Is my butt destined to remain flat? (photos)

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, post-deflation sagging, etc.). It is not quite as much the quality of the doctor but rather the quality of the procedure that is a large part of the problem. Thus, going back for round 2 BBL most often produces the same disappointing results but at another financial loss. Buttock implants indeed provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the buttock and often smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging. 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.

Dear Awesome20109,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Some people have a flat spot on the lower inner part of their buttocks.

It’s typically the area that receives a fair amount of pressure when sitting.

Areas in the body they can tolerate great deals of pressure like the soles of the feet, palms and hands, back of the upper thighs and lower inner buttocks have an abundance of connective tissue that serves a structural support to hold the skin in place.

This connective tissue does not have pliability so it doesn’t stretch.

The best analogy to demonstrate this is the pinch and lift the skin on the back of your hand. Now try to do the same in the center of your palm.

The skin in the center of the palm can’t be pinched and lifted because it stuck to the underlying fascia layer with connective tissue. Think of the flat spot of your buttocks as being the palm of your hand. Should someone fat graft the palm of the hand area will develop the appearance of cellulite but won’t project because the connective tissue will not stretch.
On the buttocks the surrounding areas that don’t need to take as much pressure have far less of this connective tissue and project and expand very nicely with fat transfer.

This is the reason the flat spot can become worse from a BBL.

The flat spot doesn’t budge but the areas around it do.

Experienced plastic surgeons will know this and pointed out during the consultation explaining the limitations of the procedure.

It took me a few years of doing this before I recognized it and it isn’t exactly described in the text box so it’s something each plastic surgeon simply has to figure out on their own or hear one of their colleagues discuss it.

The flat spot was probably less prominent when you were younger with a lower BMI and didn’t have the skin laxity. at that point the projection where the flat spot is was efficient to have a curved bottom. With increased weight and skin laxity the flat spot did not increase while the rest of the body did creating it.

It appears from your pictures like you’ve had a tummy tuck. Sometimes collecting the skin laxity over the love handles or liposuctioning the periphery of the buttocks can improve the shape for more than trying to graft fat in the flat spot where it would appear you need the projection the most.

It’s probably possible to improve your shape to some degree but you will need to be working with a plastic surgeon who has and understanding of why the flat spot is there and understand the limitation it causes.

By the way the same connective tissue is what causes cellulite and it’s not unusual for people to get worsened cellulite from fat transfer procedures.

Best,

Mats Hagstrom MD