My butt has a weird contour & is top heavy with an indent transition on each cheek (Photos)

Question

I had a 360 body lift and my surgeon suggested a bbl at the same time so that my butt wasn’t super flat after the body lift. I agreed with his recommendation but now I am 9 months post op and I don’t like the overall shape. It feels like most fat kept or was added to the top half. What are my options? I don’t want my butt significantly bigger just a better shape with the lower half to blend into the top.

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can based upon your photos. 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.

You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, insignificant hip augmentation, post-deflation sagging, fatty necrotic cyst or scar tissue, etc.) as most of the fat melts away. It is not quite as much the quality of the doctor nor liposuction technique but rather the quality of the procedure that is a large part of the problem.  Thus, going back for additional rounds of BBL most often produces the same disappointing results but at another financial loss.   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.

Fillers, such as Sculptra and hyaluronic acids,  for augmentation of the buttock/hips are a rip-off, period!

Buttock/hip implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the hips and central buttock, and often help smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging.  When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants. 
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

John Reilly, MD, FACS · Answer

Hi, I'm sorry you're not happy with your surgical results. There's a discrepancy between the flatter lower half and the more full upper half. If you have more fat available elsewhere best to place it in the areas of the lower buttock. If you don't you can remove it from the upper half and put it into the lower half. Just a simple idea of supply and demand always trying to keep the best shape of the buttock.

Daniel Barrett, MD · Answer

Dear Megtx92839,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
 Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Zoran Potparic, MD · Answer

Based on this scar you, very likely, had a boddy/buttock lift which included buttock augmentation with a flap tissue from upper buttocks/flanks, which would be discarded in more traditional buttock/body lift. This flap normaly shapes and increases volume only in the upper, possibly central buttock due to a limited mobility. Further contouring and volume augmentation could be achieved with fat grafting of lower and lateral buttocks and hips. You should discuss this issue with your surgeon or seek a second opinion consultation. Good luck

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment regarding the outcome of any plastic surgery procedure, we generally need to see a complete set of proper before and after pictures.If you don’t have before, and after pictures and ask your surgeon to forward the pictures they took.My best guess is that if you’re unhappy with the outcome of your procedure, maybe you should review your before pictures a little longer. When you have a BBL done in conjunction with the body lift, it’s going to be difficult to determine the impact of the BBL.I’m guessing that most of your outcome is related to the body lift, but I wasn’t there during surgery.I think you could probably get some improvements from Liposuction alone Reducing the lower part of your love handles Just below the scar should improve your female contour. Anytime you get a second opinion consultation always include before and after pictures.Either follow up with your provider and talk to him or her about revising the outcome or get in person second opinion consultations with other providers in your community.If you’re going to get a second opinion consultation, then you should also have a copy of your operative report Since that would be important for a new surgeon to read. Before, and after pictures and copies of your operative report are part of your medical record, and you can request them from your current provider by simply asking for them.Best,Mats Hagstrom MD

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