54F, 5'3", 128 lbs. - Butt lift vs lower body lift? (photos)

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.

Buttock “sagging” is usually a combination of loss of volume or deflation (after weight loss, liposuction, or post-BBL) and/or the effect of aging and gravity. So, I personally first treat patients like you by restoring volume to the buttock with a buttock implant. This will create a more desirable smooth and rounded perky buttock profile. If not adding volume with an implant, the buttock will most certainly always appear much more flat with just a buttock lift/lower body lift from above…thus, i always strongly advise against this approach. If so desired and further beneficial, a lower buttock tuck may then be performed at six months following implants. In this sequence, the implants have fully settled into final position so that any remaining loose skin can be most accurately identified and removed with the lower buttock tuck. Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel away from your local area to seek consultation with this particular type of 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.

I don’t think there is really any easy answer for your concerns and because your situation is complex, you should skip all aspects of virtual consultations and instead have in person consultations exclusively.
Quality assessment requires quality information.
Collect all proper before and after pictures and upper to reports from previous providers and bring those with you during in person consultations for whatever procedure you are contemplating.
Loose skin makes body contouring difficult, including gluteal fat transfer.
Best,
Mats Hagstrom MD