I Have a Lot of Excess Skin on my Buttocks (They Sag and Are Heavy). What is the Best Way to Repair Them?

Dear sunnilu,

   The reason for your buttock skin laxity, is that you lost significant amount of volume (fat).  Your skin  could not shrink enough and accomodate your new butt size. Well, the logical solution is to restore the lost volume. The 2 most common techniques are fat injection and silicone implants. Unfortunately, fat injection is unpredictable and most of the time disappears after a year. Buttock implants are soft , feel and look natural and most importantly , do not disappear. Consult with a board certified plastic surgeon who is experienced in buttock implant augmentation.  Check his or hers before and after and make sure that you like the results.

        Best of luck,

                                    Dr Widder

Congratulations on losing 187 lbs!  Unfortunately in these situations you are left with a lot of excess sagging skin that can only be treated by surgical excision (removal).  Thus I recommend first undergoing a buttock lift (probably even a "total body lift") and then once you are completely healed and the tissues are settled into their final shape then look into the (probable) need for buttock implants to restore volume.  Glad to help...RAS 

There are numerous ways to improve your buttocks shape while removing excess skin.  For patients with a similar history to yours I prefer to perform a circumferential lower body lift and fat transfer to the buttocks in the same surgery.  It leads to a great result with a natural shape to the buttocks. If additional volume is needed, then you could consider a buttocks implant.  However, this is not very common as most of the time a large amount of fat can be harvested from the area which is removed in the circumferential body lift.  I hope this helps and best wishes. 

   In general, a body lift may be helpful as well as a medial thigh lift, but this is hard to determine without pictures.  This procedure can be broken up into stages as well.  Autoaugmentation with rotational flaps may help some, but physical exam would be needed to confirm feasibility of this option.  If you have any fat left to transfer, that may be a better idea for volume filling.

I am concerned when you state you have talked to a "board-certified surgeon" instead of an American Boad of Plastic Surgery-certified plastic surgeon. Too many self-proclaimed "surgeons" are not fully-trained in plastic surgery, and particularly with this amount of massive weight loss (Congratulations! What an achievement!), you almost certainly need a full lower body lift (circumferential belt lift) with autologous buttock dermal-fat augmentation. This is something that only a few fully-trained ABPS-certified plastic surgeons are presently doing, and very few do lots of them.

SO let's assume you have been talking to an appropriately-experienced "real" plastic surgeon who has done a significant amount of body contouring surgery after massive weight loss. A medial thigh lift in continuity with a buttock lift is an operation done where the patient has already undergone an abdominoplasty, so the anterior (belly) loose skin has been removed and the abdomen tightened. Loose medial thigh, hip, lateral thigh, and buttock skin remains, and the long spiral excision is termed a Lockwood type I lower body lift. By contrast, the much more common abdominoplasty that extends all the way around the body (lower body lift or circumferential belt lift) is termed a Lockwood type II lower body lift.

"Putting skin/flesh 'back' onto [your] buttocks" but not by injection sounds like a non-medical description of an autologous pedicled dermal-fat flap buttock augmentation, but you should have a full understanding of what is planned and just how this is to be performed, or you could end up with a hunk of dead tissue that becomes infected, causes significant problems, and could even be deadly!

You don't want to get this wrong! Seek several opinions and verify your surgeon's credentials and experience with the exact operation planned. For examples of my patients undergoing this type of procedure, click on the web reference link below, and read my article (on my About page on this site) titled "Lower Body after Massive Weight Loss--Is Outpatient Beltlift Surgery Safe? Best wishes! Dr. Tholen

Thank you very much for your question.  Buttock contouring after weight loss is one of the areas of body contouring after weight loss that requires special attention to get excellent results.  Photos would be more helpful in giving you advise, but from your description it seems to me like you would be a good candidate for a buttock lift with auto-augmentation with your own tissue.  This procedure is very effective in restoring the shape and lifting the buttock after weight loss.  In severe cases, it can be combined with a staged posterior thigh lift and infra-gluteal diamond lift for a better result.  For more information on these procedure please refer to the following article:  

Gluteal Contouring Surgery in the Massive Weight Loss Patient
Clinics in Plastic Surgery, Volume 35, Issue 1, Pages 73-91
Robert F. Centeno, Constantino G. Mendieta, V. Leroy Young

Good luck!

Congratulations on your weight loss! For gluteal Reshaping after massive weight loss, I recommend a lower body lift with autologous augmentation (the excess skin from the back is de-epithelialized or the superficial skin is shaved off, the tissue is reshaped and tucked into the gluteal area for volume).  This is an extensive procedure and takes a couple of weeks time off from work, but the results are amazing.  Good luck and take care!

The sagging buttocks can be lifted with a lift and the excess skin removed. The incision is on the top of the buttocks,

A dermis fat graft can be put in the buttock for volume and projection if desired.

Medial thigh lift does not do anything to the buttocks unless you extend the scar to the buttock crease which is more obviuous and poor in healing and very noticable.