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Cortes W, Mather T, LoGiudice J, Dzwierzynski W. Abdominoplasty Combined with Hip Expansion by Fat Grafting: An Evolution in Waistline Contouring. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6059. [PMID: 39129844 PMCID: PMC11315588 DOI: 10.1097/gox.0000000000006059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/10/2024] [Indexed: 08/13/2024]
Abstract
Background Recent sociocultural trends show numerous patients requesting more curvaceous profiles. Abdominoplasty techniques had evolved into a combination of fascial plication with liposuction of the lateral torso, but often left patients with "boxy" profiles. The senior author performs 360-degree liposuction of abdomen and back, hip expansion with structural fat grafting, excision of redundant soft tissue, and wide plication of abdominal fascia to create the desired profile. Methods Retrospective review of patient charts and CosmetAssure claims of female patients treated from January 2014 through May 2022 identified 1125 patients with a minimum 6-month follow-up who underwent abdominoplasty using 360-degree liposuction of waist, back, and flanks; wide plication of the rectus abdominis muscle; and hip expansion with fat grafting. Authors reviewed pre- and postoperative photographs to evaluate the technique's effectiveness. Results Hip expansion with fat grafting combined with abdominoplasty was successfully achieved in 1125 cases. Average age was 38 years. Average body mass index was 29 kg per m2. Average amount of aspirated fat was 1896 mL. Average amount of fat injected into the bilateral hips was 493 mL. Complication rates were comparable to those observed in similar abdominoplasty series reported in the literature. Conclusions Abdominoplasty combining liposuction of the waist, back, abdomen, and flanks followed by wide fascial plication and expansion of the hips with fat grafting is a safe, reproducible technique for female patients. This technique prioritizes the hip anatomical area as an aesthetic consideration in abdominoplasty and facilitates creating a harmonious hip-to-waist ratio characteristic of a feminine figure.
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Affiliation(s)
| | - Tara Mather
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| | - John LoGiudice
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisc
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Ge H, Lin B, Fang B. Ultrasound to Improve the Anatomic Approach to the Temple and a Retrospective Study on the Efficacy of Large-Volume Autologous Fat Grafting. Plast Reconstr Surg 2024; 154:262e-270e. [PMID: 37220395 DOI: 10.1097/prs.0000000000010725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) has been used widely in temporal-hollowing augmentation, but its efficacy and safety are unclear. The authors examined the use of Doppler ultrasound (DUS) in large-volume lipofilling after performing an anatomic study of the temporal region. METHODS To clarify safe and stable levels of AFG of the temporal fat compartments, 5 cadaveric heads (10 sides) were dissected after dye was injected into targeted fat pads with DUS guidance. In addition, the authors retrospectively analyzed 100 patients with temporal fat transplantation, including groups with conventional AFG ( n = 50) and DUS-guided large-volume AFG ( n = 50). RESULTS The anatomic study revealed the approach of 5 injection planes and 2 fat compartments in the temporal region: the superficial and deep temporal fat pads. In the AFG study, all patients were female, and there were no statistically significant differences between the groups in age, body mass index, tobacco or steroid use, or previous filling history. Between the conventional AFG group and the DUS-guided large-volume AFG group, the average volume of temporal lipofilling per side was 10.55 ± 2.25 versus 22.32 ± 5.19 mL/side ( P < 0.001), surgeon Likert scale score was 2.86 ± 0.97 versus 4.24 ± 0.66 ( P < 0.001), and rate of satisfaction was 74% versus 92% ( P < 0.05) (statistically significant differences). CONCLUSIONS The anatomic approach to the main temporal fat compartment is feasible. DUS-guided large-volume AFG is an effective and safe way to improve temporal hollowing augmentation.
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Affiliation(s)
- Haojie Ge
- From the Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University
| | | | - Bairong Fang
- From the Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University
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Agullo FJ, Castro-Garcia JA, Mohan VC. Multidisciplinary Experience for Gluteal Fat Grafting. Aesthetic Plast Surg 2024:10.1007/s00266-024-04163-2. [PMID: 39009870 DOI: 10.1007/s00266-024-04163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Gluteal fat grafting, colloquially known as Brazilian Butt Lift, has experienced a significant rise in popularity in recent years. Despite this increase, potential complications associated with the procedure have also been observed, necessitating a thorough examination of the current practices and outcomes. METHODS This study collected experiences of a multidisciplinary group of surgeons through a detailed survey sent in April 2022. This study aimed to shed light on the practices employed by these surgeons, the frequency and types of complications they encounter, and the overall outcomes of their procedures. RESULTS Of the 100 surgeons surveyed, 86 responded. The study identified that pulmonary fat embolism (PFE) was the most serious complication, with fatality due to PFE recorded at a rate of 1:23,878. Liposuction site seromas were the most common complications, with an overall rate of 2.45%. Although there were no overall differences in complications between plastic and non-plastic surgeons, plastic surgeons were found to have a sixfold increase in the odds of experiencing a liposuction seroma. The survey also revealed substantial practice variations, particularly regarding fat preparation methods, recipient-site preparation, antibiotic use, and postoperative care protocols. CONCLUSION Despite known complications, a strong tendency to continue performing these procedures was observed among surgeons, demonstrating the sustained demand and acceptance of the procedure. This study underscores the need for continued surveillance and research to enhance the safety and effectiveness of gluteal fat grafts. The experiences and data gathered from practicing surgeons provide valuable insights, paving the way for refining techniques, building consensus, and facilitating informed discussions with patients about the risks and benefits of the procedure. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Francisco J Agullo
- Division of Plastic Surgery, Department of Surgery, Texas Tech University Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
| | - Jose A Castro-Garcia
- Division of Plastic Surgery, Department of Surgery, Texas Tech University Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA
| | - Vamsi C Mohan
- Division of Plastic Surgery, Department of Surgery, Texas Tech University Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA
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Daneshi K, Mansour HRK, Pacheco-Barrios N, Asaju A, Pérez Pachon M, Hoyos A, Khajuria A. A Bibliometric Analysis of the Top 100 Papers on Gluteal Augmentation. Aesthet Surg J Open Forum 2024; 6:ojae053. [PMID: 39100865 PMCID: PMC11295219 DOI: 10.1093/asjof/ojae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
