What are your thoughts on the autologous butt fat flap?

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.

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. So, I personally first treat patients like you 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 surely appear more flat with just a lower body lift or buttock tuck. Unfortunately, the results from a buttock fat flap are far inferior to buttock implants because it only minimally and partially augments the upper third of the buttock and not the lower 2/3rds. BBL also, is often a very poor option in a massive weight loss patient like yourself.

After implants, a lower buttock tuck and/or a lower body lift 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.

Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel away from your local area to seek consultation with this particular type of 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.

Thank you for the question and pics. Congratulations on your weight loss! Rotation flaps to your buttocks are a reasonable thing to do. It can provide a little more projection to your buttocks, but doesn't really do anything for the lateral butt or Hip dip area. The only negative things about the rotation flap is that they give you fullness of your upper buttocks, but not always the lower buttocks. This all depends on how long of a flap can be safely created. The biggest issue is blood supply to the tip of the flap. If it doesn't have good blood supply, it can die and turn into fat necrosis and feel hard.

The procedures you’re referring to it’s going to give you a similar outcome to what you currently have.
The problem is the volume is too high in the pot, making the lower part look even more deflated.
Focus on getting the body lift done correctly to start with then focus on the next issue.
In the end, provider selection is the most important variable.
Best,
Mats hagstrom MD