What is a safe BBL?
The safe BBL must avoid fat grafting into or under the gluteus maximus muscle to avoid fat embolus into the superior gluteal vein. Several measures are employed to minimize the risk of fat emboli. These safety measures include:
- Injecting fat only in retrograde fashion while the cannula is moving
- Injecting fat with a grafting cannula that is larger than 4mm
- Injecting fat using a rigid cannula with a single hole tip
- Placing the patient in a slightly flexed position (ani-flexed)
- Using a sacral port that makes direct injury to the superior gluteal vein impossible
- Knowledge of muscle and vascular anatomy
- Use of a portable ultrasound to guide fat graft transfer
What is a portable ultrasound?
Portable ultrasound can be used to guide your fat injection. Using specialized cannulas, you can not only visualize the cannula but also the fat as it exits the cannula tip. By being able to visualize the safe plane, the subcutaneous fat, you can localize the transferred fat in between the skin and the muscle fascia. The boxed area in purple above describes an area where the ultrasound should be used as this is the danger zone located near the gluteal veins, the vessels identified in the mechanism of fat emboli.
Not only is an ultrasound helpful in performing a safe BBL, but it can assist in cases where a buttock implant is involved. Patients who already have a buttock implant or those who desire buttock implant augmentation simultaneously with their fat transfer, must be assured that no fat is positioned near the implant. If fat graft is positioned near the newly placed implant or in the capsule surrounding a previously placed implant, there is a risk of fat dying and getting infected. Another set of patients who have experienced complications with their previously placed buttock implants may desire simultaneous implant removal and fat transfer. In these patients, it is prudent to use an ultrasound to ensure that fat is not replaced within the void pocket created following removal of the buttock implant.