Background Gluteoplasty or gluteal augmentation is a popular cosmetic procedure that is used to improve the volume, shape, and contour of the buttocks. Objectives This bibliometric analysis aims to characterize emerging research trends and to assess the methodological quality of the highest impact gluteoplasty research. Methods The 100 most-cited publications in gluteoplasty were identified on Web of Science, across all available journal years (from Inception to August 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine level of evidence (LOE) of each study was assessed. Results The 100 most-cited publications regarding gluteoplasty were cited by a total of 2375 publications. Citations per publication ranged from 5 to 176 (mean 23.75 ± 25.86), with the highest-cited study being authored by Simonacci, discussing autologous fat grafting (n = 176). Most publications were LOE 5 (n = 55), representative of the large number of case series and reports. The number of publications for LOE 1, 2, 3, and 4 was 1, 9, 13, and 22, respectively. The main content focus was "surgical technique" in 38 publications, followed by "outcomes" (n = 34) and "risk factors/prognosis" (n = 10). Patient-reported outcome measures (PROMs) were used in 20 publications, and 33 publications reported aesthetic outcome measures. Conclusions This analysis demonstrates a need for improvement in research methodologies regarding gluteoplasty research. This advancement would be facilitated by robust, high-quality research through randomized control trials and multicenter studies, as well as the further development of validated PROMs for gluteoplasty. Level of Evidence 2
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Affiliation(s)
| | | | | | | | | | | | - Ankur Khajuria
- Corresponding Author: Dr Ankur Khajuria, Department of Surgery and Cancer, London W2 1NY, UK. E-mail:
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Wang B, He P, Zhao R. B-ultrasound-assisted gluteal fat grafting in Asians: A prospective study of quantitative results from three-dimensional imaging and B-ultrasound analysis. J Plast Reconstr Aesthet Surg 2024; 94:12-19. [PMID: 38729047 DOI: 10.1016/j.bjps.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/16/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The increasing number of fatalities caused by gluteal fat grafting is concerning; thus, there is a need to determine ways to obtain the ideal aesthetic effect while ensuring a safe operation. In this study, three-dimensional (3D) measurements combined with B-ultrasound were used to evaluate the effect of gluteal fat augmentation in Asians, whose safety and effectiveness were confirmed using quantitative data. METHODS Thirty-five consecutive female patients were evaluated in this prospective clinical study. All patients underwent B-ultrasound-assisted gluteal fat augmentation on the subcutaneous plane alone. 3D imaging and B-ultrasound analysis of the adipose tissue thickness in the gluteal region were performed preoperatively and at 1 week, 3 months and 6 months post-operatively. RESULTS The waist circumference of the patients decreased, gluteal circumference and length of the gluteal crease increased and average waist-to-hip ratio improved from 0.78 to 0.74. At 3 months and 6 months post-operatively, the adipose tissue thickness decreased by 5.1% and 15.1%, respectively. The fat retention rates calculated using 3D imaging measurements at 3 months and 6 months post-operatively were 77.9% and 64.7%, respectively. According to the BODY-Q scale scores, patients reported a high level of satisfaction post-operatively. CONCLUSIONS B-ultrasound guidance can effectively prevent the occurrence of fatal fat embolism during gluteal fat grafting and maximise the augmentation effect. The quantitative data obtained using 3D measurements and B-ultrasound confirmed the safety and effectiveness of fat injections for gluteal augmentation under B-ultrasound guidance.
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Affiliation(s)
- Baicheng Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China.
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6
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Güzey S, Ergan Şahin A. Brazilian Butt Lift: An Experience Over 3000 Patients. Aesthetic Plast Surg 2024; 48:2677-2693. [PMID: 38580866 DOI: 10.1007/s00266-024-03965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/23/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. METHOD Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. RESULTS Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. CONCLUSION BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Nteli Chatzioglou G, Govsa F, Gokmen G, Bicer A. Analysis of the Thigh Aesthetic Profiles: One of Physical Ideal Body Proportions. Aesthetic Plast Surg 2024; 48:2294-2305. [PMID: 38528131 PMCID: PMC11233370 DOI: 10.1007/s00266-024-03948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/16/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The contour of the thigh is increasingly being recognized as crucial component of the ideal human physique, giving rise to heightened interest in attaining the perfect thigh profile. Notwithstanding, the contemporary landscape of cosmetic surgery appears to be bereft of efficient and precise objective methodologies to evaluate the outcomes of thigh contouring treatments. The present study is aimed to investigate the aesthetic appeal of varying thigh contours, employing specialized software as an indispensable instrument for quantitative and qualitative analysis. METHODS Standardized photographs of the lower body were obtained from a sample of 200 healthy volunteers. A linear analysis was conducted, examining aspects such as the vertical length and transvers width of the thigh, as well as angular measurements including the posterior gluteal angle (PGA) and lateral angle thigh (LAT). Variables relating to thigh measurements and body mass index (BMI) were documented, with the relationships between them ascertained through Pearson's correlation and regression analysis. RESULTS In males, the LAT was measured at 168 ± 3.9, and the PGA at 170 ± 3.4, while in females, these measurements were 166 ± 2.8 ve 166 ± 2.8, respectively. Linear analyses, including the vertical length of thigh (VLT), transverse width of thigh (TWT), lateral width (LW), and posterior width (PW), were conducted. Based on the LW inferior/LW superior ratio values, the most commonly observed thigh types were Type III (0.90) at 45% and Type II (0.85) at 24.75% while the least common was Type V at 4% (0.99). PW inferior/PW superior was 84.7%. The PWI/PWS ratio was highest for Type V, at 0.99, accounting for 84.70% of the total. Furthermore, an increase in the LWI/LWS ratio leads to an increase in the PWI/PWS ratio. The frequency of the VLT/TW1 ratio 0.31-0.35 (Type 3) was found to be on the left side and Type 4 on the right side. A strong correlation was found between BMI and all thigh indexes, with a significant positive correlation between the index and factors tied to the buttocks and upper thigh. CONCLUSIONS The concept of an ideal thigh may vary based on an individual's gender, race, country of residence, and self-esteem, aiming to achieve a more natural silhouette. Focusing on the different ratios of hip and thigh varieties in the study is quite intriguing. Further inquiry and rigorous exploration are warranted to delineate the optimal techniques and methodologies for attaining ideal thigh proportions. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Figen Govsa
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, 35100, Izmir, Turkey.
