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Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study

Del Vecchio, Daniel A., M.D.; Villanueva, Nathaniel L., M.D.; Mohan, Raja, M.D.; Johnson, Bret, M.D.; Wan, Dinah, M.D.; Venkataram, Aniketh, M.D.; Rohrich, Rod J., M.D.

Plastic and Reconstructive Surgery: November 2018 - Volume 142 - Issue 5 - p 1180-1192
doi: 10.1097/PRS.0000000000005020
Cosmetic: Original Articles
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Background: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration.

Methods: A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection.

Results: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space.

Conclusions: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.

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Boston, Mass.; Dallas, Texas; and Bangalore, India

From Back Bay Plastic Surgery; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Dallas Plastic Surgery Institute; and the Venkat Center for Skin and Plastic Surgery.

Received for publication February 13, 2018; accepted July 11, 2018.

Disclosure:Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Medical Publishing. He is a clinical and research expert for Allergan, Inc., and MTF Biologics, and the owner of Medical Seminars of Texas, LLC. No funding was received for this article. Dr. Del Vecchio is a founder of Surgistem Technologies, LLC, a device company involved in fat transplantation, receives royalties from Microaire, and is a founding member of Peninsula Partners, LLC, a consulting firm in the plastic surgery sector. The remaining authors have no financial interest to declare in relation to the content of this article.

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Daniel A. Del Vecchio, M.D., 38 Newbury Street, Boston, Mass. 02116,

Copyright © 2018 by the American Society of Plastic Surgeons