Background <p>The demand for gluteal augmentation, commonly known as Brazilian Butt Lift (BBL), has significantly increased, driven by evolving beauty standards. Despite its popularity, the procedure is associated with serious complications, including pulmonary fat embolism, due to the challenges of ensuring the correct injection plane. The development of ultrasound-guided fat grafting offers a potential solution, enhancing the safety and precision of the procedure.</p> Objectives <p>To demonstrate the efficacy, safety, and superior aesthetic outcomes of ultrasound-guided gluteal lipofilling. This will be attempted by using specialized software for processing photos and digital images, such as Photoshop, in order to obtain values through measurements that allow for an objective comparison of images of patients who have undergone gluteal lipofilling with and without ultrasound guidance.</p> Methods <p>A retrospective study was conducted on 200 patients who underwent BBL, divided into two groups: 100 patients with traditional, non-ultrasound-guided fat grafting, and 100 with ultrasound-guided fat grafting. The study used preoperative and postoperative photographs analyzed through two-dimensional software to measure changes in gluteal volume. Measurements focused on the distances between fixed anatomical landmarks on the gluteal and thigh regions. Outcomes from the two groups were compared to evaluate the effectiveness and safety of the ultrasound-guided technique.</p> Results <p>The ultrasound-guided procedure showed improved distribution of adipose tissue in the gluteal region compared to the non-ultrasound-guided technique, with fewer complications reported. The data analysis shows that, for lateral projection images, the average percentage variation was 2.04% for non-ultrasound-guided procedures and 2.81% for ultrasound-guided lipofilling.</p> Conclusion <p>The integration of ultrasound technology in BBL procedures allows for real-time visualization of the cannula tip, reducing the risk of intramuscular injections and improving fat distribution. Although minimal, the difference in efficacy between the two techniques is evident. Furthermore, the ultrasound-guided technique has been associated with a lower complication rate according to numerous studies and is therefore preferable.<UnorderedList Mark="Bullet"> <ItemContent> <p>Comparison of Techniques: The study compares the efficacy of ultrasound-guided and non-ultrasound-guided procedures, analyzing data from 200 patients.</p> </ItemContent> <ItemContent> <p>Methods: The results were obtained using software for processing photos and images.</p> </ItemContent> <ItemContent> <p>Efficacy Outcomes: The ultrasound-guided procedure showed a slight but measurable improvement in percentage variation over the non-ultrasound-guided method.</p> </ItemContent> <ItemContent> <p>Clinical Recommendations: Based on the findings, the ultrasound-guided method is recommended due to its demonstrated safety benefits and reliable results.</p> </ItemContent> </UnorderedList></p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>