Buttock Fat Graft: SSBA rather than BBL

By Dr. Sutton Graham on June 15, 2019


BBL has become a common abbreviation for Brazilain Buttock Lift, meaning liposuctioning out your own fat to contour other "donor" areas and use this fat to fill and enhance the buttocks.  Interestingly, the term was coined by a US plastic surgeon and is not actually a lift at all.  However recently there is a growing awareness of risks with this procedure being significantly higher than with other plastic surgery procedures.  There have been a number of deaths associated with buttock fat grafting, caused by fat entering the patient's bloodstream and cloging the lungs (fat embolism). 

The ASPS (American Society of Plastic Surgeons), ASAPS (American Society of Aesthetic Plastic Surgeons) and the ISPS (International Society of Plastic Surgeons) professional societies conveined a task force to investigte.  They did a thorough review of existing literature.  They were granted access to several autopsies to add a operating surgeons' perspective to the coroner's evaluation.  All of the fat embolism cases demonstrated fat within and beneath the buttock muscles (gluteus muscles).  No cases involved fat grafting limited to the subcutaneous layer.  This is the zone of natural fat, under the skin and above the buttock muscles.  Eventually they obtained cadaver samples and had recognized expert buttock surgeons perform their individual techniques to evaluate their safety in laboratory conditions.  All of these surgeon's placed fat accurately within the subcutaneous space. 

The panel's recommendations are included in the attached link.  They include careful patient positioning, proper equipment, careful cannula placement, and importantly only placing fat grafts within the subcutaneous layer.  This is not new for Dr. Graham.  Our buttock augmentation has always been done in this manner.  At the recent ASAPS national meeting a surgeon suggested we stop using the BBL name, and start explaining the preferred procedure as SSBA, Safe Subcutaneous Buttock Augmentation.  This is an exellent term for an effective procedure. 

https://www.plasticsurgery.org/for-medical-professionals/advocacy/key-issues/fat-grafting-to-the-buttocks

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