Ant Deformity - BBL revision. Would losing weight help?

Question

I had a BBL in 2018. No complications. But as time went on, my butt grew and it all started to sag. Creating an ant deformity. I went back in 2021 to correct it. Doctor suggested a lift. Incisions/cuts were made in many places; lower back above the buttocks, around the butt and on the outer sides of my thighs; since I couldn’t tolerate the size and lipo was not enough. I was left with very ugly scars. I’m so ashamed. I’m sagging again. Would losing weight help?

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you’ve had more than one procedure that we need to see before, and after pictures of each of the operations you’ve had. If you don’t have before, and after pictures, then ask your surgeons to forward the pictures they took. Always include a complete set of before and after pictures when getting a second opinion or assessment.
Different plastic surgeons have very different views on how the BBL procedure should be done. Some plastic surgeons believe it in reducing the size of the upper thigh in order to make the buttocks look bigger. This creates what I sometimes referred to as the lollipop look. I think the ant look may also be appropriate. in my opinion, it’s a big mistake to reduce the thigh while increasing the buttocks. That contour it should be smooth and harmonious, and if anything defined needs to be built up as the buttocks and hips are made larger. There are many problems with your body currently, but one of them is that your hips and buttocks are too large and your thighs were made smaller on purpose, and do not in any way transition naturally.
Improving the outcome once surgery is done, becomes more complex and increasingly more difficult. I cannot emphasize enough the importance of provider selection when having the primary procedure. I recognize that you’ve already had surgery, including a revision but for those who have not yet had the procedure I want to emphasize the importance of provider, selection, and Point out that not all plastic surgeons know how to do this procedure well. In fact, delivering consistent quality, liposuction and fat transfer results is far more difficult than most people realize. The number of plastic surgeons who have mastered these procedures are in a small minority. Most plastic surgeons think they’re far better at these procedures that they actually are. Doing these well is not easy and requires a total lifetime dedication. 
To find the best provider, I suggest patients have multiple in person consultations, preferably with local plastic surgeons, who seem to have a lot of experience with Liposuction and fat transfer. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like or how many of these procedures surgeon has actually performed. to master this procedure requires doing thousands of cases and plastic surgeons should have hundreds or even thousands of before and after pictures to choose from if you’re looking for someone who is truly experienced. 
If a provider is in capable of delivering quality outcomes on the first go around, they are most likely not the right provider to do revision surgery. Revision surgery is far more difficult and complex than primary procedures that should only be done by surgeons who have a proven track record.
When making an assessment and determining what the goal for a patient is, I usually envision an S-curve, a.k.a. Coke bottle a.k.a. hourglass figure that starts from the armpit and ends just above the knee.
If you envision a smooth, continuous S-curve on your own body, you can see that it’s badly broken up Starting at your hips and transitioning onto the thigh. This is not a smooth curve at all.
I don’t understand how plastic surgeons find this to be attractive, appealing or appropriate but somehow they are under the belief that reducing the thigh somehow makes the butt look bigger and that’s the goal of the procedure. