BBL sagging? How to fix? (Photo)

Question

I recently went for a tummy tuck and a BBL round two with a revision mainly… My main issue was my lower right butt cheek and had like an indentation which form like a little shelf on the bottom butt cheek. The doctor said it will be difficult to fix but after the surgery, the problem looks exactly the same as before. Now he said an incision needs to be made in that area to fix it specifically... what do you think happened and how to fix it ?

Zoran Potparic, MD · Answer

It is impossible to achieve perfect buttock shape in every patient just with fat grafting. Your existing buttock shape and given anatomy will dominate the result. Adding fat to certain areas for purpose of shaping and augmentation may not always create desired improvement. You have already had two attempts and your result doesn't look bad. Give it some time to settle (at least 12-18 months after last surgery. It is impossible to evaluate your result without pre op photos. There may be a time to say enough?

Ryan A. Stanton, MD · Answer

For starters, it appears as though you are very soon in the postoperative recovery. And will have to wait at least another 5 to 6 months to see how everything settles at the place. Secondly, your surgeon was honest and correct when suggesting that it is a difficult problem to fix (with more BBL). Thirdly, It appears as though you have, the not so uncommon, post-BBL deflational sagging whereas after the fat is transferred in high volumes combined with the severe postop swelling, the tissues get significantly  stretched. Then, when the fat melts away and the swelling resolves over 6+ months, patients are left with a sagging deformity like you have.  Although there is no perfect correction, I’ve had the best luck with utilizing buttock implants to reinflate the buttock tissues and give some lift to the lower buttock pole. Occasionally a lower buddy tuck may also be beneficial.  Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in 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.

Daniel Barrett, MD · Answer

Dear JessicaFunes.xo,
it is hard to tell for sure without an examination. Based on your photos, it looks like you would benefit from revision surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Arian Mowlavi, MD, FACS (license on probation) · Answer

You would benefit from an in person consultation. High definition VASER liposuction may be able to resolve the issue. The definitive correction for liposuction deformities requires the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I encounter suboptimal liposuction outcome referrals weekly. VASER liposuction has been the only modality that has consistently corrected liposuction caused deformities. VASER liposuction ensures a smooth contour regardless of severity of contour irregularities by virtue of being able to remove any and all remaining fat comprehensively and uniformly. Finally, when skin redundancy irregularities are observed, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing.

Respectfully,
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

Many people have a flat spot on their lower in her buttocks in particular the area that takes most pressure when were sitting.

This area typically has a high concentration of connective tissue bands that hold the skin a certain distance from the underlying muscle fascia.

The best analogy I can give you for this is comparing the skin and the back of your hand and the palm of your hand.

You can pinch and tent up the skin on the back of your hand easily. And I tried doing that in your mid palm.

It’s not possible because the skin in your palm has lots of connective tissue bands anchoring the skin in place to tolerate lots of force and pressure. This is true for all the areas in the body that can tolerate great pressure like the soles of the feet, palms of the hands, back of the thigh and lower in her buttocks that can tolerate our full body weight.

The surrounding areas have less of these connective tissue bands and expand better with fat transfer while the problem areas do not expand because of the connective tissue bands just like you can’t pinch and lift the skin in the mid palm.

For that reason adding fat makes the area worse.

Like your doctor said, this is a very difficult situation to fix and patients who are thinking of having a BBL should be warned of this during in person consultations.

Compared to what I’ve seen your case is it really that bad and I would suggest consider leaving it alone.

I think your doctor did everything he or she could but it is simply an inherently difficult area that will not project from volume restoration.

These connective tissue bands that are limiting the projection of your skin or the same type of tissue that creates cellulite which can also be made worse from fat transfer like a BBL.  cellulite tends to form in similar areas where there is a greater abundance of this connective tissue.

Best,

Mats Hagstrom MD

BBL sagging? How to fix? (Photo)

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