# From Cosmetic Surgery to Critical Care: Clinical Mimicry of Acute Respiratory Distress Syndrome Following Gluteal Augmentation Surgery

## TL;DR

This case report describes a patient who developed severe breathing problems after gluteal augmentation surgery, highlighting the rare but serious risk of fat embolism syndrome.

## Contribution

The paper presents a clinical case emphasizing the underdiagnosed risk of fat embolism syndrome following Brazilian Butt Lift surgery.

## Key findings

- A patient developed acute respiratory failure within an hour after gluteal augmentation surgery.
- The case highlights the importance of early diagnosis of fat embolism syndrome to prevent worsened outcomes.
- Clinical mimicry of acute respiratory distress syndrome following BBL is a rare but critical complication.

## Abstract

Gluteal augmentation surgery, commonly known as the Brazilian Butt Lift (BBL), has become increasingly popular and is offered at numerous surgical centers. Typically performed on an outpatient basis, the procedure takes less than four hours, making it an appealing option for many patients. However, BBL is associated with multiple complications, some of which can be severe, resulting in high mortality rates. Most such post-operative adverse events necessitate urgent transfer to hospitals for optimal care, with post-operative respiratory distress being one such critical sign. Fat embolism syndrome (FES) is a notable complication of BBL. The diagnosis of FES is primarily clinical, supported by imaging studies such as chest X-rays and CT scans. FES often goes underdiagnosed due to the lack of definitive diagnostic criteria and its clinical and radiological similarities to other conditions. Despite its underdiagnosis, FES is reported in approximately 0.06% of patients undergoing BBL. Failure to diagnose it early can lead to complications from empiric treatment of other suspected conditions, potentially worsening the prognosis. Our patient developed respiratory failure within an hour after undergoing BBL. The time to symptom onset and the patient's agitation before the respiratory episode broadened the differential for her condition. This case report highlights the importance of recognizing FES and exploring potential preventive measures, including advancements in surgical techniques and prophylactic strategies.