| | - Gokhan Gokmen
- Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Bicer
- Department Plastic and Reconstructive Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Seabra Robalo Gomes Jorge AC, Feng YS, Santos Stahl A, Grözinger G, Nikolaou K, Glanemann M, Daigeler A, Stahl S. Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting. Aesthetic Plast Surg 2024; 48:1597-1605. [PMID: 38302712 PMCID: PMC11058931 DOI: 10.1007/s00266-023-03824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution. OBJECTIVES The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks. MATERIALS AND METHODS This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed. RESULTS CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34-87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15-1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72-1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue. CONCLUSION The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | | | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular, and Pediatric Surgery, Saarland University Hospital, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Tübingen, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
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Vidal-Laureano N, Huerta CT, Perez EA, Earle SA. Augmented Safety Profile of Ultrasound-Guided Gluteal Fat Transfer: Retrospective Study With 1815 Patients. Aesthet Surg J 2024; 44:NP263-NP270. [PMID: 38124368 DOI: 10.1093/asj/sjad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Gluteal augmentation with autologous fat transfer is one of the fastest growing aesthetic surgical procedures worldwide over the past decade. However, this procedure can be associated with high mortality from fatal pulmonary fat embolism events caused by intramuscular injection of fat. Ultrasound-guided fat grafting allows visualization of the transfer in the subcutaneous space, avoiding intramuscular injection. OBJECTIVES The aim of this study was to assess the safety and efficacy of gluteal fat grafting performed with ultrasound-guided cannulation. METHODS A retrospective chart review of all patients undergoing ultrasound-guided gluteal fat grafting at the authors' center between 2019 and 2022 was performed. All cases were performed by board-certified and board-eligible plastic surgeons under general anesthesia in ASA Class I or II patients. Fat was only transferred to the subcutaneous plane when over the gluteal muscle. Patients underwent postoperative follow-up from a minimum of 3 months up to 2 years. Results were analyzed with standard statistical tests. RESULTS The study encompassed 1815 female patients with a median age of 34 years. Controlled medical comorbidities were present in 14%, with the most frequent being hypothyroidism (0.7%), polycystic ovarian syndrome (0.7%), anxiety (0.6%), and asthma (0.6%). Postoperative complications occurred in 4% of the total cohort, with the most common being seroma (1.2%), local skin ischemia (1.2%), and surgical site infection (0.8%). There were no macroscopic fat emboli complications or mortalities. CONCLUSIONS These data suggest that direct visualization of anatomic plane injection through ultrasound guidance is associated with a low rate of complications. Ultrasound guidance is an efficacious adjunct to gluteal fat grafting and is associated with an improved safety profile that should be considered by every surgeon performing this procedure. LEVEL OF EVIDENCE: 3
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Araya S, Chang AH, Moss C, Gubara SM, Gebreyesus MT, Jordan K, Ruth KJ, Baltodano P, Patel SA. Contemporary Prophylactic Antibiotic Practices and Adjunct Therapies in Autologous Fat Grafting Procedures: A Survey of The Aesthetic Society Members. Aesthet Surg J Open Forum 2024; 6:ojae001. [PMID: 38333667 PMCID: PMC10852999 DOI: 10.1093/asjof/ojae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background Autologous fat grafting (AFG) is a widely used surgical technique that involves extracting a patient's own adipose tissue and transferring it to different areas of the body. This practice is still evolving. Guidelines for antibiotic prophylaxis and use of adjuncts in plastic surgery are currently limited, with a notable absence of standardized guidelines for AFG. Objectives In this survey, we assess contemporary antibiotic practices and adjuncts in AFG procedures. Methods A 52-question survey was emailed to 3106 active members of The Aesthetic Society. Two hundred and ninety-three responses were recorded, representing a 9% response rate. Results We analyzed 288 responses. The most common AFG procedures were facial (38%), gluteal (34%), and breast (27%) augmentation. Preoperative antibiotics were used by 84.0% overall, with rates of 74.3%, 88.0%, and 92.7% in face, breast, and gluteal AFG, respectively. Lipoaspirate-antibiotic mixing was reported by 19.8%, mainly during gluteal AFG (46.9%), and less so in face (2.8%) and breast (8%) AFG. Notably, 46.9% of surgeons administered prolonged prophylaxis for 72 h or more. Tranexamic acid was utilized by 39.9% of the surveyed surgeons. Platelet-rich plasma was used by 5.6%. Doppler ultrasound was incorporated by 16.7% in AFG, with 21.5% in gluteal AFG, 14% in the face, and 19% in breast procedures. Conclusions In this survey, we offer insights into antibiotic practices and adjunct therapies in AFG, especially intraoperative antibiotic mixing. Practices among members of The Aesthetic Society vary from guidelines. It is crucial to standardize practices and conduct further research to pave the way for evidence-based guidelines in AFG. Level of Evidence 5
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sameer A Patel
- Corresponding Author: Dr Sameer A. Patel, Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Avenue, Philadelphia, PA 19111, USA. E-mail:
