Gluteal Augmentation with Fat Grafting: A Systematic Review and Meta-Analysis of Complications and Procedural Factors

Fat grafting has become one of the most widely used methods for gluteal augmentation, yet concerns remain regarding its safety and complication profile. This study aims to update and synthesize complication rates associated with gluteal fat grafting, with a particular focus on procedural factors.

A systematic search through PubMed, Embase, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original clinical studies reporting complications following autologous fat grafting for gluteal augmentation were included.

A total of 38 studies comprising 22,151 patients were included. The pooled incidence of minor complications was 3.58% (95% CI, 1.75% to 5.99%), with seromas occurring in 2.03% and contour irregularities in 2.29% of cases. Pulmonary embolism had a pooled incidence of 0.04%. Ultrasound-guided fat grafting was associated with lower rates of both major (0.02% versus 0.08%) and minor (2.82% versus 3.70%) complications. Subcutaneous-only injection planes demonstrated the lowest complication rates compared with intramuscular or combined approaches. The use of lipoaspirate additives and drains did not consistently lower complication rates and was sometimes associated with increased adverse outcomes.

Fat grafting is generally safe when performed using evidence-based techniques. Subcutaneous-only injection and ultrasound guidance are associated with improved outcomes and may enhance procedural safety. Continued research with prospective, standardized studies is necessary to refine procedural strategies and minimize complication risks.