Following an extensive four-year review of clinical data, new technology and techniques, the British Association of Aesthetic Plastic Surgeons (BAAPS) has published its Gluteal Fat Grafting (GFG) guidelines.
In 2018, BAAPS dissuaded all its members from performing Brazilian Buttock Lift (BBL) surgery, until more data could be collated, due to the high death rate associated with the procedure.
Gluteal fat grafting is currently the procedure with the biggest growth rate in plastic surgery worldwide, with an increase of around 20% year-on-year. It has become the most popular means of buttock volume augmentation, overtaking gluteal augmentation with implants. In 2020, The Aesthetic Society statistics recorded 40,320 buttock augmentation procedures, which included both fat grafting and buttock implants.
In 2015, there were reports of intraoperative mortality related to pulmonary fat emboli associated with BBL surgery and, with growing concern about the high mortality rate associated with this procedure, three years later BAAPS recommended it was not performed by its members.
Stimulated by new evidence based on scientific review and analysis, BAAPS guidelines now recommend that GFG is safe to perform under two key conditions:
1. Injection into the subcutaneous plane only -– the evidence shows that the only deaths from the procedure have been when fat has been injected into the deeper muscle layer.
2. Intraoperative ultrasound must be used during the placement of fat in the gluteal area to ensure that the cannula remains in the subcutaneous plane – this is the only way that surgeons can be confident they are not in the muscle layer.
“The new BAAPS guidelines are very robust and comprehensive, and the evidence has been critically analysed,” said BAAPS president Marc Pacifico. “The deaths recorded with BBL have all had breeches of the fascia with fat injected into the muscle. So, it’s no to BBL but yes to Superficial Gluteal Lipofilling (SGL) where the fascia is not compromised. To ensure this we are recommending that Surgeons should only perform this with real time ultrasound guidance as the only way to ensure the procedure is performed superficially and safely.”
Despite the previous ruling on BBL surgery by BAAPS, the public still sought out the risky procedure and many were prepared to risk their lives by going abroad.
“An increasing number of UK based patients are continuing to seek this procedure by surgeons not on the GMC Specialist Register or by venturing abroad,” added Pacifico. “There is a concern regarding higher risk of exposure to risks and complications, such as sepsis, poor techniques, deep vein thrombosis, and pulmonary embolism. The majority of BBL complications seen in the National Health Service are related to sepsis, fat necrosis, and skin necrosis. So, by introducing the new GFG guidelines we will help protect the public seeking this procedure.”
