At a recent conference of the Australasian Society of Aesthetic Plastic Surgeons in Auckland NZ, one topic of discussion was “buttock enhancement” sometimes called a Brazilian Butt Lift. What started as a demand from South America spread to North America and has now come to Australia. Women are requesting larger rounder buttocks. Buttock implants have not been particularly satisfactory so surgeons have been injecting fat into the buttocks. This has proven to be a highly dangerous procedure with a death rate of 1 in 3,000.

Extensive investigation has indicated that some of the fat that is injected can find its way into large veins just beneath the gluteal muscles and result in what is known as a “fat embolus”. The fat enters the vein and travels to the heart, where it blocks the flow of blood by occluding the right atrium.

There has been considerable discussion on how to avoid this tragic complication. It has been suggested that any fat grafting be performed away from the centre of the buttock where the gluteal veins are. It has been suggested that the fat be placed superficially just under the skin and never into the muscle. Unfortunately accidents can occur and, with a large volume fat grafting procedure, inadvertent injection of some fat into the muscle is a possibility with potentially devastating consequences.

The most sensible suggestion is to avoid fat grafting into the buttocks altogether. In fact, by liposuctioning the hips and the tissues around the buttocks, one can obtain a much more aesthetic and rounder looking buttock without the need for fat transfer in many cases.

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