Hello, and thank you for your question regarding sagging glutes after significant weight loss. Thank you as well for your history and your pictures. From the images provided, it appears that your left infragluteal fold (where the buttock meets the upper thigh) is lower than the right, which creates visible asymmetry. If this asymmetry is confirmed during an in-person physical examination, the most effective solution would likely be a posterior buttock or posterior body lift. During this procedure, an incision is made across the upper portion of the buttocks, and skin and fat are lifted and removed. In your case, more tissue would be removed from the left side to create symmetry and improve the overall shape and contour of your gluteal area. Additionally, your photos show excess skin and tissue in the upper inner thigh, which is a common concern after major weight loss. If this is confirmed during a physical exam, you may benefit from a thigh lift — more specifically, a modified vertical medial thigh lift. This involves an incision starting in the groin and extending partially down the inner thigh. A wedge of skin and fat is removed, and the remaining tissue is tightened to smooth and contour the thigh. Depending on your overall health, lab results, and lifestyle (particularly non-smoking status), these procedures can often be performed together in a single stage. Many patients who have undergone massive weight loss choose to combine a posterior body lift with a thigh lift to address both the sagging buttocks and the loose thigh tissue, achieving a more balanced and youthful lower body contour. Since you're 22, at a stable weight, and appear to be in good health, you may be an excellent candidate for these procedures — but a thorough in-person consultation with a board-certified plastic surgeon experienced in post-weight loss body contouring is essential to confirm your candidacy. Thank you again for your thoughtful question. I hope this gives you helpful insight into how to improve the shape of your glutes and thighs after weight loss. Sincerely, Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS (Certified by the American Board of Plastic Surgery and President of the American Board of Bariatric Plastic Surgeons)