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Public Attitudes Toward Gluteal Fat Grafting Safety And The Impact Of Education On Willingness To Accept Risk
Waverley Y. He, B.A.1, Darya Fadavi, B.S.1, Franca Kraenzlin, M.D.1, Halley Darrach, B.S.1, Pragna Shetty, M.P.H.2, Karan Chopra, M.D.1, Helen Xun, B.A.1, Justin M. Sacks, M.D., M.B.A.1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2University of North Carolina School of Medicine, Chapel Hill, NC, USA.

PURPOSE: Buttock augmentation via autologous fat grafting (colloquially known as "Brazilian Butt Lift" or "BBL") has the highest mortality rate of any cosmetic procedure (1 in 3,000 procedures). Injected fat can enter the bloodstream via the gluteal vessels, resulting in fat emboli that can cause cardiovascular collapse. Despite the risk, it continues to be a popular procedure among patients desiring gluteal augmentation. This study aims to understand how sociodemographic factors influence perceptions of BBL procedures among adult women and to also investigate whether education about the dangers of BBL changes willingness to receive this procedure. METHODS: This was an IRB-exempt study. Qualtrics© survey platform was used to create a survey and then collect data. Inclusion criteria included female sex. We gathered information about survey respondents' demographics, experience with cosmetic procedures, and willingness to undergo BBL. Participants were given information about the procedure throughout the survey and then re-assessed for willingness to receive a BBL. Patients received $0.25 per completed survey. RESULTS: Survey data from 489 female participants were included in this study. 78.1% of participants found the BBL mortality rate to be higher than they expected. Multivariate logistic regression showed that even after education on the risks of BBL, respondents were more likely to undergo a BBL if they altered their image on social media (OR 3.6, p<0.05) or were unhappy with their buttocks and had previously considered surgery (OR 3.7, p<0.05). Of the original 177 willing participants, 129 participants (72.9%) were unwilling after education. Of the 312 participants who were originally unwilling, 300 (96.2%) remained unwilling after education. Multivariate regression analysis indicated that those individuals who were more willing to undergo a BBL after education were more likely to know an individual who had received a BBL (OR 230.2, p<0.05) or have a diagnosis of body dysmorphic disorder (OR 60.5, p<0.05). CONCLUSION: Overall, survey participants were less willing to undergo BBL after being provided with information about its risks. Individuals with body dysmorphic disorder or those who know someone who has received a BBL are more likely to be willing to undergo the procedure even after receiving education of its risks. This study demonstrates that while there is a general lack of awareness regarding the BBL mortality rate, the informed consent process and counseling play critical roles in patient education. Our findings also highlight that individuals who are unhappy with their body shape, or who feel cultural or social pressure to attain a certain body shape, may accept higher levels of risk to improve their looks, suggesting that patient motivation for the procedure may limit even the most effective informed consent process. Therefore, the surgical community should regulate this procedure and improve safety using evidence-based risk-reduction techniques.


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