Villanueva et al identified risk factors for complications during and after gluteal fat transplantation (augmentation). These can help identify ways to reduce the risk of serious morbidity and mortality for an elective, cosmetic procedure. The authors are from the University of Texas Southwestern Medical Center, Dallas Plastic Surgery Institute, and Back Bay Plastic Surgery in Boston.

Danger triangle associated with sciatic nerve and the major gluteal vessels:

(1) posterior superior iliac spine

(2) greater trochanter

(3) ischial tuberosity


Complications may include:

(1) fat and/or air embolus

(2) deep vein thrombosis with pulmonary embolism

(3) sciatic nerve compression

(4) hemorrhage

(5) infection


Risk factors for complications:

(1) injections deep to muscle in the danger triangle (not superficial to it), with injection into the deep medial gluteal region

(2) therapeutic anticoagulants

(3) failure to use prophylactic anticoagulation

(4) use of herbal remedies

(5) personal or family history of deep vein thrombosis and/or pulmonary embolus

(6) lower extremity varicose veins

(7) preoperative sciatic nerve compression

(8) failure to use a large, blunt cannula (diameter > 4 mm)

(9) failure to use a continual motion during injection

(10) use of excessive graft fill pressure

(11) inexperienced or poorly-trained surgeon


Additional factors not listed in paper:

(1) nonsterile technique

(2) coagulopathy

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