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Dr. Grant Stevens Addresses Brazilian Butt Lift Complications

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Inter-Society Gluteal Fat Grafting Task Force Conducting Extensive
Research to Prevent Tragic Outcomes

Grant Stevens, MD, FACS, a board certified plastic surgeon, founder of
Marina Plastic Surgery in Marina del Rey, CA, and president of The
Aesthetic Society, confirmed that five of the world's preeminent plastic
and cosmetic surgery-related organizations have banded together to
research complications and deaths associated with the surgical procedure
called the Brazilian Buttock Lift (BBL).

According to the American Society for Aesthetic Plastic Surgery
(ASAPS/The Aesthetic Society), recent deaths and serious complications
associated with the popular Brazilian Buttock Lift procedure have
prompted five of the world's top plastic and cosmetic surgery related
organizations to come together to form an Inter-Society Gluteal Fat
Grafting Task Force. The Task Force will examine the causes behind
complications and deaths to try to prevent them from occurring through a
variety of physician and patient safety education measures, including
unprecedented research.

"ASAPS, the American Society of Plastic Surgeons, the International
Society of Aesthetic Plastic Surgery, the International Society of
Plastic and Regenerative Surgeons and the International Federation for
Adipose Therapeutics and Science have all recognized that the death rate
for BBL (approximately 1/3,000) is the highest for any aesthetic
procedure and accordingly, action must be taken now in order to prevent
further tragedies from occurring," said Stevens. "We believe that it is
essential for our organizations to come together to address the
complication and death rate associated with an increasingly popular
aesthetic procedure in order to change the course of these adverse
events as much as is possible for patient safety."

To date, the societies have reviewed autopsy reports that have made it
evident that all deceased BBL patients have had specific findings in
common, including:

  1. Fat in the gluteal muscles
  2. Fat beneath the muscles
  3. Damage to the superior or inferior gluteal vein
  4. Massive fat emboli in the heart and/or lungs

Further, the Task Force has identified factors that added additional
risk to the procedure as well as those that proved to be protective
and/or preventative. These findings have led to the adoption of the
following recommendations:

  1. Avoid injecting fat into the deep muscle. No deaths have occurred with
    fat found only in the subcutaneous plane, (under skin but over muscle)
  2. Avoid gluteal veins and the sciatic nerve. Fat should only be grafted
    into the superficial planes with the subcutaneous space considered
    safest.
  3. Use a >4.1 mm single hole injection cannula and instrumentation that
    offers control, avoiding bendable cannulas and mobile luer
    connections. Vibrating cannulas may provide additional tactile
    feedback.
  4. Avoid downward angulation of the cannula.
  5. Position patient and place incisions to create a path that will avoid
    deep muscle injections.
  6. Maintain constant three-dimensional awareness of the cannula tip.
  7. Only inject when the cannula is in motion to avoid high pressure bolus
    injections.
  8. Consider pulmonary fat embolism in unstable intra- and post-operative
    patients.
  9. Review gluteal vascular anatomy and draw landmarks to identify and
    avoid injection into the pedicle.
  10. Include risk of fat embolism and surgical alternatives in the informed
    consent process.

"These guidelines should be adhered to by anyone performing the BBL in
order to curtail complications as much as is possible," Dr. Stevens said.

Additional research is being conducted in the form of more anatomic
studies via cadaver labs, injectable dye studies with ultrasound and
fiber optic equipment, cannula testing, injection depth testing and
specific site injection testing. Once those results are finalized, a
comprehensive set of guidelines for the procedure will be submitted for
publication in major clinical journals.

Dr. Stevens suggests that any patients interested in the procedure
should research board-certified plastic surgeons in their area that
specialize in BBL, should ask to see before-and-after photos and ask for
patient references.

For more information, visit Marina
Plastic Surgery
; like Marina Plastic Surgery on Facebook;
follow on Twitter @DrGrantStevens; and sign up for his blog BeautyByStevens.

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