Scientific Abstract Presentations: Aesthetic 1 Thursday, October 26 Thu, Oct 26 3:00-4:30 p.m. CDT

BACKGROUND: Maintenance of nasal tip projection and rotation are important factors to consider when evaluating the utility of specific rhinoplasty techniques with respect to desired long-term outcomes. Whereas septal extension grafts have been shown to be associated with preserved tip projection and rotation over time, the long-term efficacy of the columellar strut graft remains debatable. This study aims to evaluate the impact of the columellar strut graft on nasal tip projection and rotation.

METHODS: This is a retrospective study of patients who underwent primary rhinoplasty at a single private practice between 2003-2022 and had at least two follow-ups with standardized photography. Preoperative and postoperative standardized right profile images were compared. Nasal tip projection was evaluated using both the nasofacial angle and the Goode ratio. Nasal tip rotation was evaluated using the nasolabial angle. Statistically significant variation between postoperative measurements was assessed using paired t-tests. Bivariate analysis was used to determine the significance of time on long-term maintenance of tip rotation and projection.

RESULTS: A total of 51 patients underwent primary rhinoplasty with a columellar strut graft and had at least two follow-ups with standardized photography. The mean age was 29.98±14.61 years. From the operation date, the mean time to the first follow-up was 444.83±338.13 days, and the mean time to the second follow-up was 1047.88±497.60 days. The mean nasolabial was 99.09±11.74 preoperatively, 103.52±12.16 at the first postoperative follow-up, and 100.17±10.93 at the second postoperative follow-up. The second postoperative nasolabial angle differed significantly from the first postoperative nasolabial angle (p=0.0007). The mean Goode ratio was 0.65±0.051 preoperatively, compared to 0.62±0.047 and 0.57±0.048 at the first and second postoperative follow-ups, respectively. The second postoperative Goode ratio was significantly lower than the first postoperative Goode ratio (p<0.0001). The mean nasofacial angle was 142.30±7.27 preoperatively, 142.09±7.50 at the first postoperative follow-up, and 142.90±6.35 at the second postoperative follow-up. Postoperative nasofacial angles were not found to be significantly different from one another (p=0.16). The time between the first and second postoperative follow-ups was not significantly associated with increased or decreased changes in nasolabial angle (p=0.93), Goode ratio (p=0.38), or nasofacial angle (p=0.24).

CONCLUSIONS: The columellar strut graft remains an effective technique for the long-term optimization of nasal tip projection, as the final postoperative Goode ratio was found to be closer to the ideal ratio of 0.55-0.60 compared to the preoperative Goode ratio. The nasofacial angle was maintained over time, indicating that the columellar strut graft may be effective for long-term maintenance of tip projection. Although both the nasolabial angle and Goode ratio were susceptible to change over time, the contributory role of postoperative swelling on these results remains unclear. Given that time between follow-ups was not associated with an increased magnitude of change for any metric, indicating that tip projection and rotation stabilize over time, surgeons may leverage estimated longitudinal changes in tip projection and rotation to achieve optimal long-term outcomes.

Background: Oftenly, cartilage is added as a supporting structure in the nose in augmentation rhinoplasty. The two most commonly used options for rhinoplasty are irradiated homologous costal cartilage (IHCC) and, autologous costal cartilage, while Tutoplast is may also be used as an alternative. Currently, there is no definitive study comparing the complications rates between grafts of IHCC and autologous costal cartilage. This study aimed to compare the outcomes of patients who had septorhinoplasty with autologous costal cartilage, IHCC, or Tutoplast grafts based on the complications rates reported in the available publications.

Methods: A meta-analysis and systematic review were conducted using various databases, including MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. The search covered articles published from the inception of the databases to December 2022. The following keywords were used: septorhinoplasty, rhinoplasty, autologous costal cartilage graft, cadaveric cartilage graft, and rib graft. Patients who went through an en bloc dorsal onlay graft were only included to ensure a homogenous study sample. A random-effects model was used to pool the data. The measured outcomes included complications such as graft warping rates, resorption, infection, contour irregularity, and revision surgery among patients who had autologous grafts vs IHCC vs Tutoplast cartilage grafts.

