Beyond Blind Injections: How Dr. Delobaux’s SMART BBL is Redefining Safety and Liability

Don Adeesha: Welcome back to the Business of Aesthetics podcast. I’m Don Adeesha, your host, and I’m excited about today’s episode. As a practice owner or surgeon, you’re constantly balancing immense patient demand with the highest standard of care. There are producers that define an era of aesthetics. They’re wildly popular and can be incredibly profitable. But what happens when one of the most in-demand procedures also carries a well-known serious risk? It’s that moment where you realize that leading the industry isn’t about offering what’s popular, but about pioneering what’s safe. So to help us navigate this, we are honored to be joined by a surgeon who is leading that exact charge, Dr. Alexis Delobaux. Dr. Delobaux is a world-renowned plastic surgeon, a true pioneer in high-definition body contouring, and the creator of the groundbreaking SMART BBL. Today we are diving into our topic, Beyond Blind Injections, how Dr. Delobaux’s SMART BBL is redefining safety and liability. We’ll explore the shift from blind technique to visually guided standard and the profound impact that this has on patient safety, clinical outcomes and the business liability of offering this procedure. And as a special thank you to our sponsor, ekwa marketing, today is all about pioneering a new standard of care. To help you attract the patients who value that commitment, ekwa is offering a complimentary high-value patient growth plan session. Build your roadmap for growth by securing your spot today at www.businessofaesthetics.org. It only takes 90 seconds to sign up. And with that being said, Dr. Delobaux, it’s a true honor to have you on the show.

Don: So let’s jump right in.

Dr. Delobaux: Hello, Dan. It’s a pleasure and honor to be here with you today. I would like to thank you for your invitation and for the organization of this amazing podcast. And thanks a lot to your team for putting the effort to organize everything. And this is one of my favorite topic, the BBL. And what we do today has nothing to do with what we were doing like 10, 20 years, 25 years ago.

Don: Thank you very much for that brief history on the BBL surgery itself. And with that being said, let’s come right now to today, right? So what specific anatomical risks of the traditional blind BBL led you to develop a new standard of care?

Dr. Delobaux: That’s a really interesting question. I mean, this is something we speak about in every Congress where I give a talk about the BBL and the new technique, the SMART BBL, in which we use the ultrasound. It became an ultrasound guided surgery. It was a blind surgery before. And we had a lot of discussions in the last 10 years. I mean, it started in 2015, 2016. We started to see a lot of tabloids in Brazil, Miami, in South Florida about death after BBL as well as in Turkey and the UK. And we had some group of experts, task force, on how we could avoid this risk of fat embolism. I mean, anatomically speaking, the risk comes from the big veins that you have below the muscle. So when you think about the anatomical layer on the butt, so you have the skin at the top, and then just below, you have a small layer of fat. This is what we call the superficial subcutaneous compartment. This is the fat that you can pinch through the skin. And then you have a layer that separates the superficial fat from the deep fat. So in every area, the two areas I just quoted, you are safe to put fat because there is no risk of entering a big vessel, like a big vein or a big artery. So there is zero risk of having any trouble when you inject the fat in this area. And below this area, this layer, you have the muscle. The muscle that you can pinch when you contract a lot, and below this muscle and inside the muscle, you have big vessels because the butt muscle, the gluteus maximus, the big muscle of the butt, needs a lot of blood flow to be irrigated. This blood flow comes from arteries and veins, and you have big veins, deep gluteal veins, and the risk is to blindly cross the muscle and enter the muscle. And creating a breach into the vein because the vein is really fragile. The fat surrounding the vein can be aspirated into the vein and it heads directly up to the heart and the blood vessels of the lung. So you can have what we call PFE, pulmonary fat embolism. And when you have this, it can be a deadly risk.

Don: So doctor, as you were mentioning, I couldn’t help but wonder like in the traditional method, you will only know if it’s wrong right if you were to puncture to the muscle that’s the only way you would know you’re wrong and until that point you’re just hoping through your experience that you’re right.

