Brazilian Butt Lift Performed By Brazilian Plastic Surgeons: Reports of an Expert Opinion Survey

INTRODUCTION: Gluteal fat augmentation is one of the hot topics in plastic surgery nowadays as the demand has steadily increased in the last 3 years. However with the increase in popularity, a recent survey showed an increase in major complications due to this procedure. Expert opinion surveys constitute a well-established tool for obtaining information involving medical conduct, providing insight into individual’s perspectives and experiences. Brazil is the country with the highest number of gluteal augmentation performed in the world according to international statistics.

METHODS:  We performed an online anonymous survey composed of two questionnaires with the objectives of identifying technical preferences of Brazilian butt lift and enumerating complications of this procedure with board certified Plastic Surgeons, members of the Brazilian Society of Plastic Surgery. Statistical analysis was performed using chi-square test for categorical variables and ANOVA for the continuous variables.

RESULTS:   A total of 853 of the 5655 board certified Brazilian plastic surgeons answered the survey (response rate 15.08%). The confidence level was 99% with 4% margin of error.  Fat grafting was considered the best technique for gluteal augmentation in comparison to implants by 79.89% of plastic surgeons. The fat harvesting technique mostly used was vacuum assisted liposuction (60.75%), attached to a 4mm diameter cannula (60 %). Fat was processed by decantation by 85.66% plastic surgeons, using a 3 or 4 mm diameter cannula (43.48%, 40.52%). The intergluteal cleft incision was used by 63,32% plastic surgeons and fat was injected in the subcutaneous plane only by 55,7%. The most frequent volume of fat injected per buttock was between 200 and 399 ml (75.62%). Seventy one percent members didn't have any restriction regarding positioning in the post-operative period. The percentages of plastic surgeons that reported complications following the procedure were: 36,5% for contour irregularities, 23,63% for fat necrosis, 17,75% for seroma, 13,5% for infection, 11,25% for oil cysts, 9,38% for hematoma, 5,13% for paresthesia, 2,25% for fat embolism, 2,13% for pulmonary embolism, 1,88% for deep venous thrombosis and 1,5% death. Seventy-six percent plastic surgeons kept their patients in observation for 23 hours. Most plastic surgeons had experience with this procedure as 76% learned it during their residency training. The mortality rate estimated was 1: 20.117 cases or 4.97: 100.000 cases (0,0049%). Non-fatal fat embolism rate was 1: 9530 cases or 10.5: 100.000 cases (0,01%).                                                                                                                                                                                                                                                                                                                                        CONCLUSIONS: With all the studies being carried out on this topic, guidelines are being established in order to prevent complications and increase safety with this procedure. Following this survey, recommendations are the following: Inject a maximum of 500 ml per buttock subcutaneously only, via superior gluteal incisions, using 3 to 4 mm diameter cannulas for fat harvesting and injection, keep the patients in observation for 23 hours. It is also recommended that plastic surgeons acquire experience before performing this procedure.