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Finkelstein ER, Wo L, Garcia O, Kassira W. The Brazilian Butt Lift Remains the Deadliest Aesthetic Surgery Procedure: Are Plastic Surgeons Adjusting Their Surgical Practice to Promote Safety? Aesthet Surg J 2023; 44:NP69-NP76. [PMID: 37738429 DOI: 10.1093/asj/sjad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The number of Brazilian butt lift (BBL) fatalities remains high in the United States despite numerous practice advisories geared towards patient safety and reducing the incidence of fatal pulmonary fat emboli. OBJECTIVES This study aimed to evaluate US board-certified plastic surgeons' opinions, understanding of BBL-related mortality, and current risk-reducing surgical practices for BBL procedures. METHODS An online 18-question survey was distributed via email by the Aesthetic Surgery Education and Research Foundation to national board-certified plastic surgeon members of the The Aesthetic Society. Survey responses were collected over 21 days on the Qualtrics platform. RESULTS The survey response rate was 10% (n = 178). Of the 77% who performed BBL procedures, 48% (n = 80) did not use ultrasound. Approximately 60% (n = 102) of all respondents disagreed with imposing regulations to require ultrasound, with the most frequent reason being that it was unnecessary with adequate surgeon experience (45%). Plastic surgeons thought that high-volume budget clinics (n = 64) and a lack of regulations imposed on individual surgeons by boards of medicine (n = 31) were the greatest contributors to BBL mortality. CONCLUSIONS Most US plastic surgeons did not use ultrasound for BBL procedures and did not agree that ultrasound should be required, which may partially be the result of unsuccessful educational outreach for risk-reducing practices and training for ultrasound. Regulations by the boards of medicine imposed on individual surgeons, in combination with new legislation targeted at ownership of high-volume clinics, are strongly backed by surgeon respondents as measures that may improve patient safety. LEVEL OF EVIDENCE: 5
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12
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Kalaaji A. Commentary on: Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better. Aesthet Surg J 2023; 43:1307-1309. [PMID: 37392429 DOI: 10.1093/asj/sjad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023] Open
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13
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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better. Aesthet Surg J 2023; 43:1295-1306. [PMID: 37158159 DOI: 10.1093/asj/sjad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although the Brazilian butt lift (BBL) is one of the most popular procedures in body contouring, it has been associated with the risk of pulmonary fat embolism when fat graft is injected into the gluteal muscles. The subcutaneous plane has been identified as a safe site for fat graft injection, but deaths from fat embolism continue to occur because there is no mechanism to confirm consistent subcutaneous placement. OBJECTIVES The aim of this paper was to determine if real-time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space. METHODS In total, 4150 BBLs were performed with real-time intraoperative ultrasound being used to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared with BBL performed by expansion vibration lipofilling without ultrasound. RESULTS Real-time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments. CONCLUSIONS Real-time intraoperative ultrasound allows the surgeon to confirm a subcutaneous-only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.
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Triana L, Reddy CL, Liscano E. Complications of Fat Grafting Versus Implants in Gluteal Augmentation: A Retrospective Review and Lessons Learnt. Aesthetic Plast Surg 2023; 47:1939-1944. [PMID: 37407707 DOI: 10.1007/s00266-023-03431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/11/2023] [Indexed: 07/07/2023]
Abstract
There have been various studies and literature reviews about gluteal augmentation, possibly due to the high complication rates associated with the procedure. But in the recent past, there has been extensive work in an effort to reduce the complications and various different methods have been developed for this purpose. This article brings to view the procedure followed in our surgery centre for fat grafting and implants for gluteal augmentation. We have compiled the complications we encountered with these procedures and the lessons we learnt to prevent them. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Stepien DM, Ghavami A. Art and Safety of Gluteal Augmentation: Future Directions. Clin Plast Surg 2023; 50:629-633. [PMID: 37704329 DOI: 10.1016/j.cps.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gluteal augmentation is a quickly evolving field that continues to grow in the realms of patient safety, surgical education, and technological advancement. This article discusses innovation in gluteal augmentation and suggests potential new pathways for developing the practice of gluteal augmentation.
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Affiliation(s)
- David M Stepien
- Duke Plastic Surgery, 2301 Erwin Road, Durham, NC 27710, USA
| | - Ashkan Ghavami
- Division of Plastic Surgery, David Geffen UCLA School of Medicine, UCLA Plastic Surgery, 200 Medcal Plaza Driveway, Suite 460, Los Angeles, CA 90095, USA; Private Practice, Ghavami Plastic Surgery, Inc., 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
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16
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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization: A New Paradigm for Safe Ultrasound-Guided BBL: Safer, Faster, Better. Clin Plast Surg 2023; 50:603-614. [PMID: 37704327 DOI: 10.1016/j.cps.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Static injection, migration, and equalization allows for always subcutaneous-targeted fat grafting to either the deep or the superficial subcutaneous spaces.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami, 848 Brickell Avenue, Suite 820, Miami, FL 33131, USA.
| | - Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, 38 Newbury Street, Suite 502, Boston, MA 02116, USA
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Pazmiño P. Ultrasound-Guided Gluteal Fat Grafting: A to Z. Clin Plast Surg 2023; 50:587-601. [PMID: 37704326 DOI: 10.1016/j.cps.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Low-cost, high-resolution ultrasound systems allow surgeons to visualize and manipulate the subcutaneous space and inject fat graft with millimeter accuracy.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami.
