Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us.

BACKGROUND: Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures? METHODS: Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently. RESULTS: Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism-inherent circulatory thrombotic abnormality-BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000. CONCLUSIONS: Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.

Classification System for Gluteal Evaluation: Revisited.

The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping or contouring and augmentation. Increasing patient demand has necessitated a more structured approach to evaluation of gluteal anatomy and the development of surgical procedures to enhance its beauty.

Gluteal Augmentation and Enhancement of the Female Silhouette: Analysis and Technique.

Dr. Constantino Mendieta demonstrates and details his personal technique for gluteal augmentation. The video demonstration is divided into three parts: Part I, Aesthetic Analysis and Preoperative Marking; Part II, Creating the Female Silhouette with Circumferential Lipoplasty; and Part III, Autogenous Gluteal Augmentation. Artistic concepts for gluteal augmentation and contouring the female silhouette and technical considerations for patient safety are emphasized. This Master Series Video article is the first in a planned series of video vignettes.

Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force.

Background: Gluteal fat grafting is among the fastest growing aesthetic procedures in the United States and around the world. Given numerous anecdotal and published reports of fatal and nonfatal pulmonary fat embolism resulting from this procedure, the Aesthetic Surgery Education and Research Foundation (ASERF) formed a Task Force to study this complication. Objectives: To determine the incidence of fatal and nonfatal pulmonary fat embolism associated with gluteal fat grafting and provide recommendations to decrease the risks of the procedure. Methods: An anonymous web-based survey was sent to 4843 plastic surgeons worldwide. Additional data on morbidity and mortality was collected through confidential interviews with plastic surgeons and medical examiners, public records requests for autopsy reports in the United States, and through the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF). Results: Six hundred and ninety-two (692) surgeons responding to the survey reported 198,857 cases of gluteal fat grafting. Over their careers, surgeons reported 32 fatalities from pulmonary fat emboli as well as 103 nonfatal pulmonary fat emboli. Three percent (3%) of respondents experienced a patient fatality and 7% of respondents reported at least one pulmonary fat embolism in a patient over their careers. Surgeons reporting the practice of injecting into the deep muscle experienced a significantly increased incidence rate of fatal and nonfatal pulmonary fat emboli. Twenty-five fatalities were confirmed in the United States over the last 5 years through of autopsy reports and interviews with surgeons and medical examiners. Four deaths were reported from 2014 to 2015 from pulmonary fat emboli in AAAASF facilities. Conclusions: Despite the growing popularity of gluteal fat grafting, significantly higher mortality rates appear to be associated with gluteal fat grafting than with any other aesthetic surgical procedure. Based on this survey, fat injections into the deep muscle, using cannulae smaller than 4 mm, and pointing the injection cannula downwards should be avoided. More research is necessary to increase the safety of this procedure.

Buttock augmentation with silicone implants: a multicenter survey review of 2226 patients.

BACKGROUND: Enhancement of buttock volume with gluteal silicone implants has been performed by surgeons for over 30 years, but no studies have examined complication rates or outcomes of more than single-surgeon experiences. Numerous technical differences in how gluteal augmentation surgery with implants is performed also exist, and to date, surgeon preferences for implant plane, incisional access, implant type, and drain use have not been quantified. METHODS: A 10-question survey was sent to 83 targeted members of the American Society of Plastic Surgeons requesting information about number of cases performed, duration of surgeon experience, implant placement plane and incisional access, implant type, length of typical surgery, use of drains and antibiotic irrigation solution, surgeon satisfaction and surgeon assessment of patient satisfaction, and number of complications experienced. RESULTS: Nineteen respondents (25 percent response rate) provided data on 2226 patients. Thirteen respondents (68.4 percent) favored the intramuscular plane of dissection over the subfascial plane. Preference for incisional access was nearly equally divided between a single incision in the gluteal cleft (10 respondents) and two incisions separated within the cleft (nine respondents). The total number of complications reported was 848 (38.1 percent). CONCLUSIONS: Gluteal augmentation with silicone implants has gained popularity in the last decade. Despite this, no previous studies have examined multisurgeon experiences with this procedure to determine complication rates or surgeon technical preferences. The authors present data from a survey sent to experienced gluteal augmentation surgeons. Advances in technique and implant options are needed to improve complication rates experienced with this procedure.

Gluteal contouring surgery in the massive weight loss patient.

This article describes some of the salient anatomic issues, a classification system, surgical techniques, and a decision-making algorithm available for contouring the gluteal region in the patient who has sustained massive weight loss (MWL). The gluteal deformities encountered in patients who have lost a massive amount of weight are unprecedented in body-contouring surgery, and plastic surgeons need uncommon techniques when contouring and augmenting the gluteal region in these patients. A better understanding of the anatomy and a new surgical armamentarium can improve the cosmetic results of gluteal contouring, and, thereby, enhance patient satisfaction in this challenging population.

Gluteal reshaping.

The author performs gluteal contouring by removing fat from areas of excess and injecting into areas that will benefit aesthetically. Assuming the patient has adequate fat for harvest, the author contends that fat grafting yields more precise augmentation, quicker recovery, and tremendous patient satisfaction compared with gluteal implants. He believes that about 80% to 85% of injected fat survives at 2 years and, even if fat is lost, there remains a lifelong change in gluteal shape.

Classification system for gluteal evaluation.

The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping and augmentation. This phenomenon is reflected in statistics collected by the American Society for Aesthetic Plastic Surgery,which demonstrate a 533% increase in gluteal augmentation between 2002 and 2003. Increasing patient demand has necessitated a more structured approach to evaluation of gluteal anatomy and the development of surgical procedures to enhance its beauty. The proposed classification system for gluteal contouring focuses on evaluating and identifying the different frame types, the different gluteal muscle types, and the relationship between the muscle and the frame. Finally, a ptosis classification system is presented.

Intramuscular gluteal augmentation technique.

Gluteal augmentation with the intramuscular approach produces very good aesthetic results and, when properly performed, has a low incidence of complications. Using the intramuscular tissue plane ensures that implants are naturally positioned. In addition, larger implants may be used than with the submuscular technique, which many patients request. Of all possible gluteal implant placement options, the intramuscular position provides the greatest amount of implant coverage and pads the implant with muscle tissue above and below as well as along the inferior edge.

Gluteoplasty.

BACKGROUND: The buttocks region has been associated with allure and sex appeal for centuries. Although gluteoplasty employing silicone implants has been practiced for more than 30 years, little has been written on how to evaluate and reshape the area or how to select and place the various implants that are available. OBJECTIVES: In this article, the clinical anatomy of the buttocks area is reviewed, the properties of silicone elastomer gluteal implants are summarized, and an approach to evaluation and augmentation of the gluteal area involving solid silicone elastomer implants is presented. METHODS: The buttocks were augmented through a single intergluteal incision with the use of implants placed in the intramuscular position. Lipoplasty and fat transfers were also performed in most patients to further contour the gluteal region. RESULTS: Between February 2002 and May 2003, 73 gluteal augmentations were performed, with a high rate of patient satisfaction. Although wound dehiscence remained an issue (30%), implant removal and implant infection rates were low (2%). CONCLUSIONS: An understanding of implant shapes, sizes, and firmness will aid the surgeon in the selection of the most appropriate implant on the basis of the individual patient's gluteal anatomy. Intramuscular implant placement will result in a more natural shape, help prevent implant migration, and, most important, help reduce implant removal rates. (Aesthetic Surg J 2003;23:441-455.).