No subfascial or intramuscular injection should be performed in the gluteus maximus muscle, and surgeons should only inject fat into the subcutaneous tissue, according to a study published in the May issue of Plastic and Reconstructive Surgery.

Simeon Wall Jr., M.D., from The Wall Center for Plastic Surgery in Shreveport, Louisiana, and colleagues defined and studied subcutaneous migration and examined whether fat placed in the subcutaneous space can migrate into the deep submuscular space. Proxy fat was inserted into four hemibuttocks from two cadavers using syringes with various fascia scenarios (1: fascia intact; 2: cannula perforations; 3: 6-mm fascia defects) or using expansion vibration lipofilling (4: fascia intact). Anatomical dissections were performed after injections to assess migration of proxy fat.

The researchers found that pressure reached about 125 to 150 mm Hg in scenario 1 and then plateaued; all proxy fat remained in the subcutaneous space. Pressure reached a 199-mm Hg plateau in scenario 2, and no proxy fat spread deeper into the muscle or beneath it. Pressure gradually increased to 50 mm Hg then decreased in scenario 3; the submuscular space contained a significant amount of proxy fat. Pressure rose to a maximum of 30 mm Hg in scenario 4, and all the proxy fat remained in the subcutaneous space.

"Surgeons should commit to subcutaneous-only injection and maintain constant focus during surgery," the authors write.

Several authors disclosed financial ties to medical device companies involved in fat transplantation.

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