Advancing Safety in Buttock Augmentation

Advancing Safety in Buttock Augmentation: Our Experience and Future Commitments

The article by Del Vecchio and Kenkel on the topic of Brazilian Butt Lift (BBL) surgery has captured our attention. Its relevance is especially poignant as the United Kingdom witnesses the cautious resumption of BBL procedures. In 2018, the British Association of Aesthetic Plastic Surgeons (BAAPS) issued guidance discouraging BBL surgery in the UK. This stance led to a proactive response from BAAPS, including a Delphi study in 2020 and a subsequent survey of its members regarding BBL surgery practices in the UK.

The culmination of these efforts occurred in October 2022 when BAAPS released new guidelines. These guidelines mark a significant step forward in ensuring the safety of BBL surgeries in the UK. Two key takeaways from the guidelines are the importance of performing fat grafting superficially, i.e., above the gluteal muscle, and under the guidance of ultrasound. These recommendations align well with the comprehensive insights provided in Del Vecchio and Kenkel's report.

Our institution recognizes the value of contributing to this ongoing discourse. We aim to share our experience with liposuction and fat transfer to the buttock and hip area, predating the 2018 BAAPS advisory that temporarily halted BBL-related procedures in the UK. Our intent is to fill a gap in the literature by shedding light on BBL surgeries conducted within the United Kingdom.

Between March 2015 and September 2018, we performed 24 BBL procedures exclusively on female patients. We aptly referred to this as "silhouette contouring" to emphasize the holistic approach. This approach encompassed liposuction not only for shaping the buttocks but also for sculpting the waist and thighs. These procedures were conducted by three surgeons, adhering to rigorous preoperative protocols, including anesthetic clearance, an ASA Grade of 1 or 2, a BMI below 30 kg/m2, and standardized preoperative photography.

While there were slight variations in our intraoperative techniques, the common thread was the placement of fat above the gluteal muscle using 10-mL syringes. We drew fat from various donor sites such as the abdomen, flanks, thighs, knees, arms, and back. On average, each patient had 1600 mL of fat aspirated, with an average fat transfer of 265 mL per gluteal side. Postoperatively, patients were advised to wear compression garments for up to six weeks and received a seven-day course of antibiotics. Importantly, our series of surgeries were free from major complications, readmissions, and fatalities.

It is essential to acknowledge the considerable variation in the technical aspects of BBL surgeries internationally, similar to the diversity observed in fat grafting to the breast. However, this variance does not inherently imply a superior technique. Our experience underscores that safe fat harvest and injection are paramount. The consensus among national and international authorities emphasizes the significance of injecting fat above the muscle to mitigate the risk of fat embolism—an extremely serious complication.

The average volume of fat we injected per gluteal side was 265cc. This might be attributed to our patient demographic, which included individuals with lower BMIs, as we had set a BMI cutoff at less than 30. Additionally, our patients typically sought a modest and natural-looking outcome.

We align ourselves with Del Vecchio and Rohrich's perspective on the terminology surrounding this procedure. They aptly argue that the term "BBL" is misleading and propose "safe subcutaneous buttock augmentation" as a more accurate description. We concur with this notion and emphasize that achieving the desired augmented buttock result often involves sculpting not only the buttocks but also the hips, flanks, and sometimes the thighs. Therefore, we have transitioned from using "BBL" to "silhouette contouring" to underscore the comprehensive nature of this approach.

In summary, we offer our limited yet potentially significant experience comprising 24 BBL surgeries conducted at our institution prior to the 2018 BAAPS guidance. We express our wholehearted support for ongoing efforts aimed at enhancing the safety of this procedure. To this end, we are committed to implementing intraoperative ultrasound guidance and will host a "safe BBL" course in the United Kingdom, featuring Dr. Del Vecchio as an esteemed international authority. Our ultimate goal is to provide local, safe solutions for our UK patients, aligning with the evolving standards of care.