The New Brazilian Butt Lift Technique Part 2

Dr. Kenneth Benjamin Hughes Plastic Surgeon Los Angeles, CA

Dr. Kenneth Benjamin Hughes is a Harvard-trained, board-certified plastic surgeon practicing in Los Angeles, CA. Dr. Kenneth Hughes has built a fully accredited, state-of-the-art surgery center in which he performs a wide range of cosmetic and reconstructive plastic surgeries. Dr. Kenneth Hughes performs tummy tuck, Brazilian... more

This article is the second in a series of delineating the evolving medicine in a procedure known as the Brazilian butt lift. This procedure involves using liposuction on areas of excess skin like the abdomen, and then transferring it to the buttocks or hips. As a background, Dr. Kenneth Benjamin Hughes is a board-certified plastic surgeon in Los Angeles, who has performed thousands of Brazilian butt lifts (BBL). Four years ago, Dr. Hughes developed a new fat grafting technique due to his concerns about the safety of intramuscular injections and the development of fat emboli (little pieces of fat migrate through the bloodstream and potentially block function of certain organs including the lungs). Before the turning point in 2015, Dr. Kenneth Hughes along with the vast majority of board-certified plastic surgeons in the United States, transferred at least a portion of the fat to the buttocks into the muscular tissue.

This technique had been adopted to produce greater fat survival rates due to the enhanced vascularity of muscle tissue. At that time, this method of injection was the standard of care and remained the standard of care until less than 2 years ago with no formal recommendation until August 2018. At this time in 2019, the plastic surgery community as a whole knows that intramuscular injection of fat into the buttocks can lead to fat embolus. The current theory is that larger diameter vessels in the muscles allows for a small risk of intravascular introduction of fat. Some of these fat emboli do not cause respiratory collapse, but can lead to significant morbidity even if the patient recovers. These emboli can migrate throughout the body affecting other organs. Some of these fat emboli will even lead to patient death.

In an effort to reduce the incidence of fat emboli, Dr. Kenneth Hughes developed a subdermal fat transfer method for the Brazilian butt lift. In this subdermal method, Dr. Hughes places fat directly under the skin, visualizing the tip of the fat transfer cannula at all times. There were many unanswered questions at the point in 2015 when this subdermal method was introduced. How would the subdermal technique affect the percentage of fat graft that would take or live? What was the likelihood for fat pooling, fat necrosis or fat death, and infection? However, these complications could be managed, whereas the complication of fat embolus could not be managed in any meaningful way.

Over the past 4 years, Dr. Kenneth Hughes has performed the fat transfer and Brazilian butt lift procedures with the subdermal transfer method. Dr. Hughes tabulated complications for this subdermal method. Of the approximately 1500 patients, infection occurred only 3% of the time. There were no instances of fat necrosis with this method of transfer. The fat resorption rate was believed to be greater though no MRI testing or volumetric analysis to confirm was performed. There were no instances of fat emboli observed with this method so far. 

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