Brazilian Butt Lift Revision. Droopy butt. (Photo)

Question

Ihad a BBL in 2016 then went back in 2018 to reduce the size & try to correct the bottom portion of my but that cuffs in. hangs over my thigh & big indentions. didn't correct anything just made it worse went back to the same surgeon) What can possibly be done to get a plump natural bum. I hate my side profile & overall shape. I want to have a natural blend from my but to my thigh. I don't feel comfortable wearing tight clothes or jeans. I have lost 45 pounds & ready to feel good in my own body.

Ryan A. Stanton, MD · Answer

Buttock “sagging” is usually a combination of loss of volume or deflation (after weight loss, liposuction, or post-BBL) and/or the effect of aging and gravity. In cases of post-BBL dropping, adding more BBL fat rarely resolves this problem. So, I personally first treat many of these patients 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.

In your case, we may just go straight to the lower buttock tuck. Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants or 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.

In your case, we may just go straight to the lower buttock tuck. Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants or 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 Vee353,
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

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. Over the years, I have really focused on the lower buttock droop. I have developed certain techniques to improve this. You are an excellent candidate for a Thong lift which is a lower buttock lift. Specifically, it really helps with boxy shaped lower buttocks and rounds out the lower buttock. Best wishes to you.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment of a plastic surgery procedure we always need to have a proper before and after pictures. If you had more than one hour operation, then we need before and after pictures of each of the procedures. If you don’t have before and after pictures, then ask your surgeon or surgeons to forward the Pictures they took. If the procedure is not done correctly, the first time, and the chance of having a high quality outcome goes down. Revision surgery and primary procedures, and patients should take this into consideration when considering having a revision surgery. It’s to me like you had fat removed from the upper part of your thigh, which, in my opinion, is a very incorrect approach to doing this procedure. My approach is always to create a smooth, harmonious S-curve that goes from the armpit to the knee. Some providers remove fat from the upper thigh in an attempt to make the buttocks larger. In my opinion, that this creates what I sometimes called the “lollipop look” and it ruins the natural S-curve that should be the goal of the procedure.
Individuals who had significant weight loss typically develops, film, laxity, and his lowers your candidacy in regards to the chance of having quality outcomes. Generally the best candidate for Liposuction and a fat, transfer a young individuals with tight skin and slight excess fat in undesirable areas. In the end, there are generally only two variables that determine quality cosmetic surgical outcomes. The first is the patient candidacy for the procedure in the first place and the second is the skill and experience of the provider. We can’t determine your candidacy for the procedure in the first place without seeing before and after pictures. Well surgeons are responsible for the outcome patients need to take responsibility for provider selection.
Delivering consistent quality, Liposuction and fat transfer result is more difficult than most people realize. The number of plastic surgeons who truly mastered this procedure are in a small minority. Because there’s so much variation in skill, experience and approach to the BBL procedure patient should have multiple in person consultations before scheduling surgery. During each consultation, ask each provider to open up their portfolio and show you their entire collection before and after pictures of previous patients who had similar body characteristics to your own. an experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful, pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. Take careful notes during each consultation, especially regarding the quality and quantity of before and after pictures. Continue having consultations until you feel very confident. You have the best provider for your needs. There’s no correct number of consultations needed but considering how much variation there is with this procedure difficult it is truly Master Liposuction and birthd transfer. I suggest patients, considerate at least five consultations before scheduling surgery. The time to be critical plastic surgeons is during the vetting process before you schedule your procedure. 
I recognize that telling you how to choose a provider for the first operation may not be useful but other people read this response, and they want all people to understand the importance of provider selection.
With each procedure the chance of having a quality upcoming goes down. This is especially true. If you’re working with providers, don’t know how to do the procedure well in the first place.
I think the biggest detriment in your case was the inappropriate removal of that from your thigh. This is going to be very difficult to fix, and it would most likely require multiple operations.
Your situation is complex and far more difficult to assess than what can be done with a post on this website. Do you need assessments that include an examination and access to all pertinent information. To do that I suggest you gather all before and after pictures and get copies of all operative, reports, consultations and follow up note from your current provider or providers. Schedule second opinion, in person consultations with other board-certified plastic surgeons, who seem to be good at this procedure bringing with you complete sets before and after pictures and operative reports.
Revision surgery can make things worse, especially in the hands of providers, so don’t know how to do the procedure. Well in the first place. Plastic surgeons often think they’re far better at a Liposuction and fat transfer than they actually are. Patients should recognize that getting consistent quality outcomes, including the ability to make accurate assessment and deliver predictable outcomes is difficult. simply being board-certified and plastic surgery with years of experience is often not sufficient.
As a patients who have already had several procedures. You also have to accept that there is a time to “cut bait” and recognize that the cost of improving the outcome may be high with increased uncertainty and incremental improvements, eventually become diminishing with each attempt.
The removal of fat from your thigh is very unfortunate and I think this is going to be difficult to restore.
Others seeking this procedure should take note and recognize the importance of provider selection, and taking an active role in vetting providers.
Best,
Mats Hagstrom, MD

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