Uneven glutes, banana roll and cellulite - how can this be fixed? (Photos)

Question

Hello, I have had uneven glutes eversince I can remember. I was told that as a child, I've received injections on the lateral sides of my glutes which have resulted in scar tissue buildup, uneven gluteal folds and lipoatrophy. Years ago I had lipo and fat transfer to the areas in need, in hopes that it would balance out. Instead, is a bit worse especially now that I am 50 pounds heavier than what I was when I got the surgery. I now have a banana roll on the right side and ofcourse lots of cellulite. I know it won't ever be completely normal but I just wish to be able to wear clothes without having to tape down the banana roll and wear shapewear. I am hoping for some kind of solution. Thank you

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, you have experienced a lot of the common side effects of BBL fat transfer – unevenness, cellulite-like dimples , and loss of good fat. So obviously, more fat grafting is not the answer. That leaves you with one remaining choice to add volume, shape, smoothing and projection - buttock implants. Please read on for more general information that I like to share with potential patients like yourself.

There are currently only two FDA approved surgical options for augmenting the buttock/hip area:  1) Buttock and cosmetic Hip Implants (which are soft semi-solid silicone rubber implants that cannot rupture &/or leak) and 2) Brazilian Butt Lift (aka BBL) - which utilizes the patients own fat from liposuction then transfers this fat into the buttock. On the other hand, “BBL” using fillers such as hyaluronic acids, Sculptra, etc… is a dangerous, guaranteed waste of money, and is NOT FDA approved. So what it comes down to, like any surgery, is proper patient selection and long-term results. Implants provide the only guarantee for a sustained permanent result and tend to be ideal for perking up not only lean or deflated buttocks but also providing substantial projection to any butt, which is what every single patient wants. Based upon your photos, a Stanton Anatomic®️ shape buttock implant may serve you best.

Unfortunately, fat typically melts away leaving disappointing results after 12 months, if not sooner. Dead fat leads to dents and dimpling like cellulite, unevenness, loss of projection, and fatty necrotic oil cysts which are hard marbles and can be very tender 
Unfortunately, because ~70+ % of the fat transferred will melt away within a year or two, most patients are not even reasonable candidates for BBL because they lack an adequate amount of fat to harvest. Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, the fastest, and the most...so please do not fall victim to this recommendation. Even those patients that had adequate amounts of fat pre-operatively, still end up seeking buttock implants after a year or so because most of the fat transferred melted away leaving them with minimal result.

Fillers such as Sculptra are cost prohibitive, provided enough volume is injected (i.e. at least 400 cc of active ingredient costing over $300,000) and last only 12 - 18 months.  Additionally, any physician promoting “biostimulators” for buttock enhancement is just a joke, and any board certified plastic surgeon promoting such, should not be trusted with your butt.

So, if you're looking for a reliable, predictable, and long-term permanent option that also provides projection in the upper, central and lower buttock and hips, buttock and hip implants are your solution. Procedures marketed as “supercharged BBL” or “hybrid BBL” that add fat at the same time of implants are simply marketing ploys. Fat that is added at the same time as a buttock implant is doomed to melt away 90+ percent. Thereby rendering it completely useless.  The reality is, when buttock implants are properly placed 100% intramuscular (i.e. surgically and precisely positioned within the gluteus muscles, not subfascial and not dual-plane and not on top of the muscles), there is absolutely no need for fat transfer.

Please note that an extremely few number of board certified plastic surgeons specialize in buttock or hip implants, so you may need to travel far and away from home to find this particular surgeon.  Getting it done right the first time around is not only the best chance for success, but also will save you from a lot of headaches and money in the future. Glad to help.

Uneven glutes, banana roll and cellulite - how can this be fixed? (Photos)

Answers (1)

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