Results: Out of 678 unique citations identified in the search, 37 studies were added in the meta-analysis. These studies included 2785 patients, of whom 2429 received autologous grafts, and 349 received IHCC grafts (regardless of type). When comparing autologous cartilage (n = 2429) vs IHCC (n = 209) vs Tutoplast cartilage (n = 140) grafts, no significant difference was found in warping (6.6%; 95%CI, 4.1%-9.8%), resorption (4.2%; 95%CI, 2.6%-6.2%), contour irregularity (2.9%; 95%CI, 1.8%-4.3%), infection (3.8%; 95%CI, 2.4%-5.4%), or revision surgery (6.8%; 95%CI, 4.3%-9.7%).

Conclusion: The study found no significant difference in outcomes or complications between autologous cartilage and IHCC grafts, indicating that either material may be used for dorsal augmentation rhinoplasty.

Background: Cosmetic tourism describes the practice of patients traveling, either domestically or internationally, to seek out cosmetic surgery at lower costs. Despite the seemingly lower initial price tag for the surgery, patients can face devastating consequences from limited preoperative evaluation and postoperative follow-up. Patients are often left alone to manage their wounds, drains and possible complications. The purpose of this study was to assess the most common complications experienced by this population and elucidate the additional burden placed on the healthcare system.

Methods: A total of 57 patients presented to the emergency department at our institution with cosmetic tourism-related complications from 2018 through 2022. Information regarding patient demographics, procedures performed, complications and hospital resource utilization was analyzed. Wilcoxon rank sum test was used to assess differences in continuous variables. Fisher test was used to assess differences in categorical variables.

Results: A total of 57 patients were identified, with 47% of patients undergoing procedures abroad and 53% undergoing procedures domestically. Overall, 95% of patients were female with a mean age of 39 ± 9.2 years. There were no statistically significant differences in sex, race, ethnicity, educational level, or insurance type between patients who underwent surgery domestically versus abroad. All the domestic cosmetic tourism occurred in Florida while 70% of the abroad patients underwent their procedures in the Dominican Republic, with the remainder occurring in Brazil, Colombia, and Mexico. The most common procedure was abdominoplasty, with 70% of patients undergoing one alone or in combination with other procedures. This was followed by liposuction and gluteal fat grafting (51% and 25%, respectively). Wound dehiscence (33%) and seroma formation (32%) were the most common complications, followed by infection (26%). Regarding healthcare utilization, 23 (40.4%) patients were admitted, 48 (84.2%) underwent at least one imaging study, 29 (50.9%) underwent a bedside or radiology-guided procedure, and 6 (10.5%) required a reoperation.

Conclusion: Complications following cosmetic tourism were found to cause significant impacts on both patients and the healthcare system necessitating utilization of radiologic imaging, bedside and operating room procedures, and inpatient management. Our analysis revealed that dehiscence, seroma formation and infection are particularly common complications experienced by this cohort. Greater awareness and patient education about the risks of cosmetic tourism should be implemented to limit the cost burden on patients and hospital systems.

Purpose: The field of aesthetic surgery has grown significantly over the past few decades with multiple specialties offering pathways into the field through fellowship training- plastic and reconstructive surgery to aesthetic plastic surgery, otolaryngology to facial plastic surgery, ophthalmology to oculofacial plastic surgery, and dermatology to cosmetic dermatology, respectively. Although potentially lucrative, bias against aesthetic fields and procedures remains prominent in the literature, though it is unclear whether this stigma is present among residents in programs with opportunities to pursue aesthetic fellowship training1-3. To address this, the authors aimed to compare trends in aesthetic fellowship specialization among eligible graduating seniors and determine the variation between fields.

Materials & Methods: A retrospective review of data from The San Francisco Match, National Resident Matching Program, American Society for Dermatologic Surgery, and The Accreditation Council for Graduate Medical Education (ACGME) was performed. Collected data included the year, number of total and matched applicants for each aesthetic fellowship (aesthetic plastic surgery, facial plastic surgery, cosmetic dermatology, and oculoplastic surgery), and number graduating residents from each respective residency program. For each field, ratios between the number of graduating residents to the number of residents applying and matching into aesthetic fellowship were calculated. The percent of graduating residents pursuing aesthetic fellowship training across the four specialties was compared using ANOVA and t-tests compared differences in means between fields.

Results: There was significant difference in the proportion of residents pursuing aesthetic fellowship training, both in participating and matched applicants, between the four specialties with otolaryngology having the highest percent, followed by plastic and reconstructive surgery, ophthalmology, and dermatology respectively (ANOVA p<0.0001). When comparing the two more surgical specialties, otolaryngology had a significantly higher percent of applicants to aesthetic fellowship compared to plastic and reconstructive surgery (t-test, p=0.000866). However, no associated difference was found in the percent of applicants to aesthetic fellowship between the largely non-surgical specialties, dermatology and ophthalmology (t-test, p=0.060).

