Gluteal contouring has become an extremely popular procedure led by celebrity images and patient requests. Many techniques exist, from implants to fillers; the use of autologous fat, to perform the popularised Brazilian Butt Lift (BBL) has resulted in a very high mortality rate reported to be in the region of 1:3,000 – one of the highest rates of death in a cosmetic procedure.
In 2018 this led many international societies to issue advisory guidance to surgeons to ensure further discussion of the potential risks with their patients, as well as providing further recommendations on safe techniques for performing BBL with fat transfer.
In the UK, the Plastic Surgery Societies (BAAPS and BAPRAS) have stated that surgeons should stop performing buttock enhancement procedures by fat transfer until further data is available from the Multi-Society Gluteal Fat Grafting Task Force. It appears that the main issue with this procedure is the inadvertent injection of fat into the intramuscular plane and submuscular space in the gluteal region, which has led to the introduction of fat into the large veins and subsequent fatality.
There has always been an interest in using injectable fillers to also contour the body and this has led to the use of these products to recontour the buttocks. When used in small volumes and placed superficially there is a low risk of fatality. Recent uses of dermal fillers to treat small volume defects and areas of cellulite with neo-collagenic injectable implants have been successful when small volumes are injected in the superficial fat area of the buttocks. However, when larger volumes are used to recontour the buttock, does this pose a similar problem and should practitioners have the same discussion with patients as a fat grafting procedure? The published evidence is not available, the practical issue is the layer in which these fillers are injected and the quantity.
A full understanding and knowledge of the underlying anatomy and position of injection of products is crucial. Whatever products are used, it is imperative that relative risks are discussed and adequate training, performance of the procedure and follow-up of the patient is closely followed. Subsequent management and reporting of adverse events should be done in an open and transparent way. Practitioners venturing into this area of body contouring must be aware of all possible risks and be prepared to deal with issues arising from this procedure.
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