As you can get, the BBL Brazilian Butt Lift is a hot topic due to the dangers seen.
Our ASPS Society formed a task committee after deaths had been reported. The dangers of BBL are being reported outside of medicine. In February of 2018, the Journal of Forensic Sciences published a series of eight deaths seen by the Miami Dade Medical Examiner. They stated,” We hope this series will raise awareness and inform the pathologist of the expected autopsy findings in a patient undergoing gluteal fat transfer and the probable mechanism of death being macroscopic pulmonary fat embolism.”
This commentary was Dr. Teitelbaum of Santa Monica.
Points in his discussion:
- The Aesthetic Society questions if fat can penetrate a vessel without it being punctured directly due to high pressure. He does not believe this is a mechanism, due to the histology, the fact if this was a big issue we should have seen many more problems because of the BBL popularity, and deaths occurred with volumes too small to cause distraction.
- In the autopsies, fat was found within the muscle with a marbled appearance. In NO death case was fat found just in the subcutaneous space. (So if you stay just in the space above the muscle, you should be safe.)
- We know there is a significantly higher risk with deep intramuscular injection.
- Those who argue “I’ve done thousands into the muscle without a problem; it is about knowing where you are and how to do it.” He replies, “This is like you do not need a seatbelt because you have never worn one and never died in an accident.” No surgeons have done so many cases that they can really comment on their death rate percentage. And the one time you have a car rollover accident with no seatbelt is all it takes.
- Intramuscular injection and warnings of the “safety triangle” have been the focus of surgeon education, but the study done shows muscular injection is not as safe as subcutaneous.
- If you need more volume, stage the procedures. (ie do multiple procedures to get build the volume each time) Convenience and cost should not trump safety.
- There are shortcomings of the cadaver applesauce model, but none of this should make you dismiss the study findings.
Overall his thought? Stay superficial, don’t go in the muscle, and the death rate should be zero.