Conclusions: The percent of residents applying into aesthetic fellowship differs significantly between the respective specialties with otolaryngology having the highest percent. While there was a significant difference in proportion of aesthetic fellowship applicants from surgical fields, no difference was seen between the nonsurgical fields. Since 2018, there has been a general trend of increased applicants to aesthetic fellowship training, possibly reflecting a growing interest in aesthetic specialization.

References 1. Jason Roostaeian, MD, James Rough, MD, Michael C. Edwards, MD, A Plastic Surgery Resident's View of Aesthetic Training and the Future, Aesthetic Surgery Journal, Volume 34, Issue 8, November 2014, Pages 1270–1273, https://doi.org/10.1177/1090820X14548889 2. Alotaibi, Ahmed S. MBBS. Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review. Plastic and Reconstructive Surgery - Global Open 9(3):p e3501, March 2021. | DOI: 10.1097/GOX.0000000000003501 3. Motakef, Saba M.D.; Motakef, Sahar M.A.; Chung, Michael T. M.D., et. al. The Cosmetic Surgery Stigma: An American Cultural Phenomenon?. Plastic and Reconstructive Surgery 134(5):p 854e-855e, November 2014. | DOI: 10.1097/PRS.0000000000000604

Background: Existing literature on rhinoplasty places little to no emphasis on variability and evolution of ideal nasal aesthetics. Our group sought to use virtual 3D computer simulation to identify potential differences in ideal nasal aesthetics between rhinoplasty surgeons with varied experience, training, and geography.

Methods: A cohort of surgeons were invited to participate in this simulation study. Participating surgeons then took part in a simulation session, in person or via Zoom, and were asked questions regarding their practice, including location, years experience, percent cosmetic and open rhinoplasty performed, number of rhinoplasties performed each year, and private vs academic. An identical set of 3D images (Vectra H1) for 3 patients (P1,2,3), with varying degrees of nasal deformities and facial proportions were used and surgeons were asked to create an ideal rhinoplasty result using the Canfield Vectra software system.

All simulated 3D images were then analyzed by placing standardized landmarks and measuring the distance (mm) of radix height (RH), dorsal height (DH), alar width (AW), nasal tip projection (NTP), and nasal tip rotation (NTR).

Results: A total of 111 surgeons from 28 countries completed the study to date (response rate 6.4%). Rhinoplasty surgeon demographics were as follows: 92% male, 70% plastic surgeons (29% facial plastics, 1% OMFS), 75% private practice, and 64% fellowship trained. The surgical practices included in the study demonstrated the following averages: 17+/-11 years experience, 123+/-101 rhinoplasties performed per year, with 75% and 77% of rhinoplasty procedures being cosmetic and via an open approach, respectively.

Radix&Dorsum: Interestingly, increasing number of years of experience was associated with an increase in both RH and DH(RH, P1,2,3;p=<0.05,<0.01,<0.01)(DH, P2,3; p=<0.01,<0.01). Similar findings of an increased RH were noted in surgeons that identified as private practice(P3;p=<0.05). Conversely, the ideal RH was noted to be lower for surgeons using an open technique(P2;p=<0.05). The ideal DH was noted to be lower for surgeons who were fellowship trained(P2;p=<0.05) and performed primarily cosmetic rhinoplasty(P2;p=<0.05).

Nasal tip complex: Ideal noses demonstrated a significant increase in NTR for surgeons who had increased years of experience(P1;p=<0.05) and those who primarily performed open rhinoplasty(P3;p=<0.05). NTP was significantly increased in ideal noses by surgeons who had increased years of experience (P2,3;p=<0.05,<0.05) and performed an increased number of cosmetic rhinoplasties(P2;p=<0.05). On the other hand, ideal noses demonstrated a significant decrease in NTP in fellowship trained rhinoplasty surgeons(P2,3;p=<0.05,<0.05), facial plastic surgeons(P2;p=<0.05), and female surgeons(P2;p=<0.05). When stratifying surgeons by location, distinct visual differences were noted in simulated ideals. For instance, Eastern European countries, such as Turkey, increased NTP, NTR and decreased DH when compared to the Northeast US, such as New York. However, these comparisons did not reach statistical significance.

