2 rounds of BBL. Sagging and proportion (butt vs. thighs). Options? (photo)

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.


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.

Important note, do not fall victim to anyone recommending fillers, such as Sculptra and hyaluronic acids, for enhancement or augmentation of the buttock/hips because they are a rip-off and guaranteed to fail, 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.

Based off your photos, there is actually minimal sag based off your anatomical junction of your lower glutes and upper posterior thigh - but if you feel as if it has gone down over the years - likely it has stretched some due to skin growth (weight gain / loss, loss of muscle tone etc.). And in order for it to not go lower faster, you actually need to tone - light weights to increase the glute muscle to perk it back up - versus looking for another BBL, fillers, or any other nonsurgical modalities. Decreasing your body fat percentage - by losing fat (8-10k steps / day at a calorie deficit and high protein diet) will help you achieve this over 3-6 months prior to seeing changes that you will notice (so you have to try that hard and long). The more volume you add to your butt - whether its fat, fillers, silicone, implants - will only stretch the skin more, then allowing it to sag more and likely faster - you need the opposite - lose some fat, tone and increase muscle mass to keep the butt up. Hope this helps.

If you think your buttocks are too big then you have the option to reduce them. We call is the brazilian butt reduction or BBR. Reducing previous BBL's is now very common in our practice. We use our signature Precision Sculpt liposculpting approach. The procedure is performed with the patient relaxed on oral medication and thorough local anesthesia. It's specialized awake liposuction. A few carefully placed small incisions mostly within the buttock creases are used to precisely remove excess fat in targeted areas. The design of the reduction is based on your specific desires regarding the buttock width, projection, slope, shape, and superior, mid, and inferior excess fullness. In determining the surgical plan, I find it helpful to know how much fat was placed during the BBLs and to look at preoperative photos. I like for the patient to give me rough percentage of decrease they desire. Inspiration photos or even drawings over current photos as help. If you're interested, reach out to us and I'll review everything.

Dear dayi4591,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I understand your concern. In your case, fillers would not be the right solution since they would only add more volume. The most effective option is a BBL reversal, which involves liposuction to reduce the size of the buttocks. Depending on your skin quality, it might be possible to perform only liposuction with J-Plasma for some tightening. However, in many cases there is still looseness and sagging, which would then require a buttock lift with a thong-like incision to restore shape and improve proportions between the buttocks and thighs.

Each provider has their own way of interpreting how this procedure should be done.
Some providers do liposuction of the upper thigh to make the buttocks appear larger and more defined.
To me, this doesn’t look natural and create a look I sometimes call the lollipop look.
Once fat has been removed with Liposuction, it’s almost impossible to restore the volume.
In your case, you may be able to obtain a more natural proportion by having some of the fat for your buttocks removed.
Each time you have a new procedure things become more complex and difficult in regards to getting a quality outcome.
The first procedure is always the best chance of getting the right results. I think it’s going to be difficult to improve your outcome in any significant way other than possibly reducing the size of your buttocks with removing some of the grafted fat using Liposuction.
Best,
Mats Hagstrom MD