What can I have done to keep my pants from falling down? Any suggestions for my flat butt? (photos)

Question

My problem is that I have a very flat butt. I have very strong waist muscles, and not much waist line. My "boney butt" would most likely make implants very uncomfortable. I also have been told that I do not have enough fat to use lipo and fat injections. I feel really stuck. I hate my butt! I am already scheduled to have a breast lift and augmentation on January 16th, along with some minor revisions to my abdominoplasty. Are there any minimally invasive options that could be done at the same time?

Ryan A. Stanton, MD · Answer

In short, you have a physique which typically benefits from sculpting of the waistline with liposuction and augmentation of the buttock with implants.Allow me to share
with you some information that you may not hear elsewhere. There are only two
proven safe and relatively effective methods for Buttock Augmentation and Hip
Augmentation: 1) Autologous Fat Transfer (using your own fat, transferring from
one area of the body to the other) and 2) Buttock/Hip Implants (semi-solid
silicone rubber implants that cannot rupture &/or leak). Both are very good
options so what it comes down to, like any surgery, is proper patient
selection.  Depending upon the
amount of your current fat reserves and their distribution, you may or may not
be a reasonable candidate for fat transfer.  Indeed because at least 50+ %
of the fat transferred will melt away within a year, most patients are not good
candidates because they lack an adequate amount of fat to harvest. Another tip
is that if you purposely gain weight (i.e. fat) for the procedure, the fat you
lose first as you get back to your baseline weight is that very same fat that
was transferred into your buttock...so don't fall victim to this
recommendation.  Although using your own fat is relatively safe, the one
serious complication that can rarely (< 1%) happen is "fat
embolism" in which some of the fat gets into the blood stream and travels
up into the lungs, heart, and/or brain causing serious problems. This
complication is more likely to happen with the larger amount of fat being
transferred. This is even more likely to happen when using fillers like PMMA
and hyaluronic acids. Also fillers, when injected in large quantities, have a
relatively high tendency to migrate away from the original area they were
placed and tend to stimulate a lot of inflammation and a subsequent disastrous
amount of scar tissue/hardening.Thus buttock/hip
implants become a very good, safe, and long term reliable option for most
patients seeking buttock augmentation (at least in my practice). I prefer to
insert the buttock implants through a 2 inch long incision over the tailbone
(concealed within the crevice between the buttock cheeks) and the hip implants
through a ~ 1 inch incision just below the beltline above the hip region. The
buttock implant should always be placed under or within the gluteus maximus
muscle. In this position, the implant is less palpable, less visible, and does
not sag or shift/migrate over time unlike implants placed on top of the muscle.
Therefore it is extremely important to seek consultation with a board certified
plastic surgeon who specializes in this procedure (in fact both implants and
fat transfer so that s/he is not bias). And in this case too, at least in my
surgical practice, the infection rate is minimized to ~5% and the infection rate is minimized
to ~2%.
I generally do not recommend fat
grafting at the same time as placing buttock implant because of a
significantly increased risk of infection.  For fat to survive it
must be grafted into muscle, however that is also where the implant sits. 
Thus, if fat is injected into the implant or implant pocket then it will
die and almost assuredly get infected - necessitating removal of the implant as
well. Because
of this risk, I frequently avoid fat grafting into a buttock that has an
implantBecause of all this, I strongly recommend consulting
with a board certified plastic surgeon that performs both procedures and not just the
Brazilian buttock lift so that s/he can provide you with an unbiased
recommendation for surgery with realistic long term results.Again, like any surgery, the key to a
satisfactory outcome is both patient education and a skilled board certified
surgeon specialist.

Kenneth Hughes, MD · Answer

There is no question in my mind that liposuction and fat transfer would produce a dramatic change in your appearance.   You have enough fat for this.  I would search for the surgeon who you feel is most likely to give you
the best results. Look at reviews and before and after pictures on that
surgeon's website. Kenneth Hughes, MDLos Angeles, CA

Tania Medina de Garcia, MD · Answer

Hello dear!
Thanks for the question and provided information as well.
Based on your pictures, you are a great candidate for liposuction with BBL, and I think you'll get very good results. 
Liposuction allows your plastic surgeon to transform your entire shape. You can improve your abdomen, back and flanks, and of course your buttock, to give you a nice heart shape.
In general, you need to be physically healthy and at a stable weight, have realistic expectations, be a non-smoker and your BMI needs to be 30 or less.
l recommend you to make an appointment with a board certified plastic surgeon to talk about your goals and anything you need to know.
Good luck :)

Tracy Kayan, MD · Answer

Thanks for the photos - they are very helpful. It does appear that you could have enough fat to transfer to your buttocks to make a modest difference. At the same time your buttocks would be enhanced, your waistline could also be better defined with liposuction in this area. If there is not enough fat in your love handle area to enhance your buttocks to a satisfactory degree you could also discuss liposuction of other areas such as arms, thighs, etc to increase the amount of fat available to transfer to your buttocks.

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