Abdominoplasty Specimens as a Practical Training Model for Ultrasound-Guided Gluteal Lipofilling

Gluteal fat grafting (commonly known as the Brazilian Butt Lift, BBL) has surged in popularity over the past decade, but this rise has been marred by safety concerns. Inadvertent intramuscular fat injection during BBL can lead to fat embolism, contributing to a reported mortality rate as high as 1 in 2,351-6,241-making it the deadliest cosmetic procedure. In response, there is growing advocacy for ultrasound guidance during gluteal lipofilling to ensure injections remain in the safer subcutaneous plane. However, practical training models to teach ultrasound-guided gluteal fat grafting are lacking or cost-prohibitive.

We present a practical, cost-free training model for ultrasound-guided gluteal lipofilling using abdominoplasty specimens. This model is designed to simulate the superficial and deep subcutaneous gluteal compartments in an anatomically realistic way, while providing immediate tactile feedback to prevent excessive cannula depth. We compare this abdominoplasty-based training setup to previously described models and highlight its advantages in simplicity, realism, and accessibility.

Resected abdominal skin-fat specimens from routine abdominoplasty surgeries were repurposed as training phantoms. Each specimen was placed skin-side up on a rigid surface to mimic the underlying gluteal muscle/fascial support. A small skin incision served as the entry point for a blunt cannula, and a wireless ultrasound probe was used externally to visualize cannula placement in real time. No synthetic or animal tissues were added. Trainees practiced advancing the cannula within the specimen's subcutaneous layer under ultrasound guidance, with the rigid base providing an endpoint "stop" if the cannula ventured too deep.

The abdominoplasty tissue model closely replicated the ultrasonic appearance and tactile feel of the gluteal subcutaneous region. Distinct superficial and deep fatty layers were observed on ultrasound, analogous to the gluteal fat compartments. Trainees could readily identify the cannula as a bright echo and steer it within the tissue. When the cannula approached the base (simulating the gluteal fascia plane), a firm resistance was felt upon contact with the rigid surface. This immediate feedback effectively alerted users to excessive depth, reinforcing proper technique. The model required minimal preparation and no additional cost, as tissues were obtained from surgical discard. Participants in trial sessions reported improved coordination between probe and cannula and increased confidence in maintaining a safe injection plane.

The abdominoplasty-based ultrasound training model offers an ethical, accessible platform to develop the skills necessary for safe gluteal fat grafting. It eliminates the costs and logistical barriers associated with cadaver or synthetic models, yet provides realistic anatomy and a built-in safety mechanism. This model can be implemented easily in any body-contouring practice and holds promise for widespread adoption in training programs. By lowering the barrier to hands-on ultrasound practice, it may help accelerate the uptake of ultrasound-guided techniques and ultimately improve the safety profile of gluteal fat grafting.

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