Plastic and Reconstructive Surgery Advance Online Article DOI: 10.1097/PRS.0000000000000112 Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong? Authors:
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Rodrigo G. Rosique, MD, PhD. Full Member of Brazilian Society of Plastic Surgery,
Active Member of ISAPS, Professor of Plastic Surgery at Federal University of Goiás, Brazil.
Marina J. F. Rosique, MD, PhD. Full Member of Brazilian Society of Plastic Surgery,
International Member of ASPS. Institution:
Master Hospital of Plastic Surgery, Rua 1123, n 232, Marista, Goiânia Goiás, Brazil,
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74175-070.
Corresponding Author: Rodrigo Gouvea Rosique, Rua 1123, n 232, Marista, Goiânia, Goiás, Brazil, 74175-070. Email: [email protected]
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Financial Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
Copyright © American Society of Plastic Surgeons. All rights reserved.
Letter to the Editor Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong? Sir: The cosmetic article by Cárdenas-Camarena et al. (1) was very
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interesting, yet disturbing for us since it showed 19 deaths in Mexico and Colombia related to gluteal lipoinjection, letting the authors conclude that injections into deep muscle planes should be avoided.
What disturbed us most was the fact that, so far, we hadn’t any case of death, neither clinically evident pulmonary embolism in our patients (2),
although we also lipoinject into the muscles along with the subcutaneous plane, like other groups with extended experience on this subject does and, also, with no such complications (3, 4).
In a experimental study with 3 groups of 10 Wistar rats each, Franco
et al (5) found fat particles in the lungs of 3 animals in the group that
underwent only liposuction and in 6 animals of the group that underwent
C C
liposuction and lipografting. No fat particles were found in any organ of the control group.
Why the difference between experimental and clinical findings? We
propose some maneuvers that could answer this question: 1. Careful patient selection using the injection toward the muscles to
A
project the fat injected in the subcutaneous plane in patients without enough buttocks' subcutaneous tissue. When patient’s subcutaneous tissue lacks width and it would be necessary to inject fat mainly into the muscles, we prefer to perform gluteal silicone implant into the muscular plane and then, complement the result with fat injection in the subcutaneous plane.
Copyright © American Society of Plastic Surgeons. All rights reserved.
2. Preoperative planning by prioritizing the buttocks' contour through the subcutaneous plane injections first. Later, projection augmentation by intramuscular injection, with a smaller percentage of the total lipoaspirate, since the good intramuscular graft take allow us to avoid the need for hypercorrection.
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3. Avoid injecting into the muscles in the danger zone (area compromised between the red lines in figure 1), which is the area where is located most of the bigger vessels. If needed, in this area, lipoinject in the subcutaneous tissue.
4. Use only blunt cannulas with 3mm in diameter attached to lowpressure syringes.
5. Keep the patient well hydrated with colloids in order to maintain a
urinary output between 1 and 2 cc per kilogram per hour
(cc/Kg/h) throughout the first 24 hours to diminish the osmotic pressure towards the gluteal vessels.
6. Fat graft in a retrograde fashion, using a slow movement to
prevent vessels damage and the entrance of fat into the
C C
bloodstream.
Since the increasing popularity of this procedure around the globe over the last years, we think it is very important to raise concerns regarding its safeness like the authors did and discuss ways to
A
improve it.
Rodrigo Gouvea Rosique, MD, PhD Marina Junqueira Ferreira Rosique, MD, PhD Master Hospital of Plastic Surgery
Copyright © American Society of Plastic Surgeons. All rights reserved.
Rua 1123, 232, Goiânia, Brazil. 74175-070. [email protected]
DISCLOSURE
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The author has no financial interest in any of the products or devices mentioned in this communication. The author has no conflicts of interest to disclose. There was no outside funding for this study.
References:
1.
Cardenas-Camarena, L., Bayter, J. E., Aguirre-Serrano, H., Cuenca-
Pardo, J. Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong? Plastic and reconstructive surgery 2015;136:58-66. 2.
Rosique, R. G., Rosique, M. J., De Moraes, C. G. Gluteoplasty with
autologous fat tissue: experience with 106 consecutive cases. Plastic and
C C
reconstructive surgery 2015;135:1381-1389. 3.
Nicareta, B., Pereira, L. H., Sterodimas, A., Illouz, Y. G. Autologous
gluteal lipograft. Aesthetic plastic surgery 2011;35:216-224. 4.
Toledo, L. S. Gluteal augmentation with fat grafting: the Brazilian
buttock technique: 30 years' experience. Clinics in plastic surgery
A
2015;42:253-261. 5.
Franco, F. F., Tincani, A. J., Meirelles, L. R., Kharmandayan, P.,
Guidi, M. C. Occurrence of fat embolism after liposuction surgery with or without lipografting: an experimental study. Annals of plastic surgery 2011;67:101-105.
Copyright © American Society of Plastic Surgeons. All rights reserved.
EP TE D C AC Copyright © American Society of Plastic Surgeons. All rights reserved.
EP TE D
Rodrigo G. Rosique, MD, PhD. Full Member of Brazilian Society of Plastic Surgery,
Active Member of ISAPS, Professor of Plastic Surgery at Federal University of Goiás, Brazil.
Marina J. F. Rosique, MD, PhD. Full Member of Brazilian Society of Plastic Surgery,
International Member of ASPS. Institution:
Master Hospital of Plastic Surgery, Rua 1123, n 232, Marista, Goiânia Goiás, Brazil,
C C
74175-070.
Corresponding Author: Rodrigo Gouvea Rosique, Rua 1123, n 232, Marista, Goiânia, Goiás, Brazil, 74175-070. Email: [email protected]
A
Financial Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
Copyright © American Society of Plastic Surgeons. All rights reserved.
Letter to the Editor Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong? Sir: The cosmetic article by Cárdenas-Camarena et al. (1) was very
EP TE D
interesting, yet disturbing for us since it showed 19 deaths in Mexico and Colombia related to gluteal lipoinjection, letting the authors conclude that injections into deep muscle planes should be avoided.
What disturbed us most was the fact that, so far, we hadn’t any case of death, neither clinically evident pulmonary embolism in our patients (2),
although we also lipoinject into the muscles along with the subcutaneous plane, like other groups with extended experience on this subject does and, also, with no such complications (3, 4).
In a experimental study with 3 groups of 10 Wistar rats each, Franco
et al (5) found fat particles in the lungs of 3 animals in the group that
underwent only liposuction and in 6 animals of the group that underwent
C C
liposuction and lipografting. No fat particles were found in any organ of the control group.
Why the difference between experimental and clinical findings? We
propose some maneuvers that could answer this question: 1. Careful patient selection using the injection toward the muscles to
A
project the fat injected in the subcutaneous plane in patients without enough buttocks' subcutaneous tissue. When patient’s subcutaneous tissue lacks width and it would be necessary to inject fat mainly into the muscles, we prefer to perform gluteal silicone implant into the muscular plane and then, complement the result with fat injection in the subcutaneous plane.
Copyright © American Society of Plastic Surgeons. All rights reserved.
2. Preoperative planning by prioritizing the buttocks' contour through the subcutaneous plane injections first. Later, projection augmentation by intramuscular injection, with a smaller percentage of the total lipoaspirate, since the good intramuscular graft take allow us to avoid the need for hypercorrection.
EP TE D
3. Avoid injecting into the muscles in the danger zone (area compromised between the red lines in figure 1), which is the area where is located most of the bigger vessels. If needed, in this area, lipoinject in the subcutaneous tissue.
4. Use only blunt cannulas with 3mm in diameter attached to lowpressure syringes.
5. Keep the patient well hydrated with colloids in order to maintain a
urinary output between 1 and 2 cc per kilogram per hour
(cc/Kg/h) throughout the first 24 hours to diminish the osmotic pressure towards the gluteal vessels.
6. Fat graft in a retrograde fashion, using a slow movement to
prevent vessels damage and the entrance of fat into the
C C
bloodstream.
Since the increasing popularity of this procedure around the globe over the last years, we think it is very important to raise concerns regarding its safeness like the authors did and discuss ways to
A
improve it.
Rodrigo Gouvea Rosique, MD, PhD Marina Junqueira Ferreira Rosique, MD, PhD Master Hospital of Plastic Surgery
Copyright © American Society of Plastic Surgeons. All rights reserved.
Rua 1123, 232, Goiânia, Brazil. 74175-070. [email protected]
DISCLOSURE
EP TE D
The author has no financial interest in any of the products or devices mentioned in this communication. The author has no conflicts of interest to disclose. There was no outside funding for this study.
References:
1.
Cardenas-Camarena, L., Bayter, J. E., Aguirre-Serrano, H., Cuenca-
Pardo, J. Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong? Plastic and reconstructive surgery 2015;136:58-66. 2.
Rosique, R. G., Rosique, M. J., De Moraes, C. G. Gluteoplasty with
autologous fat tissue: experience with 106 consecutive cases. Plastic and
C C
reconstructive surgery 2015;135:1381-1389. 3.
Nicareta, B., Pereira, L. H., Sterodimas, A., Illouz, Y. G. Autologous
gluteal lipograft. Aesthetic plastic surgery 2011;35:216-224. 4.
Toledo, L. S. Gluteal augmentation with fat grafting: the Brazilian
buttock technique: 30 years' experience. Clinics in plastic surgery
A
2015;42:253-261. 5.
Franco, F. F., Tincani, A. J., Meirelles, L. R., Kharmandayan, P.,
Guidi, M. C. Occurrence of fat embolism after liposuction surgery with or without lipografting: an experimental study. Annals of plastic surgery 2011;67:101-105.
Copyright © American Society of Plastic Surgeons. All rights reserved.
EP TE D C AC Copyright © American Society of Plastic Surgeons. All rights reserved.
