Butt/upper thigh saggy skin post weight loss - how can I fix this while mitigating scars as much as possible? (Photos)

Question

Hello! I had gastric bypass a few years ago and lost nearly 100 lbs. I’m now very thin. Around 105 lbs at 5’7 1/2”. However, I now have severe ptosis of the buttocks and posterior, medial, and lateral thigh region that I find very embarrassing. I want to mitigate scars as much as possible. What type of butt or thigh lift would best fix this problem? Could I do a Miami thong lift combined with inferior buttocks tuck or would a full superior butt lift be required? I also want to add projection to my butt as it is completely vertical now. I didn’t have much projection before the weight loss either so gaining weight will not help. I have nearly zero loose skin on my abdomen as you can see from the photos. I’m unsure if any plastic surgeon would attempt a bbl on someone’s size or if butt implants or auto augmentation are my only options. Also, can they be performed at the same time as the lift? 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.

Buttock “sagging” and/or loose skin is usually a combination of loss of volume or deflation (after weight loss, liposuction, or post-BBL) and/or the effect of aging and gravity. So,  I personally first treat patients like you by restoring volume to the buttock with a buttock implant. This will create a more desirable smooth and rounded perky buttock profile. If not adding volume with an implant, the buttock will most certainly always appear more flat if just a buttock lift from above is performed. On the other hand, an “autologous buttock lift” usually provides very little volume and projection, and almost nothing to the lower 2/3rds of the buttock.

A lower buttock tuck is usually then performed at six months following implants. Coincidentally, a lower buttock tuck also doubles as a thigh lift, removing loose wrinkled skin from this area as well. In this sequence, the implants have fully settled into final position so that any remaining loose skin can be most accurately identified and removed with the lower buttock tuck. Any “non-surgical” treatment or device as well as exercise, unfortunately, will have little to no effect on this problem area. Furthermore, fat transfer and “fillers” perform very poorly in this area and usually result in just a waste of hard earned money.

Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants or buttock tucks you may have to travel away from your local area to seek consultation with this particular type of surgeon.  Getting it done right the first time around is not only the best chance for success, but also will save you from a lot of headaches and money in the future. Glad to help.

Zoran Potparic, MD · Answer

There is a procedure, that I considered myself as one of the pioneer,  which is a combination of buttock lift and augmentation of the upper and central buttock with tissue above the buttock (skin and fat flap). This will tighten the skin of buttock and, to a certain degree, upper thighs, and provide substantial volume of live tissue for buttock augmentation. Any fat grafts that can be additionally harvested from your inner thighs and lower abdomen should be used for additional buttock augmentation. In person or teleconference consultation with a board certified plastic surgeon with experience with this procedure is recommended. Good luck.

Mathew A. Plant, MD, FRCSC · Answer

Excellent question. As people are looking for solutions for this specific problem that do not involve the massive scars associated with body contouring surgery I am personally turning towards offering non-surgical solutions to address the two problems that are contributing to your current appearance.

The excess skin is too significant for tightening, so nothing like Renuvion or Morpheus is going to work, you need excision of the excess. Traditionally this involved a full lower body lift procedure, however with the availability of Ellacor and Microcoring now you can remove this skin without scars. The second issue is the loss of volume, which creates some of the excess skin and also affects the overall appearance of the butt and thighs. I would suggest looking into a liquid butt lift procedure (since you don't have enough fat for even a skinny BBL) to add volume back to the butt and fill some of the skin excess to decrease the amount of microcoding required to remove the excess.

Its a novel solution, so don't expect that your typical small town plastic surgeon will know how to handle this, but if you find someone near you with significant experience in managing excess skin in post weight loss patients who don't want to accept the traditionally significant scar patterns you should be able to achieve your goals within the parameters you've set. Hope that helps!!

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question and pictures here !First of all Congratulations on your weight loss !, 100lbs is impressive . Unfortunately skin redundancy is very common in this situation but once addressed it will make you feel a lot better. That being said the issue you are presenting is very complex and multifaceted . 
for optimal results you will need to address both the skin redundancy and the volume loss. restoring volume is a complex issue in your situation since you don't have much fat and thus a BBL is a little tricky , you can always opt for cadaveric fat like alloclae but you might need multiple sessions and it might turn out to be expensive . Auto-augmentation can be an option that is done in conjunction with a lift but might not give you enough volume you might need to couple that with alloclae BBL etc . a buttock implant could be a shortcut and might give you the most dramatic outcome but it does have a high complication rate so you have to do your research before venturing into it since implants in general are not life long devices.
As for the skin redundancy , if it was mild to moderate then I would have suggested tring an energy device if you want to avoid scars but in your case you have a lot of redundancy that this will almost definitely not be sufficient . you also seem to have a lot of laxity at the superior aspect of your buttock that a thong lift might not be able to address , though you might have to couple the superior buttock lift with an inferior buttock tuck to also address the laxity in the posterior thigh and inferior buttock.
Those are only observations though based purely on the pictures provided , for an in depth medical advice I would recommend consulting with a plastic surgeon in person so that they can come up with a plan that works for you .
I hope this helps, best of luck !

Butt/upper thigh saggy skin post weight loss - how can I fix this while mitigating scars as much as possible? (Photos)

Answers (4)

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