Help! How do I fix my extended (elongated) butt/back crack? (Photos)

Hello, The condition of skin folds occurring at the waist and hip junction, characterized by excess skin in both vertical and horizontal directions, is caused by the removal of skin only in the horizontal plane in a person with excess skin. Similar skin problems can occur in individuals who have lost significant weight during abdominal tightening procedures, particularly above the navel in the midline. To prevent this, the Fleur de Lis surgery is performed, which involves skin excision in both the horizontal and vertical planes. It is quite difficult to get rid of the folds in the waist area without removing skin from the midline.

Your tattoo serves as an important land mark. In your before picture there is no crease at the same level. This makes me think it may be related to how the procedure was done. Massive weight loss patients develop skin laxity in all directions.
The 360 body lift a.k.a. wraparound tummy tuck only removes skin laxity in a vertical direction leaving patients still having horizontal skin laxity. Some surgeons add a “fleur du lys” patten with an added vertical scar to treat the skin laxity in both directions. When this is not done the surgeon has to decide what to do with the remaining horizontal skin laxity. Usually skin markings are made before surgery to correctly line up the skin edges.
Personally I like to bring some on the horizontal skin laxity a bit towards the back so it does not show as the abdomen hanging forward when patients lean forward. If some horizontal skin laxity was brought together towards the backside midline it could contribute to a fold. I’ve personally not seen this before. You did not have a gluteal crease the high on your before pictures so the outcome is a bit puzzling. To differentiate skin laxity issues try putting tension on the skin. If that fixes the problem then typically the problem is related to skin laxity. If that’s the case then there is really no easy solution other than redoing the procedure or adding a big vertical scar which would probably be worse than the crease.
In the end you may have to accept the outcome recognizing that the procedure will only treat skin redundancy in one direction. After that much weight loss most patients have significant skin laxity. Typically a 360 TT will do the job well enough but there will always be some residual skin laxity in a horizontal direction. You can probably feel it if you move your skin back and forth parallel to your scar.The only other thing that comes to mind is if your surgeon did purposeful liposuction in the area for the sake of contouring. I’m reluctant to say this because it puts the fault directly on the surgeon and based on an overall good outcome it seems unlikely. It’s common for surgeon to do liposuction in the midline on the front of the abdomen to create some abdominal midline definition sometimes called the “linea alba” line.
If you feel the fat layer being abnormally thin in the problem area then that could be an explanation. Again, I’m reluctant to even mention it because I do not want to plant some seed that your provider did something wrong. When I have patients who focus too much on an imperfection I sometimes suggest spending more time looking at the before pictures. Sometimes some people are focusing on a tree missing the entire forest.
To get an accurate assessment you need in person second opinion consultations. For second opinion, consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report, which are all part of your medical records that you can request from your current providers office.
Best,
Mats Hagstrom MD