Where Does the Transplanted Fat is Located in the Gluteal Region? Research Letter.

INTRODUCTION: Liposuction is one of the most popular plastic surgery procedures. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have been reported. A possible explanation is the puncture and tearing of gluteal vessels during the procedure, especially when a deep injection is planned. OBJECTIVE: To identify the places where fat can be located after injection during a fat graft in the gluteus. METHODS: An experimental study was done in which colorant was injected in four directions using four different quadrants of the gluteus. We Injected 10 cc six times following clock hands until 60 cc were injected, and the cutaneous flap and the muscles were then elevated. Our main purpose was to describe where the colorant went and if it was in contact with the vessels (superior and inferior gluteal vessels). In total, four gluteus muscles were injected and dissected. RESULTS: Injection in the lower lateral quadrant was mainly into the muscle, and colorant was observed in the hypogastric vessels. The injection in the upper quadrants stayed mainly in the subcutaneous tissue. CONCLUSIONS: During surgery, it is important to identify the location of the perforators and to avoid a deep injection, especially from the lower lateral quadrant to the superior medial quadrant (Q4 to Q1), as the probability of puncturing and injecting fat into the main vessels from this direction is higher.

Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers.

INTRODUCTION: Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. METHODS: A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. RESULTS: We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. CONCLUSIONS: The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.