Bottoms Up! Surgeons say “No to BBL but Yes to SGL”

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Following an extensive four year review of clinical data, new technology and new surgical 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 one of the most popular cosmetic procedures with the biggest growth rate in plastic surgery worldwide, with an increase of 20% yearly. It has become one of the most popular treatments of buttock volume augmentation, among Sculptra buttock enhancement, overtaking gluteal augmentation with implants.

In 2020, The Aesthetic Society statistics recorded more than forty thousand buttock augmentation procedures, which included both fat grafting and buttock implants.

In 2015, there were a few 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, clinic review and analysis, BAAPS guidelines now recommend that GFG is safe to perform under two key conditions:

1. Injection into the subcutaneous plane only (under the skin) 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 only, this is the only way that surgeons can be confident they are not in the muscle layer or under the muscle.

“The new BAAPS guidelines are very robust and comprehensive, and the evidence has been critically analysed,” said BAAPS president. “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, unfortunately, the public still sought out the risky procedure and many were prepared to risk their lives by going abroad and increasing number of UK based patients are continuing to venture abroad for the BBL procedure.

It goes without saying that there are considerable concerns regarding higher risk of exposure to serious 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. Therefore, introducing the new GFG guidelines we will help protect the patients seeking this BBL procedure.  Also, this explains the big demand on non-surgical buttock enhancement procedures, such as Sculptra buttock enhancement and dermal fillers for buttock enlargement.

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