Dent on buttocks after BBL surgery. What are my options?

Question

I had a trauma injury in my buttocks a year ago, after swelling, and bruising, it left a dent. I had a BBl few months ago and the dent is still visible or even worse than before. would like to see what other options are available.

Daniel Barrett, MD · Answer

Dear juliet35,
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

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can without any 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.

Hence, here is my generic answer:
You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, insignificant hip augmentation, post-deflation sagging, fatty necrotic cyst or scar tissue, etc.) as most of the fat melts away. It is not quite as much the quality of the doctor nor liposuction technique but rather the quality of the procedure that is a large part of the problem.  Thus, going back for additional rounds of BBL most often produces the same disappointing results but at another financial loss.   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.

Fillers, such as Sculptra and hyaluronic acids,  for augmentation of the buttock/hips are a rip-off, period!

Buttock/hip implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the hips and central buttock, and often help smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging.  When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants. 
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

Mats Hagstrom, MD (license on probation) · Answer

Uneven contours, or indentations on the buttocks is not all that uncommon. For most people, it represents cellulite, which is connective tissue pulling on the skin.
There can be other ideologies, such as scar tissue from previous injuries, childhood injections, or other variables. It’s important to understand the true ideology of the problem in regards to coming up with a treatment solution that is going to be effective. Often the problem is not simply a lack of volume and for that reason volume restoration typically fails to fix the problem and can make the problem worse.
For example, cellulite is often made worse by fat transfer, and individuals who have significant cellulite should be aware of this before choosing to happen, fat, transfer procedures like the BBL.
To make an assessment on the outcome of a plastic surgery procedure, we generally need to see before and after pictures
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
If scar tissue or connective tissue is pulling in on the skin and creating the indentation in this tissue needs to be released before volume augmentation contour. 
Some contour irregularities can be improved by using a variety of techniques. Others may be more challenging to treat.
Best,
Mats Hagstrom, MD

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