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Pazmiño P, Garcia O. Brazilian Butt Lift-Associated Mortality: The South Florida Experience. Aesthet Surg J 2023; 43:162-178. [PMID: 35959568 PMCID: PMC9896146 DOI: 10.1093/asj/sjac224] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Brazilian butt lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. By 2017, the risk of death from pulmonary fat (PFE) was identified, earning the BBL the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation. OBJECTIVES The purpose of this study was to explore the factors involved in making South Florida an outlier in terms of BBL mortality. METHODS The anatomic findings of the gluteal dissections from 11 post-BBL surgery autopsies (22 hemibuttocks) were assessed for commonalities. The public records of patients who died from BBL-related fat emboli were examined to determine commonalities. RESULTS All BBL PFE cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality involved the location where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume, budget clinics located in South Florida. Short surgical times of approximately 90 minutes appeared to be the norm for these cases. CONCLUSIONS South Florida has experienced 25 BBL-related fat emboli deaths between 2010 and 2022; however, 14 of these occurred after publication of the Aesthetic Surgery Education and Research Foundation's 2018 guidelines and the 2019 Florida Board of Medicine's BBL "subcutaneous-only" rule. The working environment at the clinics, and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Onelio Garcia
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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19
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Ramírez-Montañana A. Commentary on: Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications. Aesthet Surg J 2023; 43:84-85. [PMID: 36053902 DOI: 10.1093/asj/sjac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023] Open
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20
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Frojo G, Halani SH, Pessa JE, Pazmiño P, Wall S, Kenkel JM, Del Vecchio DA. Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications. Aesthet Surg J 2023; 43:76-83. [PMID: 35977084 DOI: 10.1093/asj/sjac230] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Advances in gluteal fat grafting have resulted in diminished risks through improved understanding of regional anatomy and technical nuances. No anatomic studies identifying the presence or absence of buttock fat compartments have yet been reported. OBJECTIVES The aim of this cadaveric study was to identify and characterize the deep subcutaneous gluteal fat compartments to further understand the nuanced differences between deep and superficial subcutaneous fat layers. METHODS A cadaveric study was performed to identify the fat compartments. Latex injection into the iliac artery and vein was used to prepare 4 fresh (N = 8 hemibuttocks) hydrated cadavers for dissection. Preliminary work identified the likely position of deep gluteal fat compartments. The cannula was positioned under ultrasound guidance in between the superficial and deep gluteal layers. Cadaveric buttocks were infiltrated by the static technique with dyed human fat, dyed applesauce, and dyed saline in an attempt to identify the gluteal deep subcutaneous fat compartments. RESULTS Dissection identified and characterized 7 discrete deep gluteal fat compartments. These comprise 3 medial fat compartments (superior, middle, and inferior); a central fat compartment; and 3 lateral (superior, middle, and inferior) deep fat compartments. CONCLUSIONS Seven deep gluteal fat compartments have been identified that have distinct boundaries and maintain injected contents separate from each other above the gluteal muscle fascia. These compartments can be selectively expanded for buttock augmentation. Knowledge of these compartments enables surgeons to perform gluteal augmentation by static infiltration, injecting autologous fat under ultrasound guidance in the deep subcutaneous fat layer, while optimizing aesthetic considerations. RESUMEN
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21
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Hoyos AE, Stefanelli M, Perez ME, Padilla M. Adipose Tissue Transfer in Dynamic Definition Liposculpture PART III. The Arms: Biceps, Triceps, and Deltoids. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4651. [PMID: 36733948 PMCID: PMC9886514 DOI: 10.1097/gox.0000000000004651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 01/31/2023]
Abstract
Arm contouring usually represents a challenge for the surgeon due to zones with high risk of irregularities/asymmetries, the variable degree of skin laxity, and the differences between patient/gender preferences. In men, the bigger and muscular the arms the better, while women tend to prefer a slim and soft silhouette. Methods We performed arm cadaveric dissections and also searched our records for patients who underwent fat grafting of the arm in addition to HD2, from January 2016 to May 2022 at a single center in Bogotá, Colombia. Results Two hundred eighty-nine consecutive patients (275 men and 14 women) underwent high-definition lipoplasty/HD2 plus fat grafting of the biceps (72 muscles), the triceps (46 muscles), the deltoids (426 muscles), or a combination of them. Mean age was 39 and 36 years for men and women, respectively. Range of the fat graft volume was 30-150 ml. No major complications were reported. Follow-up period ranged from 2 to 24 months. Most patients were satisfied with the results. Conclusions Men usually seek an overall well-toned and muscular extremity, while women tend to prefer a slim but also athletic contour. Such outcomes can be achieved through intramuscular fat grafting of the biceps, triceps, and deltoids. The proper recognition of the pedicles and a precise surgical technique will ensure both its safety and the reproducibility of the results.
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Affiliation(s)
- Alfredo E. Hoyos
- From the Department of Plastic Surgery, Total Definer Research Group Bogota, Colombia
- Colombian Society of Plastic, Aesthetic, Maxillofacial, and Hand Surgery
- American Society of Plastic Surgeons (ASPS), Bogota, Colombia
| | - Matt Stefanelli
- French College of Plastic Surgery (CFCPRE)
- European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS), Paris, France
| | | | - Mauricio Padilla
- Mexican Association of Aesthetic and Reconstructive Plastic Surgery (AMCPER)
- Department of Plastic Surgery, Total Definer Research Group, Ciudad de México, Mexico
- Dhara Clinic, Bogota, Colombia
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22
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Tillo O, Nassab R, Pacifico MD. The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review -and Recommendations. Aesthet Surg J 2022; 43:675-682. [PMID: 36495200 DOI: 10.1093/asj/sjac316] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Superficial gluteal lipofilling (SGL) is a fat grafting procedure that is performed to correct a trochanteric depression and buttock deflation. Brazilian Butt Lift (BBL) is gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in Brazilian Butt Lift (BBL) was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of using intraoperative ultrasound scan has been demonstrated in guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicised risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management.
