Ultrasound in Gluteal Fat Grafting: Safety Tool, Standard of Care, or Emerging Evidence?: A Scoping Review

Abstract

Gluteal fat grafting is associated with rare but potentially fatal complications, particularly fat embolism related to inadvertent intramuscular injection. Current safety recommendations emphasize strict subcutaneous fat placement. Intraoperative ultrasound has been proposed as a tool to enhance procedural safety; however, the extent and quality of supporting evidence remains unclear. A scoping review was conducted according to PRISMA-ScR and Joanna Briggs Institute methodology. Six electronic databases were searched from the earliest available records through March 2025. Studies including adult patients undergoing ultrasound-guided gluteal fat grafting were eligible. Nine studies published between 2018 and 2025 met inclusion criteria. Evidence consisted predominantly of observational case series and one systematic review with meta-analysis; no randomized or high-quality comparative studies were identified. Ultrasound was primarily used to guide cannula positioning and confirm subcutaneous fat injection in real time. Verification of the injection plane relied mainly on intraoperative visualization rather than standardized imaging-based confirmation. No cases of fat embolism or procedure-related mortality were reported. Additional procedural benefits were described but were largely qualitative and infrequently assessed using comparative outcome measures. Intraoperative ultrasound appears to be a useful safety adjunct in gluteal fat grafting; however, current evidence is limited and primarily non-comparative. Further comparative studies are required to establish its clinical benefit.