What is the right procedure to help lift butt off the back of my thighs? (photos)

Question

White female 5’4, 130lbs. I am an active person but no matter what I can’t get rid of the fat under my butt that basically makes it look flat from the side. I’ve been told that lipo would basically remove that “shelf” my butt sits on and it will sag even more. So I am wondering if it can be lifted? I’ve seen things such as infragluteal thigh lift/ thong lift possibly working for this type of issue but mine seems severe. If it helps it’s also genetic, my mom has the same issue

Ryan A. Stanton, MD · Answer

Buttock “sagging” is usually a combination of loss of volume or deflation (after weight loss or post-BBL) and/or the effect of aging and gravity, or familial genetics. So,  I personally first treat patients like you by restoring volume to the buttock with a buttock implant. This will create a more desirable smooth and rounded perky buttock profile. If not adding volume with an implant, the buttock will be shortened but may appear more flat with just a buttock lift. A lower buttock tuck is usually then performed at six months following implants. 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. Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel away from your local area to seek consultation with this particular type of surgeon.  Glad to help.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding what to do to lift the buttock off the back of your thighs. Several things could be done. First, the buttock could be lifted. This can either be done by fat transfer like a BBL. Another way to lift the buttock would be to make an incision over the upper portion and lift the buttock upward. This will lift the buttock off the back of the thigh. Another approach would be to reduce the size of the posterior thigh. This could be achieved with posterior upper thigh liposuction or an inferior gluteal incision. The banana roll liposuction would not flatten this area so much that the buttock would sag. In my opinion, that does not happen. Another approach would be to make an incision underneath the buttock, excise a crescent-shaped area of the upper posterior thigh skin, and lift the back of the thigh upward. This will remove excess skin in this region. In my opinion, I would proceed with liposuction, which is the easiest of these procedures. The others require incisions with an extended recovery. Thank you for your question regarding what to do to lift the buttock off the back of your thighs. 
Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric  Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery,  and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

George Bitar, MD · Answer

You have done your research, and I agree.  Generally, I do not recommend liposuction underneath the buttocks, in which case they will sag further.  Based on your photos, I think a conservative Brazilian butt lift would be the best.  We would move fat from somewhere else on your body to your buttocks.  It would create a more rounded buttocks, and the added volume will give them a lift.

Malik Abaci, MD · Answer

Thank you for your question and photos provided. You need gaining weight fisrtly. Then doing lipo and fat injection to enjence your shape and volume. Hope this helps

Darryl J. Blinski, MD · Answer

From the nicely posted photos I see 2 issues. Though your do look very good. So you must consider doing anything surgically there could be a negative outcome. I see banana rolls and slight hanging inferior buttock. I might try just superficial lipo on both areas with specialized taping and severe compression girdle. Or might do lipo on banana rolls/taping/thong incisional lift. Best to virtual consult with....

Mats Hagstrom, MD (license on probation) · Answer

That area is a bit complex and potentially challenging to understand. Everybody understands why they get a bulge on their lower abdomen in the sitting position because the torso is flexed and the skin gets pushed together.
Because the hips flex forward when you’re an on upright standing position the skin on the back of the thigh is being pushed together just like the skin is pushed together of your lower abdomen when you sit.
The skin on the back of the thigh has a lot of connective tissue that decreases the mobility and this forces the skin to be pushed up into the buttocks creating the banana roll fold that you have.
It is a skinfold that primarily forms in an upright standing position and most likely flattens out if you bend forward 45° or more.
Treating it with Liposuction doesn’t work and usually leaves some type of disfigurement.
Cutting out excess skin maywork but probably would just leave a visible undesirable scar.Fat transfer done in a modest and correct way is probably the best option. Well I’ve done 8000 liposuction and fat transfer procedures I have not specifically done fat transfer to treat banana rolls but from all the fat transfer cases I have done that area seems to improve nicely from appropriately added volume.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe and this includes plastic surgeons.
If you opt for having surgical intervention then please make sure you pick the most experienced and talented provider in your community.
To do that have as many in person consultations as it takes. It can be a substantial commitment of time and effort to interview a number of plastic surgeons but properly vetting providers is the key to finding the one who can walk the walk as well as talk the talk.
During consultations ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in. If it’s Liposuction ask exactly what areas were included and what areas were not included and look carefully at the transition zones. Take your time and look carefully at all areas treated does look for any contour irregularities or uneven skin contours. 
Simply being shown a handful of pre-selected pictures which most likely represent the best results of the providers career is insufficient to get a clear understanding of what the average results look like in the hands of each provider.
This is why patients should ask providers to open up their portfolio and show their entire collection. Ask the provider to show as many pictures as possible of patients with similar body characteristics to your own. Likewise ask the provider to show examples of excellent outcomes, average outcomes and outcomes that were less than or patients who needed revisions.
To me these are fair and appropriate questions and all the plastic surgeons have patients who had results that were less than what we had hoped for and all plastic surgeons do revisions from time to time.
And experience provider should have no difficulty showing you at least 50 sets of before and after pictures of The procedure you’re interested in.
Highly experienced surgeons will have hundreds or even thousands of before and after pictures of commonly performed procedures.
I also recommend reading all reviews on various physician review websites avoiding providers for any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling and having an abundance of positive reviews.
There’s nothing wrong with not having surgery and excepting your body the way it is. Having a banana roll is common and millions of others have it as well.
It is not a simple thing to fix. In my opinion your best option as well done augmentation with fat grafting.
Fat grafting of the buttocks should be aimed at creating smooth continuous S curves that go from the armpit to the knees rather than the cartoonish lollipop looking buttocks we often see an associate with this procedure.
Different plastic surgeons have very different views of what looks good and how the procedure should be done.
This is why it is so important to find the right provider when considering any plastic surgery procedure but especially Liposuction and a fat transfer.
Best,
Mats Hagstrom MD

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!From your photos, I note a degree of buttock ptosis, creating a banana roll. There are significant stretch marks about the buttocks. Stretch marks indicate the presence of permanently damaged overstretched skin usually occurring during pregnancy or significant weight fluctuation where when pregnant or overweight, the skin's dermal elastic fibers rupture, resulting in the loss of elasticity and the development of streaks on the skin surface. The skin will stretch over a greater surface area and will predispose to further sagging.
The problem doesn't appear to represent excess fat below the buttock...it is laxity of the buttock skin itself. 
Surgical correction would require a transverse skin excision from hip to hip posteriorly in the crease between lower back and upper buttock (within the area covered by the attire in the photos). It will, however, limit future clothing choices. Only you can decide if it is worthwhile. Best wishes...

What is the right procedure to help lift butt off the back of my thighs? (photos)

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