Gregory A. Wiener, MD, FACS

Hello, and thanks for the question and the picture. You have a very common problem. It is really a combination of issues. Skin laxity, combined with dimpling and irregularities from cellulite. Half of my "Brazilian Butt Lift" patients have some form of these issues.

I treat these patients with fat transfer to the subcutaneous layer above the muscle. This will add volume and fill up some of that excess, droopy skin. However, due to the fibers holding the skin onto the muscle surface, not all of the depressed areas or dimples will expand nicely, so some of these are released (cut beneath the skin) during the process. This is called "subcision" and is done at a deeper level of the subcutaneous layer, and in a very limited way, so we don't cause more irregularities .Fairly aggressive massaging is also done throughout the procedure to release some of these bands without subcision, so the tissue expands as evenly as possible.

This will partially correct your problems, but it is unlikely you will have a complete correction, or a perfectly shaped buttock free of any depressed areas. For patients like you, I will recommend a touch up fat transfer 6-12 months after the first, in order to further smooth and fill in any problem areas.

If there is a significant amount of skin hanging over the buttock fold ( the crease between the buttock and the back of the thigh) that still won't lift after fat transfer, we can consider excising this fold along the line of the fold. This will give you a sizeable scar along the fold which would be visible in a bathing suit. It is an option only in the more severe cases of skin laxity.

Hope this helps!

Hello, and thanks for the question and photos. From the photos, I can see the crease and some skin laxity above and below it. Though it is possible that the crease was caused by pressure from the garment not fitting properly, it also looks like the skin laxity, or even some residual fat above and below the crease could be factors here. Something like this could possibly be improved with some additional liposuction above and below the crease with undermining and shifting of some fat to directly under the crease to help smooth the contour. Additionally, for a more predictable, flatter, and smoother abdomen, you may be a candidate for a tummy tuck. An in person exam would be the best way to really assess things and give you the most realistic options.

I hope this helps.

Hello, and thanks for the question and photos. From your weight, height and photos, it looks like you are a good candidate for a Brazilian Butt Lift. While you are not heavy, you do have excess fat on the abdominal wall, waistline and lower back as well as some in the mid to upper back. All of these areas can be treated with liposuction to contour each area, and the fat can be harvested and transferred to the buttocks to improve your shape and volume. Your waistline will really benefit from a complete, fairly aggressive suctioning to narrow it as much as possible, and this will also make the buttock look rounder and fuller indirectly. From the photos, it looks like your skin will contract reasonably well, especially in the waistline, but an in person exam would be the best way to give you a more accurate picture of what is really possible.

Hope this helps!

Hi, and thanks for the question and photos. I think the most important thing, initially, is that you lose weight, and I'm glad you are already planning this. From the pictures, I can see that you carry a fair amount of excess fat inside the abdomen as well as outside, and this gives your belly that rounded look. Only weight loss will improve this, and it will have to be significant weight loss (40-50 lbs). Then your belly will be flatter, but you will still have a layer of excess fat on the abdomen, hips, back and waistline that could be suctioned to contour you further (and even though you don't care about a tiny waist, making your waist as small as possible will enhance the look and shape of your butt) and that fat could be transferred to your butt. You will still also have excess abdominal skin as well, but you could hold off on the tummy tuck to fix this until after having children.

Hope this helps!

Hello, and thanks for this very good question. The most likely answer is that there was always some degree of cellulite/dimpling there to begin with, but it wasn't obvious. The increased buttock volume from your fat transfer pushing the tissue out caused these irregularities to become more obvious, and maybe even enhanced them. It is unlikely that the fat transfer actually caused cellulite. Both cellulite and dimples occur because of irregularities in the length of fibers called "septa" that run from the undersurface of the skin down to the fascia (covering of the muscle). When the fibers are all of similar lengths, the fat in between the fibers is spaced out in a smooth, uniform manner. When the fibers are of different lengths, the fat in one "compartment" bounded by fibers all around it may be lower or higher than the compartment of fat next to it. This causes the irregular, bumpy look to the skin we see in cellulite, and if the fibers are all shortened in a larger area compared to the surrounding fibers, it causes a dimple (also likely a form of cellulite). This, unfortunately, has to do with your genetics more than anything else, because even thinner people can have some cellulite.

However, exercise and hydration can improve things to some degree. There are creams and procedures involving rollers and suction that have been used for years, but results are transient, and they do not cure the condition. Various other procedures involving lasers and/or cutting of the fibers beneath the skin (to allow the fat compartments to equalize and smooth out) have also been used for years with unpredictable results.

I tell my patients (and there are many with cellulite and dimpling) that fat transfer (BBL) will make their buttock fuller and improve their figure, but it will not smooth out cellulite and dimples, and could even enhance them. I do, however, perform limited "subcision" (cutting of the shorter, tighter fibers) during fat transfer procedures where there are deeper dimples. If it is done carefully (with a small cannula with a small forked blade on the end) deeper dimples can be safely softened and partially or completely smoothed out. Too much subcision, however, could lead to irregularities that are even worse than the dimples.

There are two procedures which may have some value. One is Cellulaze, which uses a laser to cut the fibers, and another is Cellfina, which uses a wire to uniformly cut the fibers in a given area. Both are done under local anesthesia. I have no experience with these treatments, but I know they can be successful, especially in limited areas.

I hope this helps.