What treatment will solve my chicken butt crease? (Photos)

Question

I’ve had no procedures or surgeries done to my body. I’m sedentary and non active most of the time but having gluteal fat in this region is genetic for me. I thought about coolsculpting, bbl, filler, small fat grafting, ligament release, thong lift... well I’m out of ideas but I still haven’t got any solutions to my specific gluteal issue. I do plan on getting lipo+bbl later this year but if I don’t fix this issue, it can get worse after a fat transfer unless it’s resolved.

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, gravity, or genetic variation. So, I personally first treat patients like you by adding volume to the buttock with a buttock implant. This will create a more desirable smooth and rounded perky buttock profile. On the other hand, BBL fat transfer rarely fixes your area of concern.

If necessary,  a modified lower buttock tuck may be performed at six months following implants. This will remove and remaining loose skin from this. 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, “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.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. The droop of the bottom of the buttock is a very common and vexing problem that I have been addressing for many years. In fact, I just Published a white paper on this topic. You are an excellent candidate for a thong lift. Please visit my website to see the results. You have very similar anatomy and should be able to have an excellent result. Best wishes to you

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and giving such a clear description of your concerns. Based on what you’ve shared, here’s a detailed perspective:

Understanding the Issue

The crease you’re describing is in the gluteal fold region and is influenced by a combination of:

Genetic fat distribution in the lower buttocks/upper thigh junction

Skin laxity and connective tissue attachments

Sedentary lifestyle contributing to less muscular support in the gluteal area

This is a very common concern and is sometimes called a “chicken butt” crease or horizontal gluteal fold prominence.

Treatment Considerations

CoolSculpting / Non-invasive Fat Reduction

Can reduce localized fat, but does not improve skin tightness or connective tissue creases.

May even make the fold more apparent if there’s laxity.

BBL / Fat Transfer

Adding volume to the upper or central buttocks can improve overall contour, but without addressing the crease itself, fat can settle and the fold may appear more pronounced.

Strategic fat placement is key, but it won’t fully correct the ligament or fold issue.

Filler / Small Fat Grafting

Can slightly improve the appearance in very localized depressions, but results are subtle and temporary for mild creases.

Ligament Release / Surgical Options

The gluteal crease is partially caused by tethering ligaments (like the gluteal fascia attachments).

Releasing these ligaments surgically can smooth the fold, but it’s an advanced procedure and carries risks such as scarring, contour irregularity, and longer recovery.

Skin-tightening / Thong Lift / Energy-based Devices

Non-invasive skin tightening (radiofrequency, ultrasound, laser) can improve mild sagging but won’t fully erase a deep crease.

A thong lift (minimal incision to lift tissue) may help slightly in selected patients.

Exercise and Muscle Development

Targeted gluteal strengthening (glute bridges, hip thrusts, squats) can improve upper glute projection and support, but won’t completely flatten a deep horizontal fold.

Practical Approach for Your Case

Since you plan a lipo + BBL later this year, the main concern is avoiding worsening the crease post-fat transfer.

Options to discuss with your surgeon before BBL:

Strategic fat placement: Avoid overfilling directly above or in the fold.

Ligament/fascia release: Only if crease is pronounced and you want a smooth contour.

Combination approach: Minimal fat transfer + skin tightening + targeted exercise for best contour.

Non-invasive treatments alone are unlikely to completely resolve a structural crease like yours, but they may improve surrounding skin texture.

Bottom line:
Your crease is primarily structural due to ligament attachments and fat distribution, so a surgical or combined approach will likely give the most noticeable improvement. Fat transfer alone can help overall buttock shape but won’t fully erase the crease unless specifically addressed. A consultation with a surgeon familiar with gluteal fold corrections is the safest way to plan a tailored solution before your BBL.

What treatment will solve my chicken butt crease? (Photos)

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