Safety in BBL is a critical concern because of a detrimental side effect of BBL surgery involving the inadvertent entry of fat into the vascular system called fat emboli. Fat emboli can be life-threatening if the fat travels through the venous system and gets stuck in the arteries of the lungs. If a large enough fat gets stuck in the lung arteries this can result in pulmonary emboli that can be life-threatening.
Fat emboli risk can be minimized by avoiding the injection of fat into or under the muscle. This is because the main vein responsible for fat entry into the vascular system is called the superior gluteal vein that is largest in caliber under the muscle. Avoiding injection of fat into or under the muscle is difficult to avoid because the soft tissue thickness of the buttock and muscle layers are difficult to gauge when performing BBL surgery. A thinner patient may have a very fat layer that may not be easily appreciated thus making fat entry into or under the muscle feasible. Several novel methods for avoiding intramuscular fat injection are currently being evaluated.
The Mowlavi fat grafting cannula avoids entry of fat into the intramuscular or submuscular plane. The Mowlavi fat grafting cannula utilizes a cannula shaft that is visible under ultrasound. This makes the cannula useable under ultrasound guidance when injecting fat. Since both the cannula as well as the fat and muscle interface are visualized, injection of fat into or under the muscle can be avoided.
What other methods are being investigated to avoid intramuscular or submuscular fat injection?
Currently, several medical device companies are studying the possibility of utilizing impedance (electronic resistance) differences of muscle and fat to devise a cannula that would provide the surgeon feedback if the tip of the cannula were to enter the muscle. For example, audible feedback would potentially inform surgeons when the cannula tip was no in the fat layer. This process would allow surgeons to avoid the injection of fat into or under the muscle.
The concept of patient positioning has been investigated anecdotally. Intuitively, it would make sense that if you were to flex the bed, called anti-flexion so that you jackknifed the patient, it would make it more difficult to place the fat grafting cannula into the muscle from a vector standpoint. However, recent studies have demonstrated that this flexion makes the fat layer thinner in girth because of the tightening of the overlying skin.
From prior descriptions, the symptoms of pulmonary emboli actually present immediately after surgery. This means that your vitals will crash, i.e. oxygenation and blood pressure, while you are in the PACA or postoperative recovery unit. If you doing well when you leave the operating suite, you don’t have to worry about this complication.
The treatment for a pulmonary emboli complication is supportive care. This means oxygenating you with oxygen supplement, intravenous fluids, and intubation on a ventilator. Whether or not you will bounce back is typically dependent on the extent of the embolus and degree of clotting that occurs in the pulmonary arteries.
Safe BBL refers to the surgery utilizing ultrasound guidance when fat grafting the buttock cheeks. The Mowlavi fat grafting cannula is utilized to transfer the fat and allows for direct visualization of where the fat cells are injected. By ensuring that all fat cells are injected only in the fat layer above the muscle, the risk of fat emboli is minimized. SCUBA, which stands for Safe California Ultrasound-assisted Buttock Augmentation describes safe BBL principles.
Part of the safe BBL guidelines is the precautions taken to ensure that patients are provided an accurate rendition of their desired buttock shape. This is done using the buttock assessment tool where patients are allowed to choose amongst buttock size and shape permutations.
Brazillian butt lift (BBL) surgery is a procedure to improve the contour of the buttocks by placing fat in strategic areas. The safe BBL or Brazilian butt lift is the most popular cosmetic surgery procedure of 2019. With an era full of stars with the idealized hourglass figure and full butt, BBLs have become ever popular.
A BBL is a fat grafting procedure that requires the removal and harvesting of excess fat from other parts of the body, then injecting the fat back into the butt. BBLs are widely known for improving the fullness and shape of the buttocks using your own fat.
BBLs improve not only the proportion and contouring of the lower body but contour the waist and abdomen. The popular BBL surgery has usurped traditional surgical options such as butt implants, providing a more natural-looking and more customizable result for unique patient needs.
With this, the big question is “Are BBLs safe?” BBLs are not without complications, which is why it is critical to do your research as a patient and pick an experienced board-certified plastic surgeon who can appreciate your personalized goals and surgical plan.
Your cosmetic surgeon should be highly knowledgeable in not only the aesthetic of the body but anatomy, as a safe BBL requires a strategic injection of fat into specific areas of the butt to create a more full and defined shape. BBLs are complex, from purifying, to harvesting, to grafting the collected fat.
A safe BBL will be conducted by a surgeon that has the proper experience and training as well as an intimate understanding of safely and correctly performing the surgery on your body.
Safe BBLs avoid fat injection into or under the muscle, eliminating the risk of a fat embolism. A proper technique for a safe BBL would only have the transferred fat injected into the subcutaneous layer of existing fat, and should not be injected any deeper.
Dr. Mowlavi, the board-certified plastic surgeon of Cosmetic Plastic Surgery Clinics in Laguna Beach, California, uses high-resolution ultrasound-assisted liposuction techniques when performing his BBLs. This practice is also known as SCUBA— Safe California Ultrasound-assisted Buttock Augmentation.
We utilize a jackknife angle on the bed when injecting the fat into the buttocks, which also minimizes fat injection to <1500 cc. Safe BBLs also require postoperative monitoring, including monitoring of S_O2 levels and tachycardia, rapid heart rate. High S_O2 levels and tachycardia are the first signs of pulmonary embolization, a life-threatening complication.
If you are interested in a BBL, we encourage you to view Dr. Mowlavi’s BBL surgery gallery of before and after photos to appreciate the changes that are possible. You are welcome to contact Dr. Mowlavi and his team, located in Laguna Beach, California at the Cosmetic Plastic Surgery Institute. Dr. Mowlavi is internationally regarded for his safe and transformative BBL results.
The patient on this page is a female patient who came to Dr. Mowlavi for a safe BBL surgery.
Photos are before and 3 months after her surgery.