Safety in Gluteal Augmentation.

Gluteal fat grafting is the fastest growing surgery in body contouring because of the powerful results that no other procedure can achieve. Efforts made to improve the safety of this procedure are reviewed.

Ultrasound-Guided Gluteal Fat Grafting: A to Z.

Low-cost, high-resolution ultrasound systems allow surgeons to visualize and manipulate the subcutaneous space and inject fat graft with millimeter accuracy.

Static Injection, Migration, and Equalization: A New Paradigm for Safe Ultrasound-Guided BBL: Safer, Faster, Better.

Static injection, migration, and equalization allows for always subcutaneous-targeted fat grafting to either the deep or the superficial subcutaneous spaces.

Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better.

BACKGROUND: Although the Brazilian butt lift (BBL) is one of the most popular procedures in body contouring, it has been associated with the risk of pulmonary fat embolism when fat graft is injected into the gluteal muscles. The subcutaneous plane has been identified as a safe site for fat graft injection, but deaths from fat embolism continue to occur because there is no mechanism to confirm consistent subcutaneous placement. OBJECTIVES: The aim of this paper was to determine if real-time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space. METHODS: In total, 4150 BBLs were performed with real-time intraoperative ultrasound being used to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared with BBL performed by expansion vibration lipofilling without ultrasound. RESULTS: Real-time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments. CONCLUSIONS: Real-time intraoperative ultrasound allows the surgeon to confirm a subcutaneous-only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.

Brazilian Butt Lift-Associated Mortality: The South Florida Experience.

BACKGROUND: Brazilian butt lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. By 2017, the risk of death from pulmonary fat (PFE) was identified, earning the BBL the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation. OBJECTIVES: The purpose of this study was to explore the factors involved in making South Florida an outlier in terms of BBL mortality. METHODS: The anatomic findings of the gluteal dissections from 11 post-BBL surgery autopsies (22 hemibuttocks) were assessed for commonalities. The public records of patients who died from BBL-related fat emboli were examined to determine commonalities. RESULTS: All BBL PFE cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality involved the location where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume, budget clinics located in South Florida. Short surgical times of approximately 90 minutes appeared to be the norm for these cases. CONCLUSIONS: South Florida has experienced 25 BBL-related fat emboli deaths between 2010 and 2022; however, 14 of these occurred after publication of the Aesthetic Surgery Education and Research Foundation's 2018 guidelines and the 2019 Florida Board of Medicine's BBL "subcutaneous-only" rule. The working environment at the clinics, and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.

Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications.

BACKGROUND: Advances in gluteal fat grafting have resulted in diminished risks through improved understanding of regional anatomy and technical nuances. No anatomic studies identifying the presence or absence of buttock fat compartments have yet been reported. OBJECTIVES: The aim of this cadaveric study was to identify and characterize the deep subcutaneous gluteal fat compartments to further understand the nuanced differences between deep and superficial subcutaneous fat layers. METHODS: A cadaveric study was performed to identify the fat compartments. Latex injection into the iliac artery and vein was used to prepare 4 fresh (N = 8 hemibuttocks) hydrated cadavers for dissection. Preliminary work identified the likely position of deep gluteal fat compartments. The cannula was positioned under ultrasound guidance in between the superficial and deep gluteal layers. Cadaveric buttocks were infiltrated by the static technique with dyed human fat, dyed applesauce, and dyed saline in an attempt to identify the gluteal deep subcutaneous fat compartments. RESULTS: Dissection identified and characterized 7 discrete deep gluteal fat compartments. These comprise 3 medial fat compartments (superior, middle, and inferior); a central fat compartment; and 3 lateral (superior, middle, and inferior) deep fat compartments. CONCLUSIONS: Seven deep gluteal fat compartments have been identified that have distinct boundaries and maintain injected contents separate from each other above the gluteal muscle fascia. These compartments can be selectively expanded for buttock augmentation. Knowledge of these compartments enables surgeons to perform gluteal augmentation by static infiltration, injecting autologous fat under ultrasound guidance in the deep subcutaneous fat layer, while optimizing aesthetic considerations.

The management of orbitozygomatic fractures.

Orbitozygomatic injuries are among the most common fractures encountered by the plastic surgeon. Appropriate management depends on an accurate diagnosis, focusing on the physical examination and data from computed tomography scans. One must pay particular attention to the orbital component of this injury, as it is from this that so much of the morbidity relating to these fractures is incurred. As with all facial fractures, accurate reduction is paramount to a successful outcome. As many buttresses as are necessary should be visualized to ensure an anatomic reduction. The amount and location of fixation depend on the fracture anatomy.A successful outcome may be expected if these basic principles are followed.