28, 5'9, BBL 5 years ago, how to resolve sagging buttocks? (Photo)

Allow me to answer your question as best i can based upon your single 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.

You are in good company with many others who have experienced post-deflation sagging and asymmetry after losing BBL fat. You appear quite lean so going back for additional rounds of BBL will likely fail to fix the problem. 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.

Fillers, such as Sculptra and hyaluronic acids, for augmentation of the buttock/hips are a rip-off, period!

Buttock/hip implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the hips and central buttock, and often help smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging. When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants.

Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these 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 MrsMakeMe,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You have a few options here. You could do a buttock lift, with incision under the cheek area, but based on your love of the fuller booty, you would prob be a better candidate for bbl or butt implants. You could do a repeat Brazilian butt lift with or buttock implants for permanent fullness. To go over your options further, feel free to come in for an in person consultation here at Smith Plastic Surgery.

Thank you for your picture and your question.

Toning your muscles and achieving symmetry can be achieved with surgery and exercise. You will benefit from another BBL to make your buttocks more symmetrical, or liposuction of the bigger buttock depending on what's your goal. But after surgery, when you're fully recovered, you should exercise as much as you can. Exercise is what will help you strengthen your muscles.

To make an assessment regarding the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures. If you don’t have your before and after pictures, then contact your surgeon and ask them to forward the pictures they took.
Most people have some asymmetry of their body as baseline. We need to know how much of this asymmetry was present before surgery and see what you look like before to have an idea of what was done during the procedure.Some plastic surgeons are in the habit of removing fat from the upper thigh, in order to make the buttocks look bigger. This creates an unnatural transition from the buttocks and hips to the thigh, creating a saggy bottom, or a bottom. That sometimes looks like a popsicle.
Delivering consistent quality, liposuction and fat transfer results is more difficult than most people realize. The number of plastic surgeons who truly mastered these procedures are the small minority. They are a significant number of plastic surgeons who are not particularly good at either Liposuction or fat transfer.
Revision work, or secondary body, contouring procedures are generally more difficult, and more complex with greater uncertainty than primary procedures.
Anytime somebody wants to have a revision work they should be extremely selective in their choice of providers. I suggest doing that I having multiple in person consultations. Best,
Mats Hagstrom, MD