Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better.

BACKGROUND: Although the Brazilian Butt Lift (BBL) is one of the most popular and powerful procedures in body contouring, it has been associated with the risk of pulmonary fat emboli (PFE) when fat graft is injected into the gluteal muscles. Autopsy findings, cadaver studies, multiple plastic surgery societies, and regulatory bodies have identified the subcutaneous plane as the safe site for fat graft injection. Despite these findings, PFE deaths continue to occur because there was no mechanism for surgeons to confirm consistent subcutaneous placement.

OBJECTIVES: The objective of this paper was to determine if real time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space.

METHODS: 4150 BBLs were performed using real time intraoperative ultrasound to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared to BBL utilizing Expansion Vibration Lipofilling (EVL) without ultrasound.

RESULTS: Real time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments.

CONCLUSIONS: Real time intraoperative ultrasound allows the surgeon to confirm a subcutaneous only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.