Loose skin after BBL. What can be done to improve this? (Photo)

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.

You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, post-deflation sagging, fatty necrotic cyst or scar tissue, etc.) as most of the fat melts away. It is not quite as much the quality of the doctor nor liposuction technique but rather the quality of the procedure that is a large part of the problem. Thus, going back for additional rounds of BBL most often produces the same disappointing results but at another financial loss.

Fillers, such as Sculptra and hyaluronic acids, for augmentation of the buttock/hips are a rip-off, period!

Buttock implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the buttock and often smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging. When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants.
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

Hello,
Thank you for your question and for providing images for context. At seven months post-BBL, concerns like back rolls and lower buttock flatness may be addressed through a BBL revision alone in some cases, often using strategic liposuction and fat redistribution to smooth contour irregularities and enhance projection. A tummy tuck is generally recommended when there is significant abdominal skin laxity or diastasis, which is not always the case in patients without prior pregnancies. If your skin quality is good and there's enough donor fat, revision without a tummy tuck may be possible. I recommend seeking a second opinion from a board-certified plastic surgeon with extensive experience in BBL revisions to evaluate whether a less invasive approach can meet your goals.

Based off your photos (and no before pictures to compare it to) - your abdominal skin and back skin will have a period of looseness post liposuction from the fat being removed and the skin needing time to retract or contract. The problem is, this doesn't always happen, which results in loose appearing skin. If you continue to decrease your weight and tone (esp the back and the core areas) that can help with the skin tightening some.
There are a few skin tightening modalities that can help potentially get some more skin tightening before you just give into a abdominoplasty -
1. Internal energy - something like, J Plasma (needs to be done with liposuction) helps contract skin and procedure more collagen while you heal post procedure over the following 8-12 months (problem here is that you've had lipo once already, it works less each time). 2. External energy - Morpheus is an example - applied to the external skin everywhere you want to be tighter - uses radiofrequency, heat, and pins to help tighten skin and also stimulates the skin to produce more collagen. 3. Decreasing your body fat with weight loss and muscle building - also helps with tightening the skin more.4. You can use a combination of these. 5. Cutting the skin - aka abdominoplasty.
The flat parts of your butt (hard to see on the photos and no before photos to compare) - are likely some spots that the fat didn't survive or areas where you put pressure (to sit, to sleep). So can try to put fat there again and see if it improves - which would require fat grafting again.

Dear kbee,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hello @kbee, thank you for your question. Ideally, a patient should undergo a personalized consultation with a surgeon, during which a surgical plan tailored to the patient's expectations will be presented. That said, from your pictures an option can be a BBL revision and JPlasma for achieving more retraction in the skin. For more information and recommendations, it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

The flattening in the lower part of the buttocks, especially near the vertical gluteal line, is caused by a very dense and short septal network in the superficial fat layer of that area. Due to this septal network, it is very difficult to add fat to that region, and flattening is inevitable afterward. The way to overcome this issue is to release the septal network using subcision or a V dissector. This will correct the flattening caused by the tight connective tissue bands.

I would suggest having a second BBL. It will improve your shape and even out the areas of liposuction and fill in the divet in your buttock. I don't see how it would be possible to perform a tummy tuck on you, to me you don't have excess skin to allow for the performance of a tummy tuck.

Usually you have to have had a significant weight loss or children in order to be a candidate for a tummy tuck.

Depending on which technologies were used for your most recent surgery will determine what the next step is. That being said, in a patient like you… a second treatment of liposuction plus or minus the use of vaser and skin tightening device like a Renuvion will give you the ability to improve the tone, texture and quality of the skin in all treated areas and thus no tummy tuck. Many times the slight flattening at the infra-gluteal region is due to a retaining ligament that can be gently treated with a second session of Fat Grafting to improve the overall Contour.

Great series of posted photos. You are classified as a "SKINNY BBL". The issue is your initial chosen surgeon should have informed you that results are limited if limited donor fat. But I still see fat available in 360, upper back, etc areas but needs expert lipo techniques. Plus I would recommend my "SKINNY COMPOSITE BBL" option of using both fat transfer (ONLY UNDER ULTRASOUND!) with injection BBL (Sculptra/Radeisse injections to add enough volume to your buttock) in combination. Fee for that combination $10,000. Best to virtual consult with....

Skin laxity is typically related to having head, weight, fluctuations, previous pregnancies and age.
Your pictures show on the mild to moderate skin laxity, fairly typical for someone your age.
The shoulder joint has more range of motion than any other joint in the body. To allow this range of motion there needs to be some skin access which presents when you have your arm in a down position. If you take pictures or look in the mirror with your arms over your head you’ll see that the skin on your back creates an improved contour.
I don’t see the indication for doing a tummy tuck because your skin laxity isn’t that bad.
Best,
Mats Hagstrom, MD