Gluteal & Hip Stem Cell Enriched Fat Grafting (Brazilian Butt Lift): Optimizing Outcomes While Minimizing Complications

Abstract

Background: Gluteal & hip fat grafting (Brazilian Butt Lift) is the most common adjuvant procedure in body liposuction.
Aim: Using evidence-based medical information to optimize a surgical technique for awake body contouring with gluteal and hip augmentation using stem cell enriched fat grafting.
Methods: Retrospective, consecutive women (n=112) analysis from 2016 to 2022 electing awake, super-wet wetting solution, conscious sedation anesthesia in body contouring using VASER ultrasound liposuction in those requesting gluteal fat grafting. Fat grafting indications were for improved gluteal contour (85%, n=95) or size augmentation (15%). Fat grafts were placed solely in the subcutaneous plane and prepared by centrifugation-filtration fat processing combining platelet rich plasma and autologous adipose-derived stem cells enrichment. Women requesting general anesthesia or a gluteal or hip silastic implant were excluded.
Results: Using the GAIS revealed very much improved, very improved, and improved (97.6%) with 3.4% stating no change or worse (one patient). Patient subjective satisfaction with the overall procedure showed 92% (n=103) satisfied. Those dissatisfied were mainly from insufficient fat volume (n=7) or dissatisfied from the body contouring outcome (n=2). Those with insufficient fat volume were given the option of gluteal or hip silastic implant placement. There was a 14.6% (n=13) complication rate with seven (7.8%) experiencing minor contour irregularities and five (5.6%) seromas treated by needle aspiration. No patient experienced a serious adverse effect or oil cyst. No bacterial infections were diagnosed, however, there was one suspected atypical mycobacteria infection. Erythema and mild discomfort without fistula formation developed 6 weeks postoperatively, which resolved on 6 weeks of sulfamethoxazole-trimethoprim antibiotic treatment. The revision rate was 4.5% (4/112) for additional gluteal and/or hip fat grafting. Mean volume of purified, compacted, enriched fat grafted per buttock was 240 cc and per hip dip area was 45 cc. Overall total buttock fat grafting combining each buttock and each hip dip equaled 570 cc compacted, enriched fat, which corresponds to 950 cc of unprocessed, harvested fat.

Conclusion: Gluteal and hip fat grafting incorporated best practices harvesting, processing, enrichment, and administration techniques combined with VASER liposuction yielded superior patient satisfaction, aesthetic results, and no serious adverse effects.