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Practice Advisory on Gluteal Fat Grafting.

Daniel Del Vecchio1, Jeffrey M Kenkel2

  • 1Massachusetts General Hospital, Boston, MA, USA.

Aesthetic Surgery Journal
|April 11, 2022
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Summary

New guidelines for gluteal fat grafting (Brazilian Butt Lift - BBL) emphasize ultrasound guidance for cannula placement and limit daily procedures to three. These changes aim to reduce BBL patient mortality by addressing surgical technique and surgeon fatigue.

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Area of Science:

  • Plastic Surgery
  • Surgical Safety
  • Patient Outcomes

Background:

  • The Multi-Society Task Force on Gluteal Fat Grafting has issued updated practice advisories due to patient deaths associated with Brazilian Butt Lift (BBL) procedures.
  • Previous advisories in 2018 and 2019 highlighted surgical technique as a primary cause of fatal complications.
  • A 2021 Working Group on BBL Patient Safety was formed to develop new safety and welfare guidelines.

Purpose of the Study:

  • To present the latest practice advisory on gluteal fat grafting, incorporating new findings and recommendations.
  • To address critical safety concerns, including surgical technique, surgeon fatigue, and distraction.
  • To provide evidence-based guidelines to improve patient safety in gluteal fat grafting procedures.

Main Methods:

  • Review and analysis of fatal complication data, particularly focusing on timing and geographic trends (e.g., BBL deaths in Florida occurring at week's end).
  • Consideration of micro-economic factors such as operative time and regional pricing in relation to patient safety.
  • Formulation of new guidelines based on identified risk factors like surgeon fatigue, distraction, and uncertainty in injection plane.

Main Results:

  • A significant number of gluteal fat grafting deaths correlate with surgeon fatigue and distraction, potentially linked to end-of-week procedures.
  • Uncertainty or lack of documentation regarding the correct injection plane is a likely contributor to mortality.
  • The advisory introduces compelling recommendations to mitigate these risks.

Conclusions:

  • The updated guidelines strongly recommend the use of ultrasound-guided documentation for cannula placement before and during fat injection.
  • Limiting the number of gluteal fat grafting cases to a maximum of three per day is advised to combat surgeon fatigue and distraction.
  • Adherence to these updated safety protocols is crucial for reducing mortality associated with gluteal fat grafting.