Background <p>Gluteal fat grafting carries risk of pulmonary fat embolism and thromboembolic events. Standardized subcutaneous-only injection has been proposed to mitigate these risks.</p> Objectives <p>To evaluate embolic events, thromboembolic complications, and overall safety outcomes in a large consecutive series of Brazilian Butt Lift (BBL) procedures using a standardized subcutaneous-only protocol.</p> Methods <p>Retrospective review of 7,000 consecutive BBL procedures performed between 2018 and 2024. Subcutaneous-only fat injection, stiff cannulas (&gt;4 mm), retrograde technique, sacral and lateral access, and multimodal thromboembolism prophylaxis were employed. Demographics, operative variables, complications, and patient-reported satisfaction were analyzed.</p> Results <p>No pulmonary fat embolism, fat embolism syndrome, deep vein thrombosis, or pulmonary embolism occurred. Estimated fat graft survival was approximately 70% with mean injection volumes of 1,200 cc per buttock. Minor complications included seroma (23%), anemia (6.6%), fat necrosis (1.9%), infection (0.43%), hematoma (0.14%), asymmetry (0.29%), and revision surgery (0.21%). Secondary procedures accounted for 3% of cases and demonstrated similar complication rates.</p> Conclusions <p>Strict subcutaneous-only injection and multimodal thromboembolism prophylaxis were associated with zero embolic events in this 7,000-case series. Minor complications were manageable. These data support standardized operative protocols to optimize safety in gluteal fat grafting.</p> Level of Evidence III <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 <a href="https://www.springer.com/00266">www.springer.com/00266</a>.</p>