I have a flat butt. Is surgery the only option?

Like any booming fad or fashion, there are always scammers trying to get a peice of the pie. Buttock augmentation/enhancement has become another victim - companies and individuals promoting magical creams, potions, lotions and pills...NONE OF WHICH WORK. It is not yet possible to take a substance that only and exclusively make your derrière grow. Other than being genetically blessed in the buttock and/or rigorous dedicated exercise, there is no "natural" way to grow the buttock other than surgery. Please read on for more surgical detialls:Regarding buttock augmentation, let me start off by saying that I currently see at least 1 - 2 patients per week that failed "brazilian buttock lift" (i.e. the fat melted away after 10 - 12 months) and are now seeking a more reliable and permanent option (i.e. buttock implants). Allow me to share with you some information that you may not hear elsewhere. There are only two proven safe and relatively effective methods for Buttock Augmentation and Hip Augmentation: 1) Autologous Fat Transfer (using your own fat, transferring from one area of the body to the other) and 2) Buttock/Hip Implants (semi-solid silicone rubber implants that cannot rupture &/or leak). Both are options but what it comes down to, like any surgery, is proper patient selection.Indeed because at least 50+ % of the fat transferred will melt away within a year, most patients are not good candidates because they lack an adequate amount of fat to harvest. Another tip is that if you purposely gain weight (i.e. fat) for the procedure, the fat you lose first as you get back to your baseline weight is that very same fat that was transferred into your buttock...so don't fall victim to this recommendation. Although using your own fat is relatively safe, the one serious complication that can rarely (< 1%) happen is "fat embolism" in which some of the fat gets into the blood stream and travels up into the lungs, heart, and/or brain causing serious problems. This complication is more likely to happen with the larger amount of fat being transferred. This is even more likely to happen when using fillers like PMMA and hyaluronic acids. Also fillers, when injected in large quantities, have a relatively high tendency to migrate away from the original area they were placed and tend to stimulate a lot of inflammation and a subsequent disastrous amount of scar tissue/hardening.Thus buttock/hip implants become a very good, safe, and long term reliable option for most patients seeking buttock augmentation (at least in my practice). I prefer to insert the buttock implants through a 1 1/2 inch long incision along the inner curve of each upper buttock cheek at the level of the tailbone, similar to two opposing parentheses ")(" (concealed within the crevice between the buttock cheeks) and the hip implants through a ~ 1 inch incision just below the beltline above the hip region. The buttock implant should always be placed under or within the gluteus maximus muscle. In this position, the implant is less palpable, less visible, and does not sag or shift/migrate over time unlike implants placed on top of the muscle. Therefore it is extremely important to seek consultation with a board certified plastic surgeon who specializes in this procedure (in fact both implants and fat transfer so that s/he is not bias). And in this case too, at least in my surgical practice, the infection rate is minimized to <2% (much lower than and contrary to popular belief by many other surgeons not experienced in buttock implants).Depending upon the amount of your current fat reserves and their distribution, you may or may not be a reasonable candidate for fat transfer. If you are wanting to utilize the fat to further augment your buttock in addition to implants, then I caution you against this. The reason being that the fat needs to be placed into the buttock muscles for optimal survival, however, this is exactly where the implant needs to reside and thus risks infection and/or death of the fat. Because of this risk, I frequently avoid fat grafting into a buttock that has an implant. Bottom line, I recommend consulting with a board certified plastic surgeon specialist in buttock augmentation (BOTH implants and fat transfer) to determine what option is best for you. Glad to help. 

Hello dear!!
Thanks for the question and provided information as well.
Looks like you could benefit from a butt augmentation with implants or a fat transfer procedure, but unfortunately, without pictures of yourself, it is very difficult to give you a proper answer. 
l recommend you to make an appointment with a board certified plastic surgeon to talk about your goals and anything you need to know.
Good luck :)