We thank Dr. Oranges and colleagues for their interest and Letter to the Editor regarding our article “Staying Safe during Gluteal Fat Transplantation.”1 We commend them for their publication and agree with their findings.2 There are various advantages when performing gluteal fat transplantation when compared to other gluteal augmentation procedures, but lowering the current mortality rate associated with this procedure is imperative. The majority of the complications associated with gluteal fat transplantation are minor and temporary when the procedure is performed correctly. Our recommendation is to remain superficial within the subcutaneous plane throughout the gluteal augmentation procedure. The sciatic nerve injuries that are related to this procedure are likely attributable to either direct injury with cannulas or secondary-compression, high-fat-graft pressures in the subgluteal compartment.3 Gluteal fat transplantation only into the subcutaneous plane may further improve the safety profile of this procedure, as there is no opportunity for damage to intragluteal vessels or the sciatic nerve, directly or indirectly from subgluteal compartment pressure. Dr. Del Vecchio recently presented at the 52nd Annual Baker Gordon Symposium and will soon publish our findings from a cadaveric study that has demonstrated that any injection below the muscular fascia can lead to deep intramuscular migration of the fat, which leads the transplanted fat to deposit directly over the gluteal vessels and sciatic nerve submuscularly.4,5 Deep intramuscular migration therefore increases the danger profile of any intramuscular injection and should be avoided.
Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Publishing. 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 Penninsula Partners, LLC a consulting firm in the plastic surgery sector. Dr. Villanueva and Dr. Afrooz have no financial interest to declare in relation to the content of this communication.
Nathaniel L. Villanueva, M.D.
Department of Plastic Surgery
University of Texas Southwestern Medical Center
Daniel A. Del Vecchio, M.D.
Back Bay Plastic Surgery
Paul N. Afrooz, M.D.
Rod J. Rohrich, M.D.
Dallas Plastic Surgery Institute
1. Villanueva NL, Del Vecchio DA, Afrooz PN, Carboy JA, Rohrich RJ. Staying safe during gluteal fat transplantation. Plast Reconstr Surg. 2018;141:7986.
2. Oranges CM, Tremp M, di Summa PG, et al. Gluteal augmentation techniques: A comprehensive literature review. Aesthet Surg J. 2017;37:560569.
3. Cardenas-Mejia A, Martínez JR, León D, Taylor JA, Gutierrez-Gomez C. Bilateral sciatic nerve axonotmesis after gluteal lipoaugmentation. Ann Plast Surg. 2009;63:366368.
4. Del Vecchio D, Villanueva NL, Mohan R, et al. Defining the migration of fat in gluteal augmentation: A dynamic anatomic study. Paper presented at: 52nd Annual Baker Gordon Symposium; February 8–10, 2018; Miami, Fla.
5. Del Vecchio D, Villanueva NL, Mohan R, et al. Defining the migration of fat in gluteal augmentation: A dynamic anatomic study. Plast Reconstr Surg. (in press).