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U.S. and international plastic surgery societies issued joint advisories: fat must never be injected into the gluteal muscle, and using ultrasound to see the cannula tip lowers the risk of fat embolism.
Gluteal fat grafting (the “BBL”) had for years the highest mortality rate of any aesthetic procedure, due to fat embolism: fat injected into or beneath the muscle entering the gluteal veins.
The Multi-Society Task Force for Safety in Gluteal Fat Grafting (ASPS, The Aesthetic Society, ISAPS, ISPRES and IFATS) has issued practice advisories since 2018 with one central rule: fat is placed only in the subcutaneous plane, never intramuscularly.
In 2022 Florida added, by regulation, mandatory intraoperative ultrasound to monitor the cannula position and limited the number of these procedures per surgeon per day; the societies endorsed the measure and promote training in the technique.
If you are considering a BBL, ask two things: in which plane the fat is injected and whether the surgeon uses ultrasound during injection. A surgeon who has mastered these techniques answers without hesitation.
This content summarizes scientific publications and professional-society guidelines; it does not replace your surgeon's or anesthesiologist's evaluation. Every item links its original source.