Conclusion: Our data suggests surgeons increased years of experience produce a more conservative nasal profile characterized by radix augmentation and less aggressive DH reduction. Analysis of geographic location showed no significance, however, visual representation of geographical ideals proves to highlight differences in the ideal nose. While aesthetic standards in rhinoplasty exist, 3D technology quantifies differences in perceived ideal aesthetics

Introduction: Obesity has been linked extensively to adverse outcomes, such as wound complications and venous thromboembolisms (VTEs), for patients undergoing plastic surgery, especially regarding body procedures.1 However, most surgeons utilize variable and arbitrary body mass index (BMI) cutoffs. The purpose of this study was to reevaluate an optimal BMI cutoff to avoid complications in elective body contouring procedures.

Methods: The 2010-2020 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing an infraumbilical panniculectomy including a lipectomy (CPT = 15830). A binary logistic multivariable regression was run to determine any significant preoperative variables associated with either wound complications or VTEs. Patients were excluded if they possessed any preoperative variables that were statistically significant in our regression for each of those complications. For both the VTE and wound complication cohorts, a receiving operating characteristics (ROC) curve was generated with a 95% confidence and a Youden's Index (J) calculated with the highest J determining the optimal BMI cut-off values.

Results: A total of 10,241 patients were included for analysis in the wound complication cohort. Within this cohort, 520 (5.1%) patients experienced wound complications. For the VTE complication cohort, 16,123 patients were included for analysis with an overall VTE complication rate of 0.8% (n = 130). The area under the curve (AUC) for the wound complication and VTE cohort was 0.643 and 0.613 respectively. The optimal BMI cutoff based on the J statistic for the wound complication cohort was 30.5 while for the VTE cohort it was 28.2.

Conclusions: Our research determined that the optimal BMI cutoffs to avoid VTEs and wound complications in patients undergoing abdominal contouring procedures are 28.2 and 30.5 respectively. These values can be utilized to guide shared decision making in patients undergoing elective body contouring surgery.

1. Joslyn NA, Esmonde NO, Martindale RG, Hansen J, Khansa I, Janis JE. Evidence-Based Strategies for the Prehabilitation of the Abdominal Wall Reconstruction Patient. Plastic and Reconstructive Surgery. 2018;142(3S):21S. doi:10.1097/PRS.0000000000004835

Objectives: This study aims to systematically assess the literature to investigate the effects of postoperative weight gain on facial hypertrophy in patients after facial fat grafting.

Methods: A search through PubMed/Medline was conducted on October 4, 2022 to identify relevant articles using appropriate search terms: "fat graft," "lipofill," "autologous fat graft," "facelift," "fat injection," "secondary facelift," "stem cell facelift," "fat transfer," "fat augmentation," "lipograft," "lipotransfer," "weight gain," "obesity," "growth," "grow," "enlarge," "excess," and "fattening." No lower date limit was used and all eligible non-animal clinical articles in English were included for review. Reports were summarized and presented as descriptive statistics.

Results: The search generated 714 articles, 202 of which were automatically excluded by the "English" and "human" PubMed criteria. After abstract and full text review of the initial set of articles, a total of 6 were included in our analysis. All articles described poor cosmetic outcomes resulting from non-anatomic hypertrophy of the grafted fat, and none of the articles reported a thorough methodology that incorporated patient-specific weight fluctuation analysis when selecting the donor site.

Conclusion: Grafted facial fat is susceptible to exaggerated hypertrophy with changes in patient weight. Given the relatively small volumes required for the face, the most abundant fat compartment in the body may not be ideal for harvesting lipoaspirate for facial fat injection.

Background: Across scar studies, there is a lack of dark-skinned individuals, who have a predisposition for keloid formation, altered pigmentation, and poorer quality-of-life. There is a need for patients-of-color to be included in scar scale development and validation. In this study, we evaluate the racial diversity of patients included in the validation of scar assessment scales. Methods: A systematic review was conducted for articles reporting on the validation of a scar assessment tool. Racial, ethnic, and Fitzpatrick skin type(FST) data was extracted. Results: Fifteen scar scale validation studies were included. Nine of the studies did not mention FST, race, or ethnicity of the patients. Two of the studies that reported FST or race information only included White patients or included no FST V/VI patients: MAPS and UNC4P. Only four studies included non-white patients or dark-skinned patients in the validation of their scar scale: the modified Vancouver Scar Scale, Modified POSAS, Acne QOL, and SCAR-Q scales. The patients included in the modified VSS validation were 7 and 13% FST V/VI, 14% African in the modified POSAS, and 4.5% FST V/VI in the SCAR-Q. Conclusion: We highlight the severe lack of diversity in scar scale validation, with only 4 out of 15 studies including dark-skinned patients. Given the susceptibility of darker-skinned individuals to have poorer scarring outcomes, it is critical to include patients-of-color in the very assessment tools that determine their scar prognosis. Inclusion of patients-of-color in scar scale development will improve scar assessment and clinical decision-making.