Dr. Delobaux: Yeah, this was a problem before, I mean, we had no possibility and no technology at that time to help us to know whether we were in the right or the wrong space. And when you are in the wrong space, the traduction of the fact that you are in the wrong space is really, really deadly.

Don: What moment during your practice, your career that you saw that okay, there has to be a safer way to do this?

Dr. Delobaux: It’s a really good question. I had a patient, I think it was in 2019 or early 2020, and she told me, look, doctor, I’ve seen all these tabloids from Turkey, from the UK, from South America, talking about the risk of death during this procedure. And how can we prevent that? And honestly, I didn’t know what to say because at that time I was not aware about a solution. So I started to do some research and to find some articles about first the anatomical risk and the reports. And I saw the report on the task force. They had a task force in 2018. So they gathered a lot of experts around this topic, the problem of humanoid fat embolism following a lot of reports of deaths in the last 10 years. And they gave us some recommendations in 2018. And in the end, I think one or two years after, they published a new paper saying that even with all these recommendations and even with surgeons following the recommendations, they still had some deaths and some pulmonary embolism. And they could find fat graft into the muscle, even if the surgeon followed the recommendations. So we started to consider that the problem was not a problem of technique. It was not a problem of cannula size, a problem of injecting in motion or not. So we started to study more the anatomy of the butt and then came the ultrasound. And we realized that we could see the candela and use the ultrasound to see the candela during the procedure. So it really started from the question from a patient.

Don: Now, how does real-time ultrasound transformed the BBL from a tactile field-based procedure into a visual and data-driven one?

Dr. Delobaux: I mean, for me, it was kind of a revelation. And if you ask me today to do a BBL without ultrasound, I would be like shocked. I would say that switching from something that you can feel with your hands to a screen where you see the anatomy, where you see every little anatomical layer… first, you add value to your practice because it’s not only in the operating room. You can use it during a consultation to show your patients on the screen, the anatomical layers and why it’s important to inject in this anatomical layer… and not in the muscle where you have the risk. That’s really important because the patients, I mean, I have a lot of patients coming only because I use the ultrasound. I’m not better than another they just tell me doctor I’ve made some research… and they tell me that you are one of the only surgeon to to do that in your area so I want safety for me and for my surgery.

Don: Doctor earlier on you mentioned that there is a bit of resistance from your colleagues… Can you speak a little bit about that? Why might they be resistant and how, like, we could change it, I mean.

Dr. Delobaux: I guess that in the story of humanity, I mean, it’s not new. Every time you have a new technology, a new concept… I think it’s the genes of humanity to resist the change. What you have to consider is that surgeons, they rely on empirism. They rely on what they have seen before, what they think is working for them. And when you bring a new concept, a new technology, it means that they have to change their mind. They have to change their beliefs. Most of the time, experienced surgeons will tell you, I’ve done 500, 1,000 BBLs and I never had any problem. But the thing is, the day you have a problem, what will you say to your patient? Because there is a possibility to avoid this risk.

Don: Dr. Alexis says beyond preventing embolism how does the precision of SMART BBL improve other outcomes like fat survival symmetry and contour regularity?

Dr. Delobaux: This is something really interesting, because when you start to use the ultrasound, you realize how versatile is this tool, not only, as I mentioned, during the surgery, but before, during, and after the surgery. During the consultation, you bring value to your patient because you show them their anatomy. You show them the different compartments into the butt. And you can also explain them, not only the importance in terms of safety, but also in terms of aesthetic results. Because if you are in the deep compartment, you can’t have the cellular in this aspect because you can really go deeper without any kind of specific risk because you see where you are. And you can explain them, look at your anatomy and look at this layer, we’re going to be below. So it’s going to be like a mattress to hide the potential irregularities and we will be deeper. You put the fat into the deep compartment of the butt. And it’s like a butt implant of fat. So you gain some projection on the butt. And because there is no resistance, you don’t need to move your cannula during the surgery to equalize the fat. The fat equalizes itself. And you don’t believe it until you see it.

