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• W4247313090 abstract "Sir: We thank Dr. Oranges and colleagues for their interest and Letter to the Editor regarding our article “Staying Safe during Gluteal Fat Transplantation.”1 We commend them for their publication and agree with their findings.2 There are various advantages when performing gluteal fat transplantation when compared to other gluteal augmentation procedures, but lowering the current mortality rate associated with this procedure is imperative. The majority of the complications associated with gluteal fat transplantation are minor and temporary when the procedure is performed correctly. Our recommendation is to remain superficial within the subcutaneous plane throughout the gluteal augmentation procedure. The sciatic nerve injuries that are related to this procedure are likely attributable to either direct injury with cannulas or secondary-compression, high-fat-graft pressures in the subgluteal compartment.3 Gluteal fat transplantation only into the subcutaneous plane may further improve the safety profile of this procedure, as there is no opportunity for damage to intragluteal vessels or the sciatic nerve, directly or indirectly from subgluteal compartment pressure. Dr. Del Vecchio recently presented at the 52nd Annual Baker Gordon Symposium and will soon publish our findings from a cadaveric study that has demonstrated that any injection below the muscular fascia can lead to deep intramuscular migration of the fat, which leads the transplanted fat to deposit directly over the gluteal vessels and sciatic nerve submuscularly.4,5 Deep intramuscular migration therefore increases the danger profile of any intramuscular injection and should be avoided. DISCLOSURE Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Publishing. No funding was received for this article. Dr. Del Vecchio is a founder of Surgistem Technologies, LLC, a device company involved in fat transplantation; receives royalties from Microaire; and is a founding member of Penninsula Partners, LLC a consulting firm in the plastic surgery sector. Dr. Villanueva and Dr. Afrooz have no financial interest to declare in relation to the content of this communication. Nathaniel L. Villanueva, M.D.Department of Plastic SurgeryUniversity of Texas Southwestern Medical CenterDallas, Texas Daniel A. Del Vecchio, M.D.Back Bay Plastic SurgeryBoston, Mass. Paul N. Afrooz, M.D.Rod J. Rohrich, M.D.Dallas Plastic Surgery InstituteDallas, Texas" @default.
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• W4247313090 date "2018-10-01" @default.
• W4247313090 modified "2023-10-01" @default.
• W4247313090 title "Reply" @default.
• W4247313090 cites W2072034268 @default.
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• W4247313090 doi "https://doi.org/10.1097/prs.0000000000004787" @default.
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