Reply to the Discussion on: Superficial Intramuscular Gluteal Lipograft by Doppler Ultrasound: A Report of 24 Patients

Dear Sir, We appreciate the time dedicated and the important analysis of our article.1 We consider that keeping in mind the possible complications that could be observed in our patients promotes a space for learning and scientific discussion. We would like to begin by pointing out that the purpose of this research was not to report the incidence of microfat embolism (MIFE), but to report a safe fat transfer technique to the buttocks in which the exact location of the injection site can be visualized and to determine whether there was migration of the fat into the deep space.2 Regarding what you mention, we agree that in the case of MIFE, it cannot be detected by ultrasound. Likewise, we believe that the probability of the existence of MIFE is possible; however, it cannot be determined that the presence of MIFE is a direct consequence of gluteal lipotransfer because there are cases of MIFE in patients with liposuction without gluteal lipoinjection. Currently, the placement of intramuscular fat has taken quite a boom in the revolution of plastic surgery. We understand the existence of the two cases of MIFE reported in the articles mentioned, in which there is a relationship but not a direct demonstration of causality. Also, in articles of Dr. Cárdenas-Camarena’s authorship, he has identified more cases of MIFE in liposuction alone versus when the procedure was performed in combination with gluteal lipotransfer.3,4 In the review of articles that he conducted from 1986 to 2015, regarding liposuction without buttock augmentation, 11 cases were reported, of which nine correspond to MIFE and three correspond to macrofat embolism. Likewise, 14 cases were reported in interventions associated with buttock augmentation, five cases were MIFE, and nine cases were macrofat embolism.5 When analyzing this information, it can be observed that there are more cases of MIFE when liposuction is performed without buttock augmentation; therefore, it is not possible to establish a causality or direct consequence of the intervention. Likewise, in the case of patients who die as a secondary consequence of gluteal lipoinjection, autopsy findings also show the presence of microembolism in all cases and macroembolism in the most severe cases, so it is not possible to establish causality.3 It is pertinent to mention that, unlike the articles reviewed, in this research the exact localization of the cannula at the time of the lipoblast transfer has been present, and the use of this technology allows for a safer intervention for the patients. Moreover, although the vasculature can change depending on the type of muscle, as can be seen in the article, no cases of MIFE have been reported.2 Finally, we are aware that our sample is small and does not allow the generalization of results, as well as that it is not possible to establish a cause–effect relationship between fat lipofiltration in the buttocks and the appearance of MIFE. DISCLOSURE The author has no financial interest to declare in relation to the content of this article.