Don: From a business owner’s perspective, Dr. Alexis, right? How does SMART BBL standard impact a clinic’s liability, the informed consent process and the patient’s trust?

Dr. Delobaux: Yeah, that’s really interesting. Especially in the US… in July 2023, the Florida state… for the first time, a state mandated and released a bill… HB 1471 mandated the use of ultrasound guidance for every BBL. Otherwise, if you don’t do it and if your patient complain about it, you can lose your medical license. And some plastic surgeon, they lost it because they didn’t use the ultrasound. Why? Because the ultrasound device is less than $3,000. What is the cost of your license? I mean, it doesn’t worth it to take the risk. Imagine if you are one of the first in your city… to have the ultrasound… It brings you a lot of trust. It’s good for your reputation. You avoid the risk of losing your license, which is something really important.

Don: How has your conversation with the patient changed when you discuss these risks, you know, for a SMART BBL versus the traditional one?

Dr. Delobaux: Yeah, that’s really important. In France, it’s really strict. I mean, you have to inform your patients about the risk and you cannot skip that risk. I find out that probably 20% of my patients have checked on CHAT-GPT before coming for a consultation. So probably a third of them are asking me about the ultrasound because they found me because of that. I always tell them, if you don’t inject in the right layer, if you are too deep, if you cross the muscle, you can die from your BBL. And two thirds of my patients, they don’t know about it.

Don: Will the traditional blind BBL soon be considered below the standard of care? And why is mastering this guided technique essential for future proofing of practice?

Dr. Delobaux: Amongst international societies, it’s now proved and published that the safest way to do a BBL is with your ultrasound. It’s well established now in most of the plastic surgery societies that this is the new standard of care. This is the gold standard for every BBL. Ethically speaking, when you know that there is data proving that PBL is dangerous when it’s done blindly… it’s clear amongst international societies that this is the thing that you have to do. Use the ultrasound.

Don: When it comes to that learning curve, Dr. Alexis, how long do you think it would on average take a plastic surgeon to learn and adopt this technique?

Dr. Delobaux: The answer is different for every surgeon. What I like with the ultrasound is that anyone can buy the device. You can buy it on the internet. And the week after, you can use it on yourself. You can use it on your wife, on your kids, on your staff. And you could start to get used to the images. I would say in a few months, you can be totally autonomous for your BBLs. But you really speed up the learning curve when you go to see an expert, when you touch the patient with him, when you put your hands on the device.

Don: Dr. Alexis, we are approaching the end of the podcast. Now, I always like to ask our guests, what’s the key takeaway you would like for our listeners to have?

Dr. Delobaux: The first word coming into my mind is safety. Safety, safety, safety. We are not treating patients with a disease. We are beautifying the patient. We are giving them back the shape, the confidence, a new look, a fresh look. And we shouldn’t risk the lives of our patients, especially when you have a solution, when you have the technology, when you just need a few training, a couple of thousands of dollars, it doesn’t worth it. So safety first.

Don: Safety first and just give it a try. I think really appreciate your insight there, Dr. Alexis. And yeah, thank you. Thank you so much for sharing your pioneering work and expertise on our topic beyond blind injections. Your insight definitely redefines safety with SMART BBL, provide a clear and essential blueprint for any practice offering high level body contouring today. If you enjoyed this episode, please share it with your colleagues and take a moment to leave us a review on your favorite podcast platform. Finally, a quick reminder to take advantage of the complimentary high-value patient growth plan from our sponsor, ekwa marketing. If attracting more high-value patients is your priority, secure a spot today at www.businessofaesthetics.org. Until next time, keep learning, keep growing, and keep building the kind of business that truly sets the standard in aesthetic medicine. Thank you.

Dr. Delobaux: Thanks a lot, Dan. It’s a pleasure.