Subcutaneous-Only Gluteal Fat Grafting: A Prospective Study of the Long-Term Results with Ultrasound Analysis.

In recent years, gluteal fat augmentation has exhibited some of the most significant growth among all plastic surgery procedures. However, as the popularity of and media attention to gluteal fat augmentation continue to rise, reports of fatalities, largely attributed to fat embolism, have raised valid concerns. Many plastic surgeons inject fat in the intramuscular plane and claim better graft take in the muscles and the possibility of injecting more volume in the gluteal region. Because of the large caliber of vessels, subcutaneous fat augmentation has been a preference of many. However, the long-term outcome of fat injected into the subcutaneous layer has been questionable, and there is a lack of prospective quantitative studies of subcutaneous-only fat grafting. Therefore, the authors evaluated the long-term maintenance of gluteal adipose thickness when fat was injected only subcutaneously. Fifty consecutive female patients were evaluated in this prospective clinical study. All patients underwent gluteal fat augmentation in the subcutaneous plane only. Ultrasound analysis of the adipose tissue thickness of the gluteal region was performed preoperatively, immediately postoperatively, and at 12 months postoperatively. Immediate postoperative measurements revealed an average increase in gluteal subcutaneous layer thickness of 56.51 percent (range, 39.5 to 108.6 percent) (p < 0.0001). At 12 months postoperatively, the gluteal adipose tissue thickness decreased by an average of 18.16 percent (range, 6.8 to 24.8 percent) (p < 0.0001). Subcutaneous-only gluteal fat augmentation is shown to be as effective as previous studies reporting intramuscular fat injection with regard to long-term fat retention in the buttocks. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Real-Time Ultrasound-Assisted Gluteal Fat Grafting.

BACKGROUND: The number of gluteal fat augmentation procedures has increased recently and so has the number of complications. Because of the increased risk of morbidity and mortality when fat is injected intramuscularly, not knowing where fat is injected is concerning. We sought to identify the planes in which fat is injected during the procedure. METHODS: We selected 15 consecutive female patients who desired gluteal fat augmentation. All patients had epidural anesthesia and the gluteal region was infiltrated with a vasoconstrictive solution. With the patient in prone position, an ultrasound probe placed on the buttocks was used to identify the fascial layers. While decanted fat was being injected with a blunt cannula, the images were projected wirelessly to a screen, so that the surgeon and assistant could follow the planes in which the cannula was being introduced and the fat injected. RESULTS: The mean volume of harvested fat was 3533 ml and the mean volume of fat injected per gluteal region was 528 ml. The evaluation of the depth and location of the cannula was performed in real time with the ultrasound, accurately and reliably identifying the planes of fat injection. All injections were subcutaneous. The downsides of this technique were the purchase cost of the ultrasound device, increased surgical time, the need for an assistant to follow the cannula and the probe constantly, and the learning curve. CONCLUSION: Real-time ultrasound-assisted gluteal fat grafting is reliable and may avoid injuring the deep vessels, further decreasing the risks of major complications.

Use of Tranexamic Acid to Reduce Blood Loss in Liposuction.

BACKGROUND: The use of tranexamic acid for blood loss prevention has gained popularity in many specialties, including plastic surgery. However, its use in liposuction has not been studied. The authors present a prospective, double-blind, nonrandomized study evaluating the efficacy of tranexamic acid in reducing perioperative blood loss during liposuction. METHODS: Twenty women undergoing liposuction were divided into two cohorts. Group 1 (n = 10) received a standard dose of 10 mg/kg of tranexamic acid intravenously in the preoperative and postoperative periods, whereas group 2 (n = 10) received a placebo. Patient hematocrit levels were evaluated preoperatively and postoperatively. Blood volume in the infranatant of the lipoaspirate was also measured; t tests were used for statistical analysis. RESULTS: Age, body mass index, and volume of lipoaspirate were comparable between the two cohorts. The volume of blood loss for every liter of lipoaspirate was 56.2 percent less in the tranexamic group compared with the control group (p < 0.001). Hematocrit levels at day 7 postoperatively were 48 percent less in group 1 compared with group 2 (p = 0.001). Furthermore, a 1 percent drop in the hematocrit level was found after liposuction of 812 ± 432 ml in group 1 and 379 ± 204 ml in group 2. Thus, the use of tranexamic acid could allow for aspiration of 114 percent more fat, with comparable variation in hematocrit levels. CONCLUSIONS: Tranexamic acid has been shown to be effective for minimizing perioperative blood loss in liposuction. Further large randomized controlled studies are required to corroborate this effect. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.