How much and what procedure do I need to fix my extremely uneven butt? (Photo)

Allow me to answer your question as best i can without any photos. However, please keep in mind that, indeed, an in-person consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.
There are currently only two acceptable surgical options for augmenting and enhancing the buttock/hip area: 1) Brazilian Butt Lift (aka BBL) - utilizing the patients own fat from liposuction then transferring it into the buttock and/or hips and 2) Buttock and cosmetic Hip Implants (soft silicone rubber implants that cannot rupture &/or leak). Both are options but what it comes down to, like any surgery, is proper patient selection and long-term results. Implants provide the only guarantee of sustained permanent results and tend to be ideal for plumping/perking up deflated buttocks and providing projection, which every patient yearns for. Fat typically melts away leaving disappointing results after 12 months, often sooner. Fillers such as Sculptra are cost prohibitive, provided enough volume is injected (i.e. at least 400 cc of active ingredient costing over $300,000) and last only 12 months or so.
Unfortunately, because ~70+ % of the fat transferred will melt away within a year, most patients are not good candidates for BBL because they lack an adequate amount of fat to harvest. Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, fast, and the most...so don't fall victim to this recommendation. Even those patients that had adequate amounts of fat pre-operatively, still end up seeking buttock implants after a year or so because most of the fat transferred melted away leaving them with minimal result. If you're looking for a reliable, predictable, long-term permanent option, buttock and hip implants are your only solution. Please note that an extremely few number of board certified plastic surgeons specialize in buttock or hip implants, so you may need to travel far and away from home to find this particular surgeon. Glad to help.

Hello, thank you for your question. It is hard to tell without proper photos and a physical examination, I recommend you to schedule a consultation with a board certified plastic surgeon.

Dear Gentle406623,
it is hard to tell for sure without an examination. 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

Buttock augmentation using fat requires expertise that includes:
1)optimizing results with
a)Closed loop system
b)choosing your ideal buttock size and shape with a Brazilian Buttock Assessment Tool
c)harvesting your fat using HD Lipo 360 Principles
2)Minimizing risk factors with
a)SCUBA- safe California Ultrasound Assisted Liposuction
b)Closed loop system
A consultation with a Buttock specialist would be incredibly helpful to show you what is possible.