Which type of filler would help correct the appearance of flat spots after butt augmentation? (photos)

Question

These flat spots are very disappointing and frustrating after my butt augmentation. Would a filler help to even them out some? If so? What is recommended. I understand, this would be off label

Arif Eroglu, MD · Answer

Hello; There are 2 FDA approved fillers; that can be used on the buttocks. These fillers are not permanent or semi-permanent fillers. One is the Bioscience company's Hyacorp body; the other is Sculptra; which is produced by Sanofi Aventis. First of all, if you desire for volume; I recommend for using the Hyacorp body.

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.

No “filler” can fix the flat spots on your lower buttocks. Based purely upon your photos, the  main problem appears to be that you had round shaped implants placed and questionably 100% within the gluteus muscles.

Other than placing buttock implants within the gluteus maximus and medius muscles (aka 100% “intramuscular”) NOT on top of the muscle, “subfascial” or “dual plane”, the most important factors in creating the perfect derriere and/or hourglass figure with implants is indeed selecting the right size AND shape. I have found the best way to assure this is to simply measure the actual dimensions of the patient’s gluteus muscles (not butt cheek fat pad, which may appear “round”) and quantity and quality/density of these muscles. With these anatomical measurements, I can select an implant that not only significantly augments the buttock but also supplies the correct 3-dimensional enhancement to look as real as possible...with positional changes (eg. bending over and squatting down) and even in the most petite patients that have small/lean muscles and minimal overlying fat. The fact is, nearly 100% of the human population has a more oval shaped gluteus muscles not round.  Therefore an oval shaped implant such as the Stanton Anatomic®️ buttock implant conforms best and produces a more realistic contoured outcome, from top to bottom, much better than round implants.  Contrary to what many think, a round implant placed correctly within the muscle actually sits up at the top of the butt cheek, creating an unnatural pointy or “gum-drop effect”, not at the lower part of the butt cheek and thus does not contribute to filling or rounding out of any of the lower buttock pole. Height and weight are considered but not nearly as relevant as the above measurements. Final note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel far away from your local area to seek consultation with this particular type of surgeon.  Glad to help.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment regarding the outcome of any plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures and ask your surgeon to forward the pictures they took.
It’s hard to assess your outcome from the pictures you’ve included.
 Try using the timer on your camera or have someone else take the pictures for you.
Individuals who have a flat spot on their inner lower buttocks should be told that this is going to remain after the augmentation.
The flats spot is usually due to areas that have extensive amounts of connective tissue that anchors the skin, a certain distance from the muscle fashion.
 These connective tissue bands are not pliable and will not stretch regardless of treatment option like fillers or fat transfer.
The best analogy I can demonstrate is the skin on the palm of your hand compared to the back of your hand.
You can pinch and lift on the back of your hand.
If you try that in your mid palm, you’ll see that you can’t lift the skin because connective tissue is anchor it in place. This is true for many parts of the body that can tolerate great amount of pressure like the soles of the feet and the lower inner part of the buttocks and back of the thigh.
Individuals who have a flat spot should be told about the limitations of the procedure regarding improving this area during in person consultations before scheduling surgery.
I don’t think fillers are going to do much other than waste your money.
It is a very difficult situation to correct with any procedure.
Best,
Mats Hagstrom MD

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