Background Autologous fat grafting (AFG) is a surgical procedure in which a patient's fat tissue is harvested from one part of the body and injected into another area to add volume, contour, or rejuvenation. Due to its natural-looking results and long-term durability, this technique has gained popularity in various cosmetic and reconstructive surgeries, such as facial rejuvenation, breast augmentation, buttocks enhancement, and soft tissue reconstruction. This survey presents a contemporary assessment of prevalent practices concerning adjunct implementation in autologous fat grafting procedures. Methods A 52-question survey was emailed to 3,106 active American Society for Aesthetic Plastic Surgery members. 187 responses were recorded to date representing a 6% response rate. Results A total of 186 surveyors report performing autologous fat grafting (AFG). 25% of the surgeons reported a practice length of 9 years or less, 37% reported 10-25 years of experience, and 38% had over 25 years of experience. The majority of respondents (97%) are in private practice. Only 55% of respondents reported performing 100% cosmetic procedures in their practice. The primary procedures involving autologous fat grafting are Gluteal (36%), Facial augmentation (35%), and Breast (27%). Contour deformities/corrections anywhere was noted at 1.6%. Preoperative systemic antibiotic prophylaxis was reported by 154 (82%) of surgeons. 91% indicating the usage of Cefazolin. Prolonged (>72hrs) preoperative use of antibiotics was reported by 57% of surgeons, the majority utilizing Cephalexin (35%) or Cefazolin (32%). Lipoaspirate and antibiotic mixture was reported in 37 out of 187 respondents (20%). The most commonly used antibiotics mixed in the lipoaspirate were Clindamycin (57%), followed by Cefazolin (38%). Six of the 37 surgeons (16%) use a combination of Cefazolin in conjunction with other antibiotics. As additional adjunct therapies 78 surgeons (42%) reported using Tranexamic Acid (TXA). Ten surgeons (5%) reported using Plasma Rich Platelets (PRP) for their autologous procedures. Additionally, 36 of the 186 surgeons (19%) reported using ultrasound as an additional adjunct in autologous fat grafting. Conclusion This survey reports on the diverse practice methods and adjunct therapies utilized in autologous fat grafting among aesthetic surgeons to date. It reveals that there is an increasing trend towards adopting new adjunct treatments as they are published in the literature. In order to ensure optimal clinical outcomes and patient safety, standardization and further research is needed to establish evidence-based guidelines.

Purpose: Facial aesthetics play an important role in a variety of social outcomes ranging from social interactions, mating preferences to job hiring decisions. The standards of an aesthetically attractive face are different for males and females, as sexual dimorphism (i.e. masculinity or femininity) plays a role in facial attractiveness. Sexual dimorphism has been studied in faces of average populations and worldwide celebrities of various ethnicities. However, a focused analysis of attractive Caucasian faces has not been conducted. Our study is the first of its kind to harness the power of artificial intelligence (AI) in facial recognition technology to efficiently analyze sexual dimorphism in contemporary attractive Caucasian male and female celebrity faces. Methods: 21 male and 21 female Caucasian celebrities were selected based on contemporary listings acquired from popular editorial rankings, modeling agencies, and casting directors from 2017-2022. Frontal photos of celebrities aged 23-42 without facial animation were selected. 100 facial landmarks were identified using custom, semi-automatic facial analysis program consisting of modified Apple Vision machine learning algorithms and additional custom points in MATLAB. Measurements were converted to absolute distances by fixing subjects' white-to-white corneal diameters to the validated average in Caucasians. Results: Attractive males had significantly greater facial height, bigonial and bizygomatic widths, medial and total brow lengths, and alar width than females. Attractive females had significantly greater upper and middle facial proportions, uniformly divided facial thirds, and greater canthal tilt compared to males. The ratio of facial height to bigonial width in females (1.613) and males (1.566) were close to the golden ratio (1.618). No faces exhibited scleral show. Conclusion: This is the first study to quantify key differences in facial features between aesthetic, Caucasian biological genders. Furthermore, our study harnesses the power of AI for efficient facial analysis that can be applied to other ethnicities as well. Identifying these contemporary patterns between genders will provide valuable insight into planning facial rejuvenation and gender affirmation surgeries.

