Fat Embolism in Gluteal Lipoinjection: Not Only a Matter of "Where" but Also of "What"

Purpose:

Gluteal fat grafting became extremely popular during the last five years according to ASPS statistics ¹. Parallel, there have been deaths reports following this procedure, usually associated with gluteal vessels damage and macroscopic fat embolism (MAFE) ². Some necropsies have failed to find macroscopic fat tissue in lungs or tore gluteal veins, but found oil in lung parenchyma in the microscopic evaluation, which has been called microscopic fat embolism (MIFE) ³. Fat embolism is known to occur even without lipoinjection, in patients subjected only to liposuction ⁴. But all papers published so far about safety in gluteal fat transplantation focus only on MAFE pathophysiology, outlining buttocks areas, machinery, and techniques that are more prone to provoke a vessel wall damage. To date, there is no initiative discussing measures to avoid MIFE, therefore not contemplating all fatal cases that occur.

 

Methods and materials:

MIFE pathophysiology, the interplay between vascular wall physiology and liposuction components, taking into account the effects of surgical metabolic response on vascular reactivity are discussed and correlated to clinical current practices.

 

Results:              

Fat injections into the muscular tissue are related to fat embolism not only because the presence of large vessels within its mass that can be damaged and suction the fat graft through the tearing but also because muscles have a higher overall vascularity and concentration of vessels compared to other tissues that allow more absorption of the free oil normally contained in the lipoaspirate through its lipophilic walls.

 

Conclusions:

Initiatives to develop fat tissue harvesting and processing machinery and techniques that avoid the presence of free oil in the graft material are pivotal to ensure maximal safety in autologous fat graft procedures.

 

 

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