Pat Pazmiño

Aesthetic rib remodeling includes parallel corticotomy, perpendicular puncture, and rib-resection approaches, but comparative safety remains uncertain. We conducted a structured narrative review of evidence published from January 2015 through June 2026. Clinical reports, systematic reviews, functional studies, directly relevant biomechanical work, and official publication-status notices were considered. Three reviewers screened the original evidence independently and resolved disagreements by consensus. Historical record-level exports and extraction sheets were not retained; therefore, no retrospective screening counts or pooled unique-patient total were reconstructed. The literature consists mainly of uncontrolled observational reports with heterogeneous selection, cointerventions, techniques, surveillance, follow-up, and potentially overlapping cohorts. Published parallel-technique cohorts appear less morbid in their reporting of major pleural events than some perpendicular-technique reports, but no head-to-head comparison, adjusted analysis, or verified unique pooled denominator establishes a causal safety advantage. Recent RibXcar reports include pulmonary-function, imaging, complication, fatalities, and patient-reported outcome data, although cohort overlap cannot be excluded. Ultrasound may assist localization, visualization, and documentation, but its incremental safety or efficacy effect has not been isolated. Current evidence supports cautious technique-specific reporting and prospective comparative studies with unique denominators, standardized complication surveillance, operator and technique-fidelity documentation, adequate follow-up, and validated patient-reported outcomes.

Background: Many board-certified plastic surgeons believe that accessibility of hands-on training in ultrasound-guided gluteal fat grafting (US-GGFG) is insufficient. Cadaver models utilized to practice ultrasound-guided fat grafting have proven to be expensive and difficult to procure. Objectives: The authors present a novel, clinically relevant buttock model, and compare this model with the costs and logistics of the cadaver model with the aim of providing affordable hands-on training for US-GGFG. Methods: A clinically relevant buttock model, the Miami butt model (MBM) was created by attaching a hemiabdominoplasty specimen to a portion of pork belly with its skin attached. The costs and logistics related to 2 separate ultrasound-guided Brazilian butt lift (BBL) workshops, 1 with cadaver specimens and the other with the MBM, were compared. Results: The specimen costs for a workshop with 20 participants (10 stations with 1 cadaver specimen for 2 participants) were $4580 per station. After adding the cost of delivery and disposal for the cadaver specimens ($7770), the total price for a 10-cadaver-specimen workshop amounted to $53,570. The MBM was found to be anatomically relevant and provided a close facsimile of US-GGFG experience in humans, at a cost of $47 per specimen. The MBM cost of specimens for a 20-participant workshop totaled $940, compared to a cadaver-based workshop with specimen costs of $53,570. Conclusions: Compared to the cadaver model, the MBM is significantly less expensive and allows the participant to perform US-GGFG on a close facsimile of human gluteal anatomy, improving the accessibility of US-GGFG training.

Pat Pazmiño, MD; Commentary on: Complications from Fat Grafting and Gluteal Augmentation in Outpatient Plastic Surgery: An Analysis of American Association

Background: Although the Brazilian butt lift (BBL) is one of the most popular procedures in body contouring, it has been associated with the risk of pulmonary fat embolism when fat graft is injected into the gluteal muscles. The subcutaneous plane has been identified as a safe site for fat graft injection, but deaths from fat embolism continue to occur because there is no mechanism to confirm consistent subcutaneous placement. Objectives: The aim of this paper was to determine if real-time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space. Methods: In total, 4150 BBLs were performed with real-time intraoperative ultrasound being used to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared with BBL performed by expansion vibration lipofilling without ultrasound. Results: Real-time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments. Conclusions: Real-time intraoperative ultrasound allows the surgeon to confirm a subcutaneous-only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.

Pat Pazmiño, MD; Commentary on: The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review ­and Recommendations, Aesthetic

Pat Pazmiño, MD; Commentary on: Description of a Novel Web-Based Liposuction System to Estimate Fat Volume and Distribution, Aesthetic Surgery Journal, , sjad02

The authors are pleased to present an expert video roundtable on the use of ultrasound in plastic surgery ( Video). The discussants include a panel of leading experts in aesthetic surgery, and the video roundtable was recorded live at The Aesthetic Meeting 2023 in Miami, FL, USA. The panelists describe their experiences using ultrasound in clinical procedures, the resulting contributions to safety in aesthetic surgery, its profound effect on patient experience, and ultimately its future as an indispensable tool in plastic surgery practices. Ultrasound has been available to plastic surgeons for years—in fact Dr. Brad Bengtson has utilized high-resolution ultrasound in his breast practice since the early 2000s.^1,2 The use of ultrasound has become more prevalent and concerns about patient safety have brought the conversation to the national stage and news media outlets. In particular, the Brazilian Butt Lift (BBL), also known as gluteal augmentation, has been at the forefront of safety concerns in Miami, Florida. Several articles published in Aesthetic Surgery Journal³ and ASJ Open Forum^4,5 contributed directly to improved outcomes and patient safety changes since ultrasound guidance provides sight into a previously blind procedure which offers unequivocal benefits.

Jeffrey M Kenkel, MD, FACS, Max Polo, MD, Pat Pazmiño, MD, Onelio Garcia Jr, MD; BBL Safety and Florida Legislature: What You Should Know, How You Can Help, Aes