Introduction: Autologous fat grafting has been well-established as a successful means of improving aesthetic outcomes following both breast reconstruction and aesthetic surgery through volume enhancement and tissue contouring.1,2 Long-lasting effects are dependent on post-operative volume retention. Several factors, including the harvesting, processing, and injection techniques, may all affect the rate of resorption and the success of deformity filling.3 Volume maintenance is linked to greater patient satisfaction and more optimal augmentation results. Our objective is to evaluate the effect of lipoaspirate processing modality on longitudinal volume retention after surgery.

Methods: A prospective, single institution randomized control trial placed consented post-mastectomy fat grafting patients into one of three treatment arms (active filtration, low-pressure decantation, and standard decantation) in a 1:1:1 ratio. A pre-operative three-dimensional scan of the upper torso is taken as baseline. At the 3-month post-operative visit, another 3D scan is taken. Audodesk Meshmixer is used to evaluate the volume change. The quantity of injected fat during the procedure is obtained using retrospective chart review.

Results: The volume of fat injected during the initial procedure did not differ significantly between the treatment arms (p > 0.05). Both active filtration and low-pressure decantation resulted in higher percent volume retention than traditional decantation (p < 0.05). Active filtration and low-pressure decantation exhibited comparable degrees of fat maintenance at three-months (p > 0.05).

Conclusion: Compared to using traditional decantation as the lipoaspirate purification technique, active filtration and low-pressure decantation may have led to higher levels of cell viability by way of reduced cellular debris and other inflammatory components that may contribute to tissue resorption and necrosis. Further immunohistochemistry studies are needed to examine whether active filtration and low-pressure decantation lead to lipoaspirates with more concentrated viable adipocytes, progenitor cells and factors for angiogenesis.3

References 1. Chiu WK, Fracol M, Feld LN, Qiu CS, Kim JYS. A Comparison of Fat Graft Processing Techniques: Outcomes in 1,158 Procedures in Prosthetic Breast Reconstructions. Plast Reconstr Surg Glob Open. 2019;7(11):e2276. Published 2019 Nov 12. doi:10.1097/GOX.0000000000002276. 2. Delay E, Garson S, Tousson G, Sinna R. Fat injection to the breast: technique, results, and indications based on 880 procedures over 10 years. Aesthet Surg J. 2009;29(5):360-376. doi:10.1016/j.asj.2009.08.010. 3. Liu, M., Shang, Y., Liu, N. et al. Strategies to Improve AFT Volume Retention After Fat Grafting. Aesth Plast Surg (2022). https://doi.org/10.1007/s00266-022-03088-y

Background: Gluteal augmentation with autologous fat grafting, more commonly referred to as the Brazilian butt lift (BBL), is an increasingly common procedure. This study aims to analyze the prevalence of complications that accompany these surgeries and subsequently identify factors that may increase the risk of adverse outcomes. Methods: Adults that experienced BBL-related complications from 2019-2021 were identified in surgery accreditation authority AAAASF's database. Patients were analyzed based on demographics, procedure and complications. Descriptive statistics were performed to evaluate complications and provide risk-adjusted measures. Results: Overall, 436 fat grafting procedures with complications were reported to AAAASF, of which 153 were confirmed to be related to gluteal augmentation procedures. The number of BBL complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%) with a mean age of 42.0 years and a mean BMI of 28.3 kg/m2. Patients spent an average of 4.2 hours in surgery at the time of their procedure. The Southeast had the most complications (45.8%) followed by Southwest (18.3%), West (15.7%), Midwest (11.8%), and Northeast (8.5%). Wound infection was the most commonly documented complication (15.0%). Meanwhile, 24.2% of patients presented to a hospital for their complications and 8.5% had at least one unplanned reoperation. There were four deaths in total resulting from venous thromboembolism (2), bowel perforation (1) and hemorrhagic shock (1). Conclusion: BBL procedures have been shown to be associated with significant morbidity through a variety of both medical and surgical complications, with the most common being infection. Given the increase in popularity of this procedure, increased surveillance to prevent and identify complications is recommended.