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Reply: Staying Safe during Gluteal Fat Transplantation

Villanueva, Nathaniel L. M.D.; Del Vecchio, Daniel A. M.D.; Afrooz, Paul N. M.D.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 596e
doi: 10.1097/PRS.0000000000004789

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

Back Bay Plastic Surgery, Boston, Mass.

Dallas Plastic Surgery Institute, Dallas, Texas

Correspondence to Dr. Rohrich, Dallas Plastic Surgery Institute, 9101 North Central Expressway, Suite 600, Dallas, Texas 75231,

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We thank Dr. Sisti and colleagues for their interest and Letter to the Editor regarding our article “Staying Safe during Gluteal Fat Transplantation.”1 We agree that their findings and those in the study by Ramos-Gallardo et al. are in accordance with the safety triangle we have highlighted as the zone of greatest potential danger, where the major gluteal vessels and sciatic nerve are found.2 Within the safety triangle, it is imperative that fat transplantation occurs in the subcutaneous plane. However, our recommendation is to remain superficial within the subcutaneous plane throughout the gluteal augmentation procedure. Therefore, the angle of approach to the gluteal muscle is not pertinent because the angle should be selected to completely avoid injection into the gluteal muscle. Gluteal fat transplantation into the subcutaneous plane only may improve the safety profile of this procedure, as there is no opportunity for damage to intragluteal vessels. Furthermore, Dr. Del Vecchio recently presented at the 52nd Annual Baker Gordon Symposium and will soon publish our findings in a cadaveric study demonstrating 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.3 Deep intramuscular migration therefore increases the danger profile of any intramuscular injection regardless of angle and should therefore be avoided.

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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
Dallas, Texas

Daniel A. Del Vecchio, M.D.
Back Bay Plastic Surgery
Boston, Mass.

Paul N. Afrooz, M.D.
Rod J. Rohrich, M.D.
Dallas Plastic Surgery Institute
Dallas, Texas

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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. Ramos-Gallardo G, Orozco-Renteria D, Medina-Zamora P, et al. Prevention of fat embolism in fat injection for gluteal augmentation, anatomic study in fresh cadavers. J Invest Surg. 2018;31:292297.
3. 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.
Copyright © 2018 by the American Society of Plastic Surgeons