Gluteal fat grafting — the one page on this site where the risk comes first

Gluteal fat grafting takes your own fat by liposuction and moves it into the buttocks.

The surgery pages on this site usually run explanation, cautions, tips, then things to think about. This page puts the risk first.

In 2017 the Aesthetic Surgery Education and Research Foundation (ASERF) convened a task force for this one operation. An anonymous survey went to 4,843 plastic surgeons worldwide; 692 responded, reporting 198,857 cases. Autopsy records and interviews with medical examiners were gathered alongside.

Here is what was reported.

• over their careers, the responding surgeons had seen 32 deaths from pulmonary fat emboli and 103 non-fatal pulmonary fat emboli
• 3% of respondents had experienced a patient death, and 7% at least one pulmonary fat embolism
• surgeons who said they injected into the deep muscle had a significantly higher incidence rate

And the conclusion is this sentence — despite the growing popularity, significantly higher mortality rates appear to be associated with gluteal fat grafting than with any other aesthetic surgical procedure.

But what this page really wants to say comes next.

The task force issued recommendations: do not inject into the deep muscle, do not use cannulae smaller than 4 mm, and do not point the cannula downwards.

In 2020 the two years after the recommendations were surveyed again.

• incidence of pulmonary fat embolism — from 1 in 1,030 in 2017 to 1 in 2,492 (P = 0.02)
• mortality trend — from 1 in 3,448 in 2017 to 1 in 14,952 in 2019
• surgeons saying they inject into deep muscle — 13.1% down to 0.8% (P < 0.01)
• surgeons saying they angle the cannula down — 27.2% down to 4% (P < 0.01)
• 94% of respondents were aware of the recommendations

Which is to say the risk of this operation turned on technique, not on its name. And when technique changed, the numbers moved.

So this page does not say 'do not have this'. It says what to ask. See below.

This site does not deal in prices, clinics or reviews.

Pulmonary fat embolism is the decisive risk of this operation. Fat enters the large veins of the buttock and travels to the lungs. It can happen during or just after surgery, and it moves fast.

And that risk turns on where the fat is put. In the 2017 report, surgeons who said they injected into the deep muscle had a significantly higher incidence. In the 2020 survey the proportion saying so fell from 13.1% to 0.8%, and over the same period the incidence more than halved.

Ask before surgery. These three questions.

• Will fat go beneath or into the muscle, or only into the subcutaneous layer?
• What diameter cannula will be used? (the 2017 recommendation was to avoid below 4 mm)
• Will ultrasound be used to see where the cannula is?

If you cannot get answers, or the questions themselves are treated as strange, that itself is information.

How much is taken and how much is put in changes the risk. As the volume of liposuction rises, so do anaesthetic time and the burden of fluid shifts. See the liposuction page alongside.

Combining it with other operations adds risk. Long anaesthesia, wide areas and several sites at once all do.

Some of the fat is resorbed. How much will remain cannot be known exactly in advance, and it differs between people.

Infection, fat necrosis, palpable lumps and asymmetry are reported.

If you become breathless, have chest pain, cough blood or feel suddenly faint, seek emergency care immediately — including on the day of surgery or the day after.

How you sit is restricted for weeks afterwards. Put it in your plans in advance.

Where you have this done matters more than for any other operation here. What the surveys above show is that the risk differs several-fold with technique.

Check who gives the anaesthetic and what is in place for an emergency. Pulmonary fat embolism is a matter of minutes, not hours.

Consider not bundling several operations into one session. The longer the anaesthetic, the greater the burden.

Have it at a stable weight. Grafted fat is still your body's fat. A large change in weight changes the result.

Check first that there is enough fat to take. In a lean build there may not be enough to move.

Ask whether the plan accounts for resorption. Volume falls over the first months.

Not smoking matters especially here. Grafted fat needs a blood supply to take.

Get instructions on sitting and sleeping positions. Pressure early on means less fat survives.

Why this page puts the risk first, again. This site tries not to push judgements on its surgery pages. But this is the only operation here with a sentence saying mortality appears higher than with any other aesthetic procedure. That sentence cannot be buried under the tips.

And that the risk is not fixed matters just as much. The numbers moved between 2017 and 2019. Because technique changed. That does not mean the operation has become safe; it means where the risk comes from is known.

The limits of that material, too. Both surveys were anonymous questionnaires sent to surgeons. People who chose to respond reported their own experience; it is not a registry of every operation. Under-reporting is possible.

Reversibility is marked 'partial'. Some of the fat is resorbed and the rest stays. There is no way back to before, and reducing it means operating again.

Matching a goal from photographs is especially hard here. The same volume looks different against a different pelvic width, muscle shape and skin thickness.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone. Especially for this one.