Skinny and very athletic. What are my options to contour the area above my butt? It’s very square (Photo)

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.

There are currently only two FDA approved surgical options for augmenting the buttock/hip area: 1) Buttock and cosmetic Hip 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 Sculptra 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. Typically a combination of sculpting the waistline with liposuction and augmenting the buttock with implants +/- the hips with implants provides the best chance for a long lasting and desirable "hour-glass" figure. Based upon your photos, you obviously do not need liposuction but, a Stanton Anatomic®️ shape buttock implant may serve you best for permanently enhancing the contour of your buttock.

Please read on for more general information.

Unfortunately, fat typically melts away leaving disappointing results after 12 months, often sooner. Unless your BBL surgeon is injecting only 200 to 300 ccs of fat into each buttock cheek, a large percentage of that fat is going to die. Dead fat leads to dents and dimpling like cellulite, unevenness, loss of projection, and fatty necrotic oil cysts which are hard marbles and can be very tender
Unfortunately, because ~70+ % of the fat transferred will melt away within a year or two, most patients are not good 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. 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. So, if you're looking for a reliable, predictable, and long-term permanent option that also provides projection in the central buttock, buttock and hip implants are your solution. Please note that an extremely few number of board certified plastic surgeons specialize in buttock or hip implants, so you may need to travel far and away from home to find this particular surgeon. Glad to help.

Dear RSMember3102,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hello and thank you for your question!

It is true that with your frame and build, it will be difficult to harvest significant amounts of donor fat. However, even with just liposuction alone of the lower back as well as a small amount of fat grafting to the "hip dips" , you will be able to see a nice change in the frame and overall shape of the buttocks. As long as expectations aren't for a "large" change, you should be on your way to improving the problem areas. Good luck with your journey!

Thank you for your query. I have done buttock contouring for several ladies matching your description. There is still some fat around the waist that can be removed and injected, giving a”lip”in the lower back and better waist to buttock ratio. I prefer Waterjet. Liposuction to harvest the fat. Please discuss your concerns with an experienced board certified plastic surgeon who can help you with all your concerns. All the best!

The only and the best improvement option I see is creating a better transition from your waist to your buttocks by reducing your love handles and focusing on getting a more perfect S curve, a.k.a. Coke bottle, a.k.a. Hourglass figure.In the hands of the right provider, this could improve your contour to some degree.That said, delivering, consistent quality liposuction results is more difficult than most people realize.Liposuction is a permanent reversible procedure that can potentially leave people this.The number of plastic surgeons who come close to Liposuction is fairly small.Most plastic surgeons think they’re better at Liposuction than they actually are. Finding someone who can deliver predictable, consistent outcomes. Every time is difficult.There is always a risk of turning out much worse than when you started, and this would be the biggest reason why it may not be a bad idea to leave good enough alone.Finding the right provider is not at all easy or straightforward.I don’t think you can do it without having multiple in person consultations and even then , sometimes it’s simply a matter of odds or luck.Depending on how motivated you are and how much risk you’re willing to take (not so much regarding medical complications, but rather having an outcome that leads to disappointment) you may or may not want to pursue this.To find the right plastic surgeon I generally recommended patient start by making a list of local providers who do a lot of Liposuction or preferably focus exclusively on Liposuction.Get a proper set of pictures, the same way plastic surgeons take before and after pictures. try using the timer on your camera or have someone else take the pictures and then crop them appropriately.Take a look at how plastic surgeons take before and after pictures to get an idea of what we need.Bring the pictures of your own body with you to use as reference during the consultation.Do not go by memory or using mirrors during the consult, if you can avoid it.I generally do not recommend people have virtual consultations whenever possible.I generally also do not recommend people travel long distances for elective surgical procedures if it can be avoided.During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar body characteristics to your own.Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider .In my opinion, an experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.There’s no correct number of consultations needed to find the right provider.The more consultations you schedule the more likely are to find the better provider for your needs. Considering how much variation there is Liposuction skills among plastic surgeons and how many plastic surgeons really don’t know how to do this procedure well as well as the consequences of choosing the wrong provider I think having five or six consultations seems reasonable for a procedure that is going to deliver, permanent irreversible body contouring results . Patients should take an active role during the consultation process.It is your responsibility to fit the provider.You’re hiring someone to do service for you.Most patients do not have a lot of experience consulting with plastic surgeons.Plastic surgeons on the other hand have years of experience having done thousands of consultations so they’re usually pretty good at conveying their side of the story.In the hands of the right provider, you could definitely have some improvements.The amount of change is going to be modest because you don’t have thick layers of fat to work with, but it should look nice.The same procedure can also lead down a road of disappointment, and Regret The biggest mistakes I see patients make is having only one consultation and then scheduling surgery.The second biggest mistake is assuming that a board certified plastic surgeon with years of experience in an overall good reputation should be able to do Liposuction well.Do not ever assume anything about plastic surgeons.Confirm and insist on seeing verification that the provider can deliver consistent quality outcomes again, and again on patients who have similar body characteristics to your own.When, in doubt, slow down and schedule more consultations.Never rush into the decision of permanent irreversible outcomesGood luck,Matt Hagstrom, MD