I Have a Lot of Excess Skin on my Buttocks (They Sag and Are Heavy). What is the Best Way to Repair Them?

Dear sunnilu,

   The reason for your buttock skin laxity, is that you lost significant amount of volume (fat).  Your skin  could not shrink enough and accomodate your new butt size. Well, the logical solution is to restore the lost volume. The 2 most common techniques are fat injection and silicone implants. Unfortunately, fat injection is unpredictable and most of the time disappears after a year. Buttock implants are soft , feel and look natural and most importantly , do not disappear. Consult with a board certified plastic surgeon who is experienced in buttock implant augmentation.  Check his or hers before and after and make sure that you like the results.

        Best of luck,

                                    Dr Widder

I am concerned when you state you have talked to a "board-certified surgeon" instead of an American Boad of Plastic Surgery-certified plastic surgeon. Too many self-proclaimed "surgeons" are not fully-trained in plastic surgery, and particularly with this amount of massive weight loss (Congratulations! What an achievement!), you almost certainly need a full lower body lift (circumferential belt lift) with autologous buttock dermal-fat augmentation. This is something that only a few fully-trained ABPS-certified plastic surgeons are presently doing, and very few do lots of them.

SO let's assume you have been talking to an appropriately-experienced "real" plastic surgeon who has done a significant amount of body contouring surgery after massive weight loss. A medial thigh lift in continuity with a buttock lift is an operation done where the patient has already undergone an abdominoplasty, so the anterior (belly) loose skin has been removed and the abdomen tightened. Loose medial thigh, hip, lateral thigh, and buttock skin remains, and the long spiral excision is termed a Lockwood type I lower body lift. By contrast, the much more common abdominoplasty that extends all the way around the body (lower body lift or circumferential belt lift) is termed a Lockwood type II lower body lift.

"Putting skin/flesh 'back' onto [your] buttocks" but not by injection sounds like a non-medical description of an autologous pedicled dermal-fat flap buttock augmentation, but you should have a full understanding of what is planned and just how this is to be performed, or you could end up with a hunk of dead tissue that becomes infected, causes significant problems, and could even be deadly!

You don't want to get this wrong! Seek several opinions and verify your surgeon's credentials and experience with the exact operation planned. For examples of my patients undergoing this type of procedure, click on the web reference link below, and read my article (on my About page on this site) titled "Lower Body after Massive Weight Loss--Is Outpatient Beltlift Surgery Safe? Best wishes! Dr. Tholen