Advocacy
J. Kevin Duplechain, MD, FAACS | AACS Advocacy Committee Chair

The Advocacy committee met on April 23, 2024. The meeting agenda included discussions specific to Brazilian Butt Lift (BBL) surgery regarding New York and Florida, along with a discussion about ongoing efforts (e.g., articles being written) that are being developed to showcase the safety practices of the AACS and ABCS physician groups. Additionally, a brief update was given on the state to state advocacy program that we launched at the AACS meeting in New Orleans.

In New York, there are no recent developments to report. Shortly after the February 2024 AACS Annual Scientific Meeting, I spoke with Rosemarie Casale, MSN, RN, NE-BC, director of the New York State Department of Health (NYSDOH) OfficeBased Surgery (OBS) division. She indicated that the guidelines regarding liposuction with and without fat grafting were still under review. All previous language that was specialty specific has been removed, and we are awaiting a final release of guidelines. As of this writing, the website still lists the guidelines as “under review.”

The Florida legislature enacted a bill this year that changed several guidelines regarding office-based surgery. These guidelines restrict office-based surgery to procedures that meet the following guidelines:1) the surgery generally results in blood loss of no more than 10 percent of estimated blood volume in a patient with a normal hemoglobin level; 2) the surgery does not require major or prolonged intracranial, intrathoracic, abdominal, or joint replacement procedures, except for laparoscopic procedures; 3) the surgery does not involve major blood vessels; 4) the surgery is not considered emergent or life-threatening.

In addition, a physician performing a gluteal fat grafting procedure in an office-based surgery setting shall adhere to standards of practice that include but are not limited to the following:

1. A physician performing a gluteal fat grafting procedure must conduct an in-person examination of the patient while physically present in the same room as the patient no later than the day before the procedure.
2. Before a physician may delegate any duties during a gluteal fat grafting procedure, the patient must provide written, informed consent for such delegation. Fat extraction and gluteal fat injections must be performed by the physician and may not be delegated.
3. Fat may only be injected into the subcutaneous space of the patient and may not cross the fascia overlying the gluteal muscle. Intramuscular or submuscular fat injections are prohibited.
4. When the physician performing a gluteal fat grafting procedure injects fat into the subcutaneous space of the patient, the physician must use ultrasound guidance, or guidance with other technology authorized under board rule that equals or exceeds the quality of ultrasound, during the placement and navigation of the cannula to ensure that the fat is injected into the subcutaneous space of the patient above the fascia overlying the gluteal muscle.
5. An office in which a physician performs gluteal fat grafting procedures must at all times maintain a ratio of one physician to one patient during all phases of the procedure.
6. If a patient is admitted to a hospital unexpectedly following BBL surgery, the incident must be reported to the state.

Although these results are a significant change from prior practice standards, the representatives of the AACS and ABCS strongly support the importance of patient safety during all procedures, and we recognize the importance of these new rules.

In addition to these issues, a state to state advocacy network is being established. States currently participating include Florida, Texas, Illinois, New York, Pennsylvania, Virginia, and Utah. We’d like to thank all of the physician leaders who are initiating the development of this network.

Finally, I am happy to report that the AACS recently passed the membership requirements of the American Medical Association (AMA) and will maintain its representation within the AMA. This is of monumental importance to our Academy and its members. We must as an organization continue to update our AMA dues, as a significant portion of our future lies within the AMA’s strong support of the AACS.

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