Sir: We found the points of view outlined by Drs. Rosique and Rosique concerning our article entitled “Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong?” (Plast Reconstr Surg. 2015;136:58–66)1 very interesting. We were among the first authors to report and standardize the surgical procedure of gluteal lipoinjection in the literature.2 Before our reports, there was very little written about this procedure, which we have continued performing for more than 20 years, with a current casuistry of more than 1500 patients, which has been published in many articles.3–6 We have had complications, which also have been published,2–6 but fortunately, despite our extensive casuistry, we have never had a case of death by macroscopic fat embolism. However, this does not mean that the problem does not exist. When a problem is identified, we must try to investigate the causal factor even though it is not part of our series but still part of our specialty, because patient safety always comes first. We identified the problem in Mexico and Colombia by direct reports of colleagues, and they were confirmed by surveys and by autopsies in forensic services. Paradoxically, as occurs in many cases in the medical literature with fatal events, these complications were not reported and published in the scientific literature. These findings are usually reported by forensic pathologists, and not by surgeons involved in the death, as we can see in a similar case that occurred in Los Angeles, California, just a few months ago.7 Thus, these complications are not going to be found easily, until the problem is sought. In our study, it was quite evident that the cause of death was the presence of fat observed macroscopically in large vessels and heart cavities. Also, the entrance of this fat was through the laceration of gluteal vessels in the piriform buttocks area. Obviously, there are secondary factors that may prevent this problem during lipoinjection, which have been well described by Dr. Rosique. However, the primary factor for avoiding these catastrophic events is to avoid damaging the gluteal vessels. If there is no injury of gluteal vessels, there is no problem, and to avoid injuring gluteal vessels, we have to stay away from them. As we described in the article, the best way is to prevent deep muscle plane lipoinjection, because the vessels are beneath the gluteus maximus and gluteus minimus muscles. For this, the cannula should always be kept parallel to the surface of the buttocks, and not be directed obliquely into the depth of them. Again, we thank the authors for their comment on our article and their interest in it. DISCLOSURE The authors have no conflict of interest to declare in relation to the content of this communication. Lázaro Cárdenas-Camarena, M.D. INNOVARE Cirugía Plástica Especializada Guadalajara, Jalisco, México Jorge Enrique Bayter, M.D. Critical and Intensive Care Medicine Clínica “El Pinar” Bucaramanga, Colombia Herley Aguirre-Serrano, M.D. Universidad Nacional de Colombia Instituto Nacional de Medicina Legal y Ciencias Forenses Regional Colombia Bogotá, Colombia Jesús Cuenca-Pardo, M.D. México, DF