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Affiliation(s)
- Omar Tillo
- Consultant plastic surgeon in private practice, London, United Kingdom
| | - Reza Nassab
- Consultant plastic surgeon in private practice, Knutsford United Kingdom
| | - Marc D Pacifico
- Consultant plastic surgeon in private practice, Kent, United Kingdom
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23
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Rios LM. Commentary on: Practice Advisory on Gluteal Fat Grafting. Aesthet Surg J 2022; 42:1030-1031. [PMID: 35639818 DOI: 10.1093/asj/sjac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luis M Rios
- Plastic surgeon in private practice in Edinburg , TX
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Abstract
On January 31, 2018, The Multi-Society Task Force for Safety in Gluteal Fat Grafting released a Practice Advisory regarding gluteal fat grafting. The Task Force was assembled in the wake of several highly publicized patient deaths involving Brazilian Butt Lift ("BBL") and produced a second practice advisory in August 2019. In 2021 the ASAPS President commissioned a Working Group on BBL Patient Safety, charging the Group to address new guidelines affecting safety and welfare of BBL patients. The "Practice Advisory on Gluteal Fat Grafting" is the first advisory developed since the Working Group was formed. In addition to surgical technique as a major cause of fatal complications of BBL, the Working Group focused on micro-economic trends of operative time and regional BBL pricing and considered fatigue and distraction in formulating the current guidelines. In Florida the majority of BBL deaths occur at the end of the week. Such a non-normalized distribution most likely represents the result of fatigue and/or distraction, which has been linked to surgical mortality in multiple published communications. In addition, mortality is likely due to uncertainty or lack of documentation as to the correct plane of fat injection. Therefore, the newest and most compelling recommendations from these guidelines include the use of ultrasound-guided documentation of cannula placement prior to and during fat injection, and the limitation of 3 BBL cases as a maximum amount of total operative cases per day. The authors thank members of the Task Force for the insights they brought to this process.
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Affiliation(s)
| | - Jeffrey M Kenkel
- Betty and Warren Woodward Chair, Department of Plastic Surgery, University of Texas Southwestern Medical Center , Dallas, TX , USA
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25
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Aesthetic Preferences of the Anterior Thigh as a Beauty Factor in Women. Plast Reconstr Surg Glob Open 2022; 10:e4055. [PMID: 35070601 PMCID: PMC8769123 DOI: 10.1097/gox.0000000000004055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
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26
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Lipo Definition in Thighs: Volumizing and Defining the Vastus Muscles by Fat Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3945. [PMID: 34849318 PMCID: PMC8615436 DOI: 10.1097/gox.0000000000003945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
Volumizing muscles in the thighs by fat grafting to complement body contouring surgeries has not been adequately investigated. Our objective was to describe a technique (VDVFAT) that defines and volumizes thigh muscles by lipotransfer in the vastus medialis and vastus lateralis muscles. Methods VDVFAT was performed in 52 patients by the same surgeon at a private clinic in Lima, Peru, between 2018 and 2019. All patients were aged between 18 and 60 years, had no cutaneous flaccidity of the thighs, had a body mass index less than 28, and had Goldman surgical risk below Class II. Results A total of 45 women aged 19-41 years (mean: 29.2 years) and seven men aged 24-41 years (mean: 33 years) were included. A mean of 173.36 cm3 of intramuscular fat was grafted to the vastus lateralis, resulting in increased muscle thickness of 21.09 mm, which is equivalent to 88.31% of the initial size of the muscle (P < 0.0001). An intramuscular fat mass of 123.53 cm3 was grafted into the vastus medialis, resulting in increased muscle thickness of 30 mm, which is equivalent to 87.02% of the initial size of the muscle (P < 0.0001). Conclusions Volumizing and defining the vastus muscles by fat transfer is a safe and reproducible method for defining and volumizing muscles. However, further studies are necessary to determine the durability of fat grafts.
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Benslimane F. Personal Strategy to Avoid Fat Embolism During Fat Grafting: Brisk Withdrawal of Cannula While Injection. Aesthetic Plast Surg 2021; 45:718-729. [PMID: 33403423 DOI: 10.1007/s00266-020-02066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Complications of fat grafting by means of injection may lead to unwanted passage of substrate into vessel lumens resulting in catastrophic complications. Likewise, a similar trend of complications is observed with non-autologous fillers regardless of an almost generalized use of blunt cannulas, the latter being implicated in the majority of serious vascular complications of hyaluronic acid injection. This report is the product of investigation to review all cases that underwent an original technique of fat injection: "The smart fat injection" during the cannula's brisk withdrawal technique. The aim of this research was to document the safety of this technique by searching if fat embolism had occurred and if yes, its incidence in this group of fat injection surgeries. METHOD This retrospective review included 3039 patients who underwent the smart fat injection at the facial or corporeal level between 2001 and 2019. The study focused on the search for complications linked to fat yet also cruorical embolism, as the latter may resemble the clinical symptoms of fat embolism. RESULTS The assessment of the 3039 patients who underwent the smart fat injection during cannula's brisk withdrawal, resulted in none presenting clinically detectable fat or a cruorical embolism. CONCLUSION This report documents the safety of the smart fat injection developed over a period of 22 years. It further explains the rationale of the technique for avoiding fat embolism while simultaneously enhancing fat take. This technique should not be implemented without appropriate in vitro training. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Batiukov D, Podgaiski V, Mikulich D, Kalinin S. Multiple polyurethane implant punctures during fat grafting: case report and review of the literature. BMC Surg 2020; 20:248. [PMID: 33081756 PMCID: PMC7576805 DOI: 10.1186/s12893-020-00915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast augmentation with implants continues to be the most popular aesthetic surgical procedure performed worldwide. Fat grafting may improve the results of breast augmentation and breast reconstruction with implants. However, fat grafting to the breast with implants carries the risk of implant puncture. To our best knowledge this is the first case in which polyurethane implant puncture during fat grafting is described. CASE PRESENTATION We report multiple bilateral implant punctures with the cannula during fat grafting in a patient who previously underwent breast reconstruction with polyurethane implants. CONCLUSIONS Implants that promote tissue ingrowth may be more prone to puncture with the cannula during fat grafting. Specific planning and surgical maneuvers decrease the risk of implant puncture. LEVEL OF EVIDENCE Level V, case report.
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Affiliation(s)
- Dmitry Batiukov
- Medical Center "Antes Med", Kozlova Lane 25-7, 220037, Minsk, Belarus.
| | - V Podgaiski
- Belorussian Medical Academy of Postgraduate Education, Brovki 3, b. 3, 220013, Minsk, Belarus
| | - D Mikulich
- Breast Cancer and Reconstructive Surgery Department, National Cancer Centre of Belarus, Minsk District, 223040, Lesnoy, Minsk Region, Belarus
| | - S Kalinin
- Department of Plastic and Aesthetic Surgery of the 4th City Clinical Hospital Named After N.E. Savchenko, Rozy Lyuksemburg str. 110, 220089, Minsk, Belarus
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Rios L, Gupta V. Improvement in Brazilian Butt Lift (BBL) Safety With the Current Recommendations from ASERF, ASAPS, and ISAPS. Aesthet Surg J 2020; 40:864-870. [PMID: 32306045 DOI: 10.1093/asj/sjaa098] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2017, the ASERF Gluteal Fat Grafting Task Force reported gluteal fat grafting to be a high-risk procedure and recommended specific surgical techniques to decrease the risk of pulmonary fat embolism (PFE). OBJECTIVES The aim of this study was to determine whether ASAPS and ISAPS members were aware of the 2017 recommendations, what their current surgical techniques were, whether they had changed their techniques based on the 2017 recommendations, and whether the incidence of PFEs had changed since the recommendations were published. METHODS An anonymous web-based survey was conducted among members of ASAPS and ISAPS. It included the questions from the 2017 survey, as well as questions about awareness of the Task Force recommendations and subsequent change in surgical techniques. RESULTS In the 2 years following the publication of the recommendations, the incidence of any PFE was 1 in 2492 compared with 1 in 1030 reported in 2017 (P = 0.02). Trends indicated a decreased mortality rate from 1 in 3448 in 2017 to 1 in 14,952 in 2019. Ninety-four percent of respondents were aware of the recommendations. Only 0.8% of surgeons in the current survey reported injecting in deep muscle, compared with 13.1% in 2017 (P < 0.01). Compared with 4.1% in 2017, 29.8% of respondents in our survey reported that they only injected with cannulas ≥4.1 mm (P < 0.01). Only 4% of respondents reported angling the cannula down in the current survey, compared with 27.2% in 2017 (P < 0.01). CONCLUSIONS It appears that members were aware of the 2017 recommendations. There was a significant decrease in recent PFE and trends showed a change to safer techniques and an improvement in safety of the procedure.
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Affiliation(s)
- Luis Rios
- Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX
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Viaro MSS, Danilla S, Cansanção AL, Viaro PS. Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2818. [PMID: 33133894 PMCID: PMC7572093 DOI: 10.1097/gox.0000000000002818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
High-definition (HD) liposuction has allowed surgeons to sculpt the abdomen, enhancing abdominal etching. To create a more athletic abdomen, fat grafting has been used subcutaneously, and rectus abdominis fat grafting has been performed in patients undergoing lipoabdominoplasty. With the objective of increasing muscle volume to obtain a natural-looking abdomen in patients who are not suitable for abdominoplasty, we propose the use of ultrasound-guided rectus abdominis fat grafting (UGRAFT) in association with HD liposuction. PATIENTS A prospective study with 10 consecutive patients undergoing UGRAFT was conducted. After HD liposuction, UGRAFT was performed from an incision in the umbilical region, using a blunt 2.5-mm cannula assisted by ultrasound. Fat injection was done closer to the anterior rectus sheath in the lower and middle muscle bellies. RESULTS UGRAFT was performed in 10 patients. The mean age was 34.8 years (range, 24-51 years). The mean body mass index was 23.83 kg/m2 (range, 20.58-28.39 kg/m2). The mean volume of fat injected per "pack" was 34 cm3 (range, 20-40 cm3). UGRAFT added a mean time of 20 minutes (range, 15-30 minutes) to HD liposuction. Comparing the rectus abdominis muscle thickness pre-UGRAFT and post-UGRAFT, average muscle thickness increase was 5.1 mm (55.7% ± 37%), with P < 0.0001. CONCLUSION UGRAFT showed to be helpful for obtaining muscle expansion and a more natural abdominal contour, avoiding that unnatural appearance that HD liposuction may provide in patients who gain weight or have skin laxity.
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Affiliation(s)
| | - Stefan Danilla
- Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital, Santiago, Chile
| | - Alvaro Luiz Cansanção
- Department of Plastic Surgery, Universidade Iguaçu (UNIG), Hospital da Plástica, Rio de Janeiro, RJ, Brazil
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31
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Ordenana C, Dallapozza E, Said S, Zins JE. Objectifying the Risk of Vascular Complications in Gluteal Augmentation With Fat Grafting: A Latex Casted Cadaveric Study. Aesthet Surg J 2020; 40:402-409. [PMID: 31665218 DOI: 10.1093/asj/sjz237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fat transfer is the most popular means of gluteal augmentation. However, this procedure may be complicated by pulmonary fat embolisms (PFEs). Of 135 PFEs out of 198,857 cases reported by the Aesthetic Surgery Education and Research Foundation task force, 32 were fatal, contributing to the mortality risk of this procedure being as high as 1:2351. OBJECTIVES The aim of this study was to generate an anatomic map of the 3-dimensional location and variability in size of the gluteal region vessels. METHODS Twenty cadaveric gluteal regions were dissected. The aorta, venae cavae, popliteal, and saphenous veins were cannulated and injected with colored latex. Dissection was performed subcutaneously, in the gluteus maximus (GM), and submuscularly to evaluate the number and vascular distribution of all the vessels. Vessels were mapped on an XYZ axis. RESULTS The subcutaneous plane, containing 25 vessels on average, had the smallest vessel diameters (artery, 0.9 [0.3] mm; vein, 1.05 [0.22] mm). The GM vein diameter was 1.3 [0.3] mm. Branches of the inferior gluteal vessels had arterial and venous calibers of 2.2 [0.04] mm and 3.5 [0.99] mm, respectively. Superior gluteal artery and vein branches were 1.8 [0.2] mm and 3.85 [1.9] mm in diameter, respectively. Superior and inferior gluteal vein diameters were 7.61 [2.24] mm and 13.65 [6.55] mm, respectively. CONCLUSIONS The deeper and more medial planes of the gluteal region house larger, more prominent vessels. This research objectifies and is consistent with recommendations made by various recent task force reports to limit fat transfer to the subcutaneous plane.
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Affiliation(s)
- Carlos Ordenana
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Sayf Said
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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32
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Everett M. Commentary on: Objectifying the Risk of Vascular Complications in Gluteal Augmentation With Fat Grafting: A Latex Casted Cadaveric Study. Aesthet Surg J 2020; 40:410-412. [PMID: 31883331 DOI: 10.1093/asj/sjz310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marc Everett
- Lenox Hill/Manhattan Eye Ear and Throat Hospital, New York, NY
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Influence of Age, Sex, and Body Mass Index on the Thickness of the Gluteal Subcutaneous Fat. Plast Reconstr Surg 2019; 144:83-92. [DOI: 10.1097/prs.0000000000005707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
BACKGROUND Recent anatomical studies have demonstrated that fat placed subjacent to the fascia of the gluteus maximus muscle can migrate deep through the muscle into the submuscular space, possibly causing tears in the gluteal veins, leading to fat embolisms. The purpose of this study was to define and to study subcutaneous migration and to determine whether fat placed in the subcutaneous space under a variety of pressures and fascial integrity scenarios can indeed migrate into the deep submuscular space. METHODS Four hemibuttocks from two cadavers were used. Proxy fat was inserted using syringes with various fascia scenarios (1: fascia intact; 2: cannula perforations; 3: 6mm fascia defects) or using expansion vibration lipofilling (4: fascia intact). Subcutaneous pressures were recorded. After injections, anatomical dissections were performed to evaluate the migration of the proxy fat for each of the scenarios. RESULTS Scenario 1: pressure reached approximately 125 to 150 mmHg and then plateaued and all the proxy fat remained in the subcutaneous space. Scenario 2: pressure reached a 199-mmHg plateau and no proxy fat spread deeper into the muscle or beneath it. Scenario 3: pressure gradually rose to 50 mmHg then fell again and the submuscular space contained a significant amount of proxy fat. Scenario 4: pressure rose to a maximum of 30 mmHg and all of the proxy fat remained in the subcutaneous space. CONCLUSIONS The gluteus maximus fascia is a stout wall that sets up the dangerous condition of deep intramuscular migration with subfascial injections and the protective condition of subcutaneous migration with suprafascial injections. These persuasive findings are profound enough to propose a new standard of care: no subfascial or intramuscular injection should be performed, and all injections should be performed exclusively into the subcutaneous tissue.
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The Expanding Role of Diagnostic Ultrasound in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1911. [PMID: 30349786 PMCID: PMC6191221 DOI: 10.1097/gox.0000000000001911] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Ultrasound in plastic surgery is quickly finding new applications. Ultrasound surveillance may replace ineffective individual risk stratification and chemoprophylaxis for deep venous thromboses. Abdominal penetration can be a catastrophic complication of liposuction. Preoperative screening for fascial defects may reduce risk. Limiting buttock fat injections to the subcutaneous plane is critical for patient safety, but it is difficult to know one’s injection plane. Methods: The author’s use of diagnostic ultrasound was evaluated from May 2017 to May 2018. Ultrasound scans were used routinely to detect deep venous thromboses. Patients undergoing abdominal liposuction and/or abdominoplasty were scanned for possible hernias. Other common applications included the evaluation of breast implants, breast masses, and seroma management. The device was used in surgery in 3 patients to assess the plane of buttock fat injection. Results: One thousand ultrasound scans were performed during the 1-year study period. A distal deep venous thrombosis was detected in 2 patients. In both cases, the thrombosis resolved within 1 month, confirmed by follow-up ultrasound scans. A lateral (tangential) fat injection method was shown to safely deposit fat above the gluteus maximus fascia. Conclusions: Ultrasound scans are highly accurate, noninvasive, and well-tolerated by patients. Some of these applications are likely to improve patient safety. Early detection of deep venous thromboses is possible. Unnecessary anticoagulation may be avoided. Subclinical abdominal defects may be detected. Ultrasound may be used in the office to evaluate breast implants, masses, and seromas. In surgery, this device confirms the level of buttock fat injection.
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