Treatment Algorithm for the Management of Soft Tissue Blowout Deformity after Autologous Gluteal Fat Transfer

We define "BBL blowout deformity" as a soft tissue deformity after autologous gluteal fat transfer. It is caused by a loss of integrity of the fascia and ligaments in the buttocks, resulting in an undesirable convexity and weakening of the lower buttock skin. A fat necrosis cyst is often found within the deformity that must be addressed for correction. Treatment guidelines are not currently defined; thus, we have created a treatment algorithm that may serve as a preliminary guide. Generally, patients with favorable factors such as younger age (<35), good skin quality, and a smaller deformity of <20% buttock surface area can tolerate a more conservative approach. For these patients, a liposuction cannula can be used to evacuate the fat necrosis cyst, fenestrate the cyst capsule, and perform a wide soft tissue release, which can achieve good correction of the deformity. Those with older age (>35), poor skin quality, or larger deformity of >20% buttock surface area are recommended to be treated with direct skin and fat necrosis cyst removal through a direct buttock-lift incision. Invasive radiofrequency skin tightening may be added in all cases to improve results. These single-surgeon clinical observations informed our proposed treatment algorithm.