed new light on the genetic mechanisms that promote metastasis in the mouse model and also implicated the typical Western high-fat diet as a key environmental factor driving metastasis.

Scarring molecule in fat tissue links obesity with distressed fat
The fat of obese people becomes distressed, scarred and inflamed, which can make weight loss more difficult, research at the University of Exeter has found.

Read More: Fat News and Fat Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to