How can I fix gluteal sulcus? (Photos)

Question

I had a bbl done more than 10 years ago and i haven’t been happy with the procedure at all. My gluteal sulcus doesn’t match. One side is lower than the other and it looks uneven. I’ve been super insecure about this and have been hiding under baggy pants for the past few years. I’ve done cool sculpting to try and fix the problem but it didn’t help much. I really don’t want to go under the anesthesia again and am scared of the mortality rate in doing another bbl. What should I do?

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.

Unfortunately, anything minimally invasive, or in the form of revision BBL, will not be effective. The only thing that can raise up the lower side infragluteal fold is a lower butt tuck.

A lower buttock tuck is kind of like a tummy tuck for the buttock in that it removes the banana rolls and/or loose sagging skin from not only the lower buttock but also the back of the thigh to tighten both areas and create a more defined buttock crease.  In doing so it also aesthetically shortens and/or rounds out the buttock cheek. It is ideal for those patients that have had significant weight loss or fluctuations, changes from fillers injected, banana rolls, banana roll liposuction complications, multiple pregnancies, or who’s derrieres have succumb to the dreaded effects of gravity and aging. It is also effective for those whom feel their buttock cheek is naturally too long or square and just want it proportionately shortened and rounded, respectively.

Like a well done tummy tuck, the 3-dimensional planning and surgical technique is key. It is best done under general anesthesia while the patient is in the prone (i.e. face down) position. The loose and/or elongated lower buttock and upper thigh skin, subcutaneous fat, and connective tissue are all excised. The fascial edges are brought together with deep  stitches secured to the gluteus muscles effectively lifting the back of the thighs at the same time. Nonresorbable/permanent stitches are used here to best define the new lower buttock crease position and help defy the effects of gravity over time. The more superficial layers and skin stitches are absorbable to avoid palpability and the nuisance of removal later on. The resultant scar is strategically placed within the junction of where the buttock cheek meets the thighs.  In many patients this scar is well worth the improved buttock/thigh contour.

Please note, because an extremely few number of board certified plastic surgeons specialize in lower buttock tucks, you may have to travel away from your local area to seek consultation with this particular type of surgeon.  Glad to help.

Daniel Barrett, MD · Answer

Dear Cleopatra627,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
 Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

In order to give you equality assessment regarding the outcome of your procedure, we need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures, then contact the provider who did your procedure and ask them to forward the pictures they took.
your pictures are part of your medical record which you were entitled to get copies of upon request.
All people have significant a symmetry and all parts of the body.
My best guess is you had some of this asymmetry before your procedure as well. I’m not sure there is a surgical or non-surgical approach to change your asymmetry.
Consider reposting with before and after pictures.
Best,
Mats Hagstrom MD

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