About 5 years ago, long before the plastic surgery organizations made the recommendation to transfer fat to the subcutaneous plane of the butt, Dr. Kenneth Hughes had pioneered a technique that involved fat transfer to just beneath the skin.  Dr. Kenneth Hughes’s technique utilizes a larger cannula that he manipulates beneath the skin of the butt to allow constant visualization of the tip of the cannula.  In this manner, the transfer of the fat is precisely controlled and not allowed to go deeper than the most superficial fat.  In this way, the fat is prevented from entering larger blood vessels that could result in fat emboli and death.  Many different techniques have been discussed to avoid fat emboli but this method holds the most promise.

Although subcutaneous injection may avoid deeper fat injection, it may not avoid inadvertent fat penetration of the muscle fascia.  The reasons for fat emboli are not entirely understood.  Certainly direct injection of fat into blood vessels could create a fat embolus, but this is not the reason for all fat emboli anatomically.  Fat could potentially migrate to deeper venous lakes with increasing pressure as more fat is placed.  Thus, this migration may account for some of these fat emboli described in the literature.  The muscle fascia is a tight connective tissue covering of the muscle and without penetration of this tissue, the injected fat is effectively shielded from deeper migration into these venous lakes.

Dr. Kenneth Hughes has performed about 1700 BBLs with this technique over the last 4.5 years without a fat embolus of any kind.  Fat emboli are grouped into two categories: fatal and nonfatal.  The nonfatal emboli occur about 3 to 4 times as commonly as the fatal emboli.  The rate for the total number of fat emboli is about 1 to 600 to 1 in 800 in the literature.

Thus, this technique represents a significant advance in Brazilian buttlift safety, and Dr. Kenneth Hughes has dedicated himself to continual improvement in safety for this operations and all operations performed at his plastic surgery center in Los Angeles.

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