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Anatomic–Radiologic Study on Gluteal Danger Zones

Pozza, Edoardo Dalla MD; Ordenana, Carlos MD; Said, Sayf Al-Deen MD; McBride, Jennifer PhD; Drake, Richard L. PhD; Gharb, Bahar Bassiri MD, PhD; Zins, James E. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 16
doi: 10.1097/01.GOX.0000584280.37875.92
Aesthetic Abstracts

Cleveland Clinic, Cleveland, OH

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: The “Brazilian” gluteal augmentation procedure has proven to be a dangerous and potentially deadly procedure. Fat injections with cannulation of gluteal veins and sciatic nerves have been described and reported in literature.1–3 This study aims to map and better describe the localization and caliper of dangerous structures of the gluteal region, dividing the 3-dimensional area in layers from superficial to deep. Therefore, a delineation of the “danger zones” of the “Brazilian” buttock augmentation would be the final purpose of this effort, with the intent of helping the surgeon limiting the potential complications during gluteal fat injections.

METHODS: Twenty dissections were performed in 10 fresh latex-injected cadavers. The dissection was performed layer-by-layer from skin to periosteum evaluating the vascular density, size, and vessel trajectory in the subcutaneous, intramuscular, and submuscular planes. Each vessel and major nerve was tracked on a xyz axis. The diameter size of each vessel was measured with a digital caliper and recorded. In collaboration with the interventional radiology unit of the Verona University Hospital (Verona, Italy), data from 30 MRAs will be analyzed to compare our ex vivo findings in an in vivo model. Localization and size of arteries, veins, and nerves will be traced on the same xyz axis after examination of T1, T2, STIR sequences, and 3-dimensional reconstructions. A map of the danger zones of the gluteal area will be estimated from our results after normalization to standardize the variability of different individuals.

RESULTS: Common patterns of distribution of veins of the gluteal area were noted in the subcutaneous plane. They presented mainly as veins comitantes to perforating vessels from the superior and inferior gluteal arteries. An average number of 25 vessels per cadaver were documented in this layer (range, 16–32) with the smallest average artery (0.9 ± 0.3 mm) and vein diameter (1.05 ± 0.22 mm). A similar pattern repeated within the gluteus maximus. Intramuscular vein diameters increased to 1.3 ± 0.3 mm. Tributaries from the inferior and superior gluteal vessels travel on the deep surface of the gluteus maximus (respectively 2.2 ± 0.04 and 1.8 ± 0.2 mm diameter in the arteries and 3.5 ± 0.99 mm and 3.85 ± 1.9 mm in the veins). The superior and inferior gluteal veins diameter were 7.61 ± 2.24 mm and 13.65 ± 6.55 mm, respectively. The superior and inferior gluteal arteries were significantly smaller (3.47 ± 0.2 and 4.3 ± 0.6 mm).

CONCLUSION: The subcutaneous plane includes frequent and small vessels. The deeper and more medial planes of the gluteal region house larger and more prominent vessels and nerves which if penetrated could be the cause of fat embolism, nerve damage, and death.


1. Cardenas-Mejia A, Martinez JR, Leon D, et al. Bilateral sciatic nerve axonotmesis after gluteal lipoaugmentation. Ann Plast Surg. 2009;63:366–368.

2. Cardenas-Camarena L, Bayter JE, Aguirre-Serrano H, et al. Deaths caused by gluteal lipoinjection: what are we doing wrong? Plast Reconstr Surg. 2015;136:58–66.

3. Astarita DC, Scheinin LA, Sathyavagiswaran L. Fat transfer and fatal macroembolization. J Forensic Sci. 2015;60:509–510.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.