Efficacy of Ultrasound for Intravascular Injection Avoidance in Fat Transfer Procedures to the Butt (BBL)
Dr. Kenneth Hughes of Hughes Plastic Surgery in Los Angeles is frequently asked to evaluate the utility of old or new technology in regard to treatment or diagnosis of plastic surgery issues. Dr. Kenneth Hughes will tackle the topic of the efficacy of ultrasound in prevention of intravascular injection of fat during BBL or Brazilian buttlift.
Ultrasound, also called sonography, uses sound waves to develop images of various anatomic areas and the pathology that results. A transducer uses high-frequency sound and records the echoes as the sound waves bounce back to determine the size, shape, and consistency of soft tissues and organs. This information is relayed in real time to produce images on a computer screen. Then a radiologist or plastic surgeon can interpret the ultrasound images.
The ultrasound transducer can be placed over an anatomic area like the butt and can be used to identify larger vessels or an abscess or fat necrosis for example. Ultrasound technology is limited by its ability to detect smaller vessels and to display them appropriately. Ultrasound is used to diagnose a variety of conditions including blood clots or DVTs or gallstones among others. Ultrasound frequently misses gallstones of 6mm or more. Therefore, the ability to detect objects smaller than this is poor. Thus, ultrasound is not going to be relied upon to prevent intravascular injection of fat for vessels less than 6 mm.
So the point is that even if the ultrasound is utilized appropriately it is not sensitive enough to identify smaller blood vessels that could be injected with fat, which could then lead to fat embolus and possibly patient death.The fat for a Brazilian buttlift or BBL should be injected under the skin where blood vessels are very small in the 1 to 2 mm size. One should also use a 4 mm blunt cannula for injection. In this manner, the much larger cannula can in no way enter a much smaller vessel. Dr. Kenneth Hughes pioneered this technique almost 6 years ago in response to as yet unknown increased number of patient deaths associated with intramuscular injection.
One should also realize that utilizing ultrasound for deeper injections would not be recommended as many vessels larger than 4 mm would be missed. However, they would be large enough to enter with the cannula. The best way to create a safe injection practice to be able to visualize the tip of the much larger blunt cannula under the skin of the butt and know that the injection is just too superficial to gain admittance to larger vessels, which rest much deeper in the butt.