Question regarding visible indentation in the buttocks - how can this be improved? (Photo)

Question

I am a 21-year-old female with low–normal body fat and no history of trauma, or surgery in the gluteal area. I have a bilateral indentation just above the infragluteal fold (lower outer portion of the gluteus maximus). It is becomes more visible when sitting. There is no pain, swelling, or skin discoloration. Is this considered a normal anatomical variation of the infragluteal fold / lower glute contour, or could it represent gluteal atrophy or a structural defect? Would targeted hypertrophy of the lower gluteus maximus improve the appearance, or is this primarily determined by anatomy? Additionally, can consistent strength training and muscle building reduce the visibility of this indentation, or is it primarily determined by anatomy? Thank you

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can based upon your single blurry photo. However, please keep in mind that an in-person, or at least a virtual, consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.

Likely what you have is a developmental malformation variant. Unfortunately, this cannot be corrected by targeted workouts to build any particular region of the gluteus muscle(s). Also likely, the most successful way to pop out these indentations would be with some form of permanent buttock augmentation.

There are currently only two FDA approved surgical options for augmenting the buttockarea:  1) Buttock Implants (which are soft semi-solid silicone rubber implants that cannot rupture &/or leak) and 2) Brazilian Butt Lift (aka BBL) - which utilizes the patients own fat from liposuction then transfers this fat into the buttock. On the other hand, “BBL” using fillers such as hyaluronic acids, Sculptra, etc… is a dangerous, guaranteed waste of money, and is NOT FDA approved. So what it comes down to, like any surgery, is proper patient selection and long-term results. Implants provide the only guarantee for a sustained permanent result and tend to be ideal for perking up not only lean or deflated buttocks but also providing substantial projection to any butt, which is what every single patient wants. Based upon your photos, a Stanton Anatomic®️ shape buttock implant may serve you best.

Unfortunately, fat typically melts away leaving disappointing results after 12 months, often sooner.  Dead fat often leads to dents and dimpling like cellulite, unevenness, loss of projection, and fatty necrotic oil cysts which feel like hard marbles and can be very tender.  
Additionally, because ~70+ % of the fat transferred will melt away within a year or two, most patients are not even reasonable candidates for BBL because they lack an adequate amount of fat to harvest. Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, the fastest, and the most...so please do not fall victim to this recommendation. Even those patients that had adequate amounts of fat pre-operatively, still end up seeking buttock implants after a year or so because most of the fat transferred melted away leaving them with minimal result. In your particular case, getting enough fat to survive just in those indented areas, without it squirting or migrating off to the sides, will be particularly challenging.

Fillers such as Sculptra are cost prohibitive, provided enough volume is injected (i.e. at least 400 cc of active ingredient costing over $300,000) and last only 12 - 18 months.  Additionally, any physician promoting “biostimulators” for buttock enhancement is just a joke, and any board certified plastic surgeon promoting such, should not be trusted with your butt.

So, if you're looking for a reliable, predictable, and long-term permanent option that also provides projection in the upper, central and lower buttock, buttock implants are your solution. Procedures marketed as “supercharged BBL” or “hybrid BBL” that add fat at the same time of implants are simply marketing ploys. Fat that is added at the same time as a buttock implant is doomed to melt away 90+ percent. Thereby rendering it completely useless.  The reality is, when buttock implants are properly placed 100% intramuscular (i.e. surgically and precisely positioned within the gluteus muscles, not subfascial and not dual-plane and not on top of the muscles), there is absolutely no need for fat transfer.

Please note that an extremely few number of board certified plastic surgeons specialize in buttock implants, so you may need to travel far and away from home to find this particular surgeon.  Getting it done right the first time around is not only the best chance for success, but also will save you from a lot of headaches and money in the future. Glad to help.

Question regarding visible indentation in the buttocks - how can this be improved? (Photo)

Answers (1)

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