What can I do to resolve this? (Photo)

Question

I have recently lost a lot of weight and my booty is suffering! I’m on a strength training journey to regain mass, but I have major concern that the saggy skin under my right buttcheek will persist. It’s also uneven vs my left side. I’ve never had surgery on my butt. Is there a procedure that may help with this skin and even out both sides? I am not interested in BBL, only in skin removal at banana rolls.

Gary M. Horndeski, MD · Answer

A direct incision of the banana roll often leads to complications with the wound coming apart and is not recommended. What can be done is a buttocks lift. This is done by an incision in both the gluteal crease that pulls up the skin of the thigh. This can be done on one side, if desired, but you will get better symmetry if both sides are done simultaneously.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

J. Timothy Katzen, MD, FACS · Answer

Hello alecbaldwin44, thank you for your question regarding what you can do to resolve saggy skin under my right buttcheek and uneven lower left butt skin. Thank you for your history and pictures. First, we should analyze your pictures to determine the best procedures. You have cutis pleonasmus (excess skin) and dermatocholosis (loose skin) of your lower buttocks in the infra-gluteal region or "banana roll". Since you have a skin issue, you need a skin excision surgery. Most plastic surgeons would agree that you need an infra-gluteal incision and dissection up the lower part of the buttock. Then, a crescent-shaped area of excess lower buttock skin and fat would be removed. This procedure is performed under general anesthesia and takes about 2 to 3 hours to complete. Usually, drains are not required. Postoperative positioning is on your abdomen with a straight back, not bending at the waist. You should be able to return to work in about 2 to 3 weeks. You should be able to return to working out at about 6 to 8 weeks. The resulting scar is usually concealed under each buttock cheek. Banana roll liposuction is not a good idea for you. You have a banana roll skin issue, not a banana roll fat issue. If you underwent banana roll liposuction, more banana roll fat would disappear, and your current banana roll skin rolls would become more (not less) evident. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. Good luck. I hope that I have answered your question regarding how to get rid of excess banana roll skin. If you have any further questions about how to remove excess banana roll skin, contact an experienced plastic surgeon. Please seek an experienced, board-certified plastic surgeon with significant experience in infra-umbilical fold surgery and weight-loss patients. Make sure they have performed many banana roll skin resection surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after photos and review their RealSelf profile. If you cannot find an experienced plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

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.

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 more flat with just a buttock lift from above. A lower buttock tuck is usually then performed at six months following implants. In this sequence, the implants have fully settled into final position so that any remaining loose (banana roll) 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.

Arif Eroglu, MD · Answer

Hello
There is a right subgluteal double fold present. This is usually something that has been there from the beginning, but it became more prominent after weight loss. It is not necessary for it to be present on both sides. The excess skin from the subgluteal fold area can be excised and reduced to a single fold. However, a stitch mark will inevitably remain after the procedure.

Zoran Potparic, MD · Answer

Very likely that correction of intragluteal crease would help. Be aware that it is very tricky procedure where experience of the surgeon is mandatory. Good luck.

Daniel P. Markmann, MD · Answer

Thank you for your question as well as including pictures.  Congrats on the weight loss, but sorry to hear that you're having this problem.   The best way to fix this problem of your right buttucks skin excess is to remove the excess skin through a scar in the crease and create a new crease similar to your left buttocks crease.   It is called a Buttocks Wedge Excision.