How do I fix this large dent in my butt and lack of gluteal fold? (photo)

It is too bad that you mention “SN - implants are not option for me” because in my 20 years experience enhancing and reconstructing buttocks, implants have been the only relatively safe, reliable, dependable, predictable and permanent option to help pop out this type of dent in your left buttock so that it matches with some normalcy to your right buttock cheek. Because of the amount of scar tissue in this area, fat transfer is highly unlikely to be successful in matching the right side. So, the question becomes, what are the reasons that buttock implants are not an option for you? Please keep in mind that there is an abundance of misinformation exists out there regarding the risks and benefits buttock implants. Because an extremely few number of board certified plastic surgeons specialize in this procedure, you must only seek consultation with one that is a reputable specialist. And in this case, you may have to travel far and away from home to find this particular surgeon. Glad to be of help.

It is very difficult to reconstruct long lasting deformity like yours. Combination of fat grafting (2-3 stages), possibly open surgery (scars) to correct central scar and created gluteal crease is something that will require time, patience and very good surgeon. In person consultation with board certified plastic surgeon with good reputation in body contouring surgery is recommended. Good luck.

Dear sophiaddd,
it is hard to tell for sure without an examination. Based on your photo, it looks like you would benefit from scar revision and fat transfer. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Dear sophiaddd,
Thank you for your question. The injury you sustained as a child has created a scar or point of tethering. This scar tethering can be released and fat grafted as part of your BBL. Yes, the fat should survive, if the amount of fat grafted doesn't overwhelm the blood supply of the tissues being grafted. Your procedure may require staging to avoid over grafting and the outstripping of the blood supply as well as to allow for the best symmetry. This means, you might benefit from additional surgeries on the left side, to allow the gradual expansion of the left buttock. By adding more volume on the left and matching the right, the fold will appear as a result of this added volume. My recommendation would be getting better contour on the left before addressing the right. Once the shapes are more symmetric, volume enhance can be done on both sides simultaneously.
I hope this helps. Good luck.

Dear Sophia,
Thanks for the questions and photo. You certainly have a post traumatic left buttock deformity. The central medial scar bands can be released during a BBL, and fat placed to better fill out the deficient area. The buttock crease is another animal all together. While you may be able to match most of the fat deficiencies, I do not feel you will be able to replicate the left infragluteal fold (crease).
Dr. T

Most likely the primary cause for your gluteal defect is contractile scar tissue rather than simply a lack of volume.

Restoring that two-way normal Contouring is going to be a challenging procedure that will require more than a simplistic approach like fat transfer.

To really get the contour correct the entire damaged section with scar tissue will need to be removed and replaced with healthy live tissue. Most likely this could only be done with three flap surgery which is possibly more than do you want to undergo.

To really understand what reconstruction of the area would entail he will need in person consultations with plastic surgeons who do complex reconstructive surgery. This is often more commonly done and academic medical centers. Plastic surgeons who do a lot of reconstructive surgery are often involved with breast cancer surgery so you could look for local plastic surgeons who do a lot of complex breast reconstruction as well.

There is no simple procedure that will restore your left side.

The lack of gluteal fold may be related to how the scar tissue in the middle buttocks is forcing tissue down because of scar tissue.

It’s a bit hard to give an accurate assessment and treatment options are for sure going to be complex.

I would not try to do this with a BBL procedure.

Free flap reconstructive surgery yes complex, takes a lot of time and requires patience to be in the hospital for quite some time. The procedure would be very expensive and most likely he would need medical insurance to cover it.

You may very well be able to get medical insurance to authorize reconstruction of the area because of the underlying ideology, primary diagnosis etc.

It’s imperative to find the right team of doctors to do this kind of work and in the end you have to ask yourself if you want to go through that type of surgery. In the end your body well still not be normal but could potentially be improved. Whether that potential improvement justifies the procedure is a fairly lengthy discussion and thought process.

Best,

Mats Hagstrom MD