Butt implants - what size and shape would you advise? (Photo)

Question

Hi, I am 40 years old, 168 cm and 56 kg. I had a tummy tuck last year and now i want to do my back area and my butt area which are sagging. What procedures will recommend for me, pls? 1. Back lift plus liposuction, butt implants and BBL 2. Lower back lift with silicone implant 3. Butt implants plus 360 lipo and j plasma What size and shape you advice? I have autoimmune disease( Hashimoto) and i want to take the best decision. Thank you

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.

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, a Stanton Anatomic®️ shape buttock implant may serve you best. You may also benefit from some form of a skin tightening procedure, such as a bra-straplasty and/or upper buttock lift and eventually a lower buttock tuck. However, please keep in mind that a physical exam is always first necessary before providing any final surgical recommendations.

Please read on:

Make no mistake, it is indisputable that the best position (aka “placement”) for buttock implants  is in the total intramuscular tissue plane, not half and half within and on top of the muscle (aka “biplanar” or “dual plane”), not completely on top of the muscle and not “sub-fascial" which is exactly the same as on top of the muscle - so please do not be fooled by this terminology. Also, supercharging with adding fat over the implant is also likely to not make any difference other that costing you more and setting you up for more potential complications. The implant life and longevity of aesthetic, tasteful, and realistic results are all best with the “intramuscular” technique, period.

Other than placing buttock implants within the gluteus maximus and medius muscles (aka “intramuscular”) NOT on top of the muscle, “subfascial” or “dual plane”, the most important factors in creating the perfect derriere and/or hourglass figure with implants is indeed selecting the right size AND shape. I have found the best way to assure this is to simply measure the actual dimensions of the patient’s gluteus muscles (not butt cheek fat pad, which may appear “round”) and quantity and quality/density of these muscles. With these anatomical measurements, I can select an implant that not only significantly augments the buttock but also supplies the correct 3-dimensional enhancement to look as real as possible...with positional changes (eg. bending over and squatting down) and even in the most petite patients that have small/lean muscles and minimal overlying fat. The fact is, nearly 100% of the human population has a more oval shaped gluteus muscles not round.  Therefore an oval shaped implant such as the Stanton Anatomic®️ buttock implant conforms best and produces a more realistic contoured outcome better than round implants.  Contrary to what many think, a round implant placed correctly within the muscle actually sits up at the top of the butt cheek, creating an unnatural pointy or “gum-drop effect”, not at the lower part of the butt cheek and thus does not contribute to filling or rounding out of any of the lower buttock pole. Height and weight are considered but not nearly as relevant as the above measurements. Final 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.  Glad to help.

Mats Hagstrom, MD (license on probation) · Answer

It looks like you’ll have a substantial amount of skin laxity.
In order to make a quality assessment, it would be very important to know your history especially any history of significant weight loss.
Most plastic surgeons in the United States do not offer gluteal implants for good reason.
The procedure has a very high complication rate, high Failure rate, high rate of undesirable outcomes, etc. etc. 
Fat transfer may be an option but it’s difficult to contour the body using grafted fat in individuals who have skin laxity.
Think of fat grafting as adding volume to what you already have.
It will create a larger version of what you have.
Of course, there is some contouring possible but the best candidates for contouring with Liposuction and fat transfer is always going to be young individuals who have tight skin.
For that reason individuals who have a history of significant weight loss or skin laxity due to other issues are probably best of addressing laxity issues first and foremost.I suggest having multiple in person, consultations with plastic surgeons in your community who seem to have a lot of experience with both Liposuction and fat transfer.
During each consultation, ask each provider to give you an assessment, the differentiates between various tissue variables.
Before contemplating having any surgical procedure, ask providers 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.
Bring pictures of your body to use as reference during consultations
You’ve included some pictures of bodies that look quite different.
I’m not quite sure which one is you or what you’re trying to achieve with these. I generally recommend people avoid virtual consultations whenever possible, and instead schedule multiple in person, consultations with providers in your community to first and foremost to get a quality assessment, and then a better understanding of treatment options.
This can also help you in starting the vetting process of finding the right plastic surgeon to be working with.
Delivering consistent quality, liposuction and fat. Transfers results is more difficult than most people realize.
The number of plastic surgeons who did this procedure is pretty small.
Generally, cosmetic surgery outcomes are primarily based onto variables.
The first is the patients candidacy for the procedure and the second is the skill of the provider.
Understanding your own candidacy is very important in maintaining high patients satisfaction.
A patient who is an excellent candidate for a surgical procedure has potential of having excellent outcomes in the hands of an excellent surgeon.
They can also have pour outcomes if provider selection is not done well.
 a patient who is not a good candidate for a surgical procedure does not have the potential of having quality outcomes regardless of who does the procedure.
Begin the process by understanding your candidacy for various procedures.
Next try to get a good comprehension of what these procedures can, and cannot accomplish.
The third step is to find the right provider.
Provider selection is in the end, the most important variable, since there isn’t too much of patience can do regarding their own candidacy.
To me, it seems like, addressing any remaining skin, laxity would be the next step.
Best,
Mats Hagstrom, MD

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