Buttock Augmentation Experts Call for More Safety

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Dr. Simeon Wall Jr., Dr. Daniel Del Vecchio, and Dr. Constantino Mendieta, three of the world’s leading authorities on gluteal fat grafting, respond to recent questions about the safety of this popular procedure.

Dr. Wall Jr. is one of the world’s leading experts on gluteal fat grafting, and he and his colleagues are calling for improved training and better techniques for this popular procedure.

In response to recent, highly publicized fatalities resulting from gluteal fat grafting, three of the world’s most experienced buttock augmentation surgeons have joined forces to raise awareness about improving the safety of the procedure. Dr. Simeon Wall Jr., Dr. Daniel Del Vecchio, and Dr. Constantino Mendieta are board-certified plastic surgeons, each with more than 15 years’ experience performing the popular procedure, and have lectured and taught hundreds of gluteal fat grafting courses to thousands of plastic surgeons all over the world. They contend that, although the procedure is highly effective and has very high patient satisfaction, it does not yet have the safety record of other commonly performed cosmetic procedures.

“Surgeons now need to focus on the instrumentation and techniques they are using in order to minimize complications and prevent potentially fatal complications,” Del Vecchio says. The risk of fat entering the bloodstream is the most serious of these complications, and can be minimized or avoided utilizing proper instrumentation and techniques, according to the doctors.

Wall, who recently published an article on gluteal augmentation safety in Plastic and Reconstructive Surgery, says, “Patient safety and well being is my number one priority. We need to continue making procedures like gluteal fat grafting safer and more effective for patients. It’s great that the procedure is so popular, but it’s concerning that many surgeons, especially those new to the procedure, may not be using the best instrumentation or utilizing the best techniques to avoid problems. It appears that the surgeons with the most experience performing this surgery use very similar techniques and have excellent track records, so focusing on a more standardized way to perform the surgery would seem to make sense.”

Wall and his colleagues take issue with recent media coverage which raises doubts about the safety of gluteal fat grafting without sufficient emphasis on the importance of proper instrumentation, technique, and surgical training. The media frenzy prompted the International Society of Aesthetic Plastic Surgery (ISAPS) to issue a release referencing the “alarming news…showing a connection between the recent popularity of gluteal fat grafting and high mortality rates in patients who elect this surgery.” The release goes on to point out that the Aesthetic Surgery Education and Research Foundation (ASERF) has formed a Gluteal Fat Grafting Task Force to investigate risk factors.

“It concerns me to see patient safety recommendations based on incomplete clinical data,” Del Vecchio says. “I think it has the potential to incite unnecessary fear and anxiety in patients, which does not serve them at all. Prospective patients need to be educated to seek out the highly qualified surgeons with excellent safety records who specialize in this procedure.”

Mendieta adds, “Patients need to know that we are doing the studies to make this procedure safer. Preliminarily, it appears that some techniques may be safer than others, so patients should make sure their surgeon is both highly trained and highly experienced in buttock augmentation.”

Wall, Del Vecchio, and Mendieta state that specialists, such as themselves, have performed thousands of gluteal fat grafting procedures without any life-threatening complications, largely due to rigorous training and the use of more advanced techniques which have the potential to be safer. “Much more work needs to be done to determine the true risk factors, and some key safety factors,” Mendieta says.

Even the ASERF’s task force acknowledges that surgical technique is a key safety factor, stating that it “has made the preliminary conclusion that the rate of fat embolism may be increased substantially by injecting into the deep muscle as opposed to injecting into the subcutaneous tissue and superficial muscle.”

All the cases of deaths from gluteal fat grafting have involved syringe-based techniques and smaller injection needles that, according to Del Vecchio, “have the potential to cause physician fatigue and needle misguidance into deeper structures, leading to fatal fat embolus."

Wall, Del Vecchio, Mendieta, and several other buttock augmentation experts have all adopted an advanced fat transplantation system developed by Wall and Del Vecchio called expansion vibration lipofilling (EVL), which offers several potential benefits, one of which may be increased patient safety. EVL uses a completely different system of large volume fat transplantation that involves vibration and specially designed large-diameter injection cannulas with blunt, expanded tips.

“As we’ve shown in our SAFELipo experience that utilized expanded-tip cannulas, these cannulas have less potential to cause problems or damage vital structures, especially blood vessels,” Wall says. Additionally, this approach shortens operating times, which may correlate with increased safety.

“I developed expansion vibration lipofilling many years ago for the correction of contour deformities from previous liposuction procedures, but it wasn’t until Dr. Del Vecchio and I developed an automated, integrated system that we were able to make the procedure much more efficient, faster, and I think safer for patients,” Wall says.

Widely credited with bringing the “Brazilian Butt Lift” to the U.S., Mendieta also stresses that surgeon education is just as important as educating patients: “The anatomy and physiology of the buttock region is complex, with several different variations that surgeons need to be aware of when performing this procedure.”

Wall and his colleagues assert that improvements in the safety of gluteal fat grafting should be led by the experts in the field, and that careful attention should be paid to the techniques used and the credentials of the providers.

“This is a popular procedure in search of a better technique,” Del Vecchio says. “It concerns me that plastic surgeons with relatively little experience in gluteal fat transplantation can condemn a procedure without a balanced recognition of the more advanced techniques that Dr. Wall and I have developed and have put into practice.”

Wall agrees, adding, “We are not only committed to our own patients' safety, but to the safety of all patients who may undergo this procedure, which is why we take time away from our practices and families to teach plastic surgeons everywhere what we know. We have ongoing studies to determine the safest way to perform these procedures, and our hope is to foster a paradigm shift when it comes to gluteal fat grafting.”

Dr. Simeon Wall Jr. (http://www.wallcenter.com), Dr. Daniel Del Vecchio (http://www.uptownbodycontouring.com), and Dr. Constantino Mendieta (http://www.constantinomendieta.com) are board-certified plastic surgeons, each with more than 15 years’ experience specializing in gluteal fat grafting. Together, they have refined innovations in gluteoplasty, including expansion vibration lipofilling and Dr. Mendieta’s comprehensive textbook on the procedure. They are involved in long-term studies of the safety and efficacy of buttock augmentation, and they each lecture and routinely teach gluteal fat grafting courses, including live teaching surgeries, nationally and internationally.

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Simeon Wall, Jr, MD, FACS
The Wall Center
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