Staying Safe During Gluteal Fat Transplantation

Nathaniel L. Villanueva, M.D.; Daniel A. Del Vecchio, M.D.; Paul N. Afrooz, M.D.; Jourdan A. Carboy, B.S.; Rod J. Rohrich, M.D.


Plast Reconstr Surg. 2018;141(1):79-86. 

In This Article

Abstract and Introduction


Gluteal augmentation with fat transplantation is increasing in demand but has been associated with a concerning number of fatality reports. Despite these reports, various surgeons have safely performed gluteal fat transplantation on a large number of patients with no reported mortality. The important aspects of safely performing gluteal fat transplantation are reviewed. Proper patient selection, favorable instrumentation, patient positioning, proper technique, and knowledge of anatomy are critical to improving the safety of this procedure. Adherence to these key principles should allow a reduction in mortality from this procedure, which would safely allow its continued offering in the setting of increasingly high demand.


Gluteal augmentation procedures are becoming more prevalent in the field of plastic surgery. Specifically, buttock augmentation with fat grafting has seen a dramatic increase in the United States in recent years. In 2016, there were 18,489 buttock augmentation with fat grafting procedures performed, which is a 26 percent increase from the year prior and nearly double the amount performed in 2011.[1] There are various reports in the literature on techniques that include fat grafting in either the subcutaneous plane, the intramuscular plane, or a combination of both.[2–27] As demand for this procedure has increased, a number of fatalities that are a direct result of gluteal fat transplantation have surfaced.[28–30] In a recent report by Mofid et al., the Aesthetic Surgery Education and Research Foundation formed a task force to evaluate the incidence of fatal and nonfatal pulmonary fat embolisms associated with gluteal fat grafting and to provide safety recommendations.[30] The authors reported a cases-per-career mortality rate of one in 6214 cases and a case rate of fatal and nonfatal fat pulmonary emboli of one in 1931 with gluteal fat grafting, with an estimated annual mortality rate of one in 3448 cases. These fatalities have been attributed to fat embolism, which is thought to be a result of either direct injection into a large gluteal vein or injury to a gluteal vein with subsequent inflow of fat lobules from the surrounding tissues. These venous injuries were associated with deep gluteal muscle fat grafting. However, there are opposing views that report no fatalities with intramuscular injections.[31] Therefore, it is of utmost importance to learn from these cases and the paucity of literature on this topic to further improve the safety of this procedure. In this article, we review the key anatomy and delineate what we feel are the most important concepts for the purpose of improving patient safety during buttock augmentation with fat grafting.