Q. I am contemplating having fat injections in my buttock area. I have seen a surgeon who has scheduled my surgery. However, I recently read some reports about problems with butt lift procedures using fat. Before proceeding, I just want to make sure the procedure is safe. What is your opinion regarding a Brazilian butt lift with fat? 

A. Like all elective surgical procedures in plastic surgery, a butt lift is generally considered safe, however there are potential risks that one takes when undergoing this surgery. Brazilian butt lifts have become quite popular, especially in South America but also, to a lesser extent, in the United States. The number of these procedures being performed in this country has been steadily rising over the last ten years. The procedure involves transferring fat from one part of a patient’s body to the buttock area. The fat is first harvested by way of liposuction of, for example, the abdomen, love handles, hip rolls, and thighs. The fat is cleaned and then concentrated by removing fluids. Once the fat has been prepared, it is reinjected in the buttocks. The harvesting of the fat is performed in a very traditional fashion using standard liposuction. This part of the process is considered very safe with limited risks. 

As always, the devil is in the details. The problems with the butt lift comes with the reinjection of the fat, with most of the serious complications related to this part of the surgery. What kind of complications? Infection, bleeding, swelling, asymmetry from side to side, pain, bruising, lumpiness, and unpredictable reabsorption of the injected fat. These complications are at least temporary and somewhat tolerable. The worst complication however, is death. Yes, I said death. There have been more than 25 deaths in the last 5 years in the United States related to the injection of fat into the buttock. Why does this happen? It is postulated, and actually proven in a couple of cases, that some of the fat is accidently injected directly into one of the large veins in the buttock muscle (gluteus muscle). When this happens, the fat will flow directly to the heart where it then gets pumped to the lungs where it causes a pulmonary fat embolism. This fat goes into the arteries of the lungs and occludes the blood vessel so that oxygenation of the blood cannot take place. If the fat globule is large enough, it can block a large portion of the lung which then makes it impossible to adequately oxygenate the blood which can lead to rapid death. Most of the deaths occurred in patients who were being operated on by well-trained board certified plastic surgeons. Most of the surgeons had experience in performing this type of surgery. So, in spite of seeing someone who is adequately trained and has experience, a fatal outcome can still occur. What is the take home message here? Be careful. I do not perform this procedure because of its relatively high risk of a complication that is unacceptable to me. Make sure that if you decide to proceed, the surgeon is board certified and has performed a large number of fat augmentations of the buttock. What defines a large number, I really don’t know the answer to that question, but I would say at least 100 cases. Make sure that this aesthetic change in your buttocks is very important to you because the surgery is not risk free as you have read.