The executive committees of the largest U.S. plastic surgery societies issued Thursday a newly-adopted safety statement on gluteal fat grafting.
Ninety-two percent of the deaths occurred at “high volume budget clinics” in South Florida, according to an August 11 Aesthetic Surgery Journal article by Drs. Pat Pazmiño and Onelio Garcia, M.D.s.
That study says a clinic’s working environment and short surgical times of roughly 90 minutes per BBL appear to be the norm for surgeries in which patients died.
“Gluteal fat grafting deaths are occurring across medical settings, from poorly regulated strip mall clinics to accredited surgical centers.”Gluteal Fat Grafting: A joint safety statement, August 18, 2022
In light of recent research and “deeply concerning levels of patient harm and mortality,” which the societies say are a national problem, Thursday’s joint safety statement outlined the societies’ position with regard to safety protocol for Brazilian butt lift surgery.
The societies jointly advocate for the following overarching recommendations:
Surgeons Should Hold Hospital Privileges
1. That gluteal fat grafting done in office-based settings should only be performed by surgeons who also hold privileges to do the procedure in a state-approved or licensed ambulatory surgery center or hospital.
Use Ultrasound While Injecting Fat
2. That ultrasound imaging technology be used in real-time during gluteal fat grafting surgery. The societies say they’re committed to ensuring members are trained in the use of ultrasound and will work to develop best practice guidance and educational opportunities for gluteal fat grafting surgeons.
Provide Pre- and Post-Operative Care
3. That surgeons be “actively engaged with their patients,” and establish a doctor-patient relationship prior to surgery, and remain available to manage postoperative complications.
In many instances in Florida, patients don’t meet their BBL surgeon any sooner than a few minutes or hours prior to their surgery, and strip mall surgery clinic contracts include clauses that allow them to assign a new or different surgeon for any reason.
Ethically Operate BBL Surgical Facilities
4. That untrained or under-trained surgeons or surgical assistants not be allowed to perform the “critical portions of” a gluteal fat grafting surgery, nor should member surgeons practice in facilities where this is allowed.
The societies note that the business practices of some BBL facilities are an area of serious concern, and that States have raised concerns over the high number of BBLs being done per surgeon per day.
“Business models that endanger patients in the pursuit of profits should not be tolerated,” the societies write, “and our Societies support those practice models that truly prioritize patient safety and quality outcomes.”
In “surgical mills,” variously qualified surgeons often oversee other less-trained assistants who do some or all of a Brazilian butt lift—whether the liposuction portion or the fat injecting portion—allowing more patients to be operated on per day than would be safely and physically feasible if only one qualified surgeon were performing the procedures.
The societies also pledge to:
- Investigate the safety and efficacy of various clinical approaches proactively.
- Train member surgeons on approaches most likely to improve patient safety.
- Sponsor additional research and collect evidence to validate clinical approaches.
- Participate in shaping public policy and supporting state and federal regulations “until the safety outcomes of gluteal fat grafting are comparable to other elective aesthetic surgical procedures.”
“It is well-recognized that this procedure [gluteal fat grafting] carries significant risk compared to other elective aesthetic surgical procedures and as a result, its increased popularity has resulted in deeply concerning levels of patient harm and mortality.”Gluteal Fat Grafting: A joint safety statement, August 18, 2022
Prior to issuance of the joint safety statement, Florida’s Board of Medicine issued an emergency order in light of increasing patient deaths.
That order expires 90 days after its issuance in early June.
“Our Societies support these patient safety measures and believe that they are likely to save lives and reduce morbidity,” the societies say of Florida’s emergency ruling, which limits surgeons to performing no more than three gluteal fat grafting surgeries per calendar day.
The societies commend the “significant actions” taken recently in Florida, but acknowledge the problem of gluteal fat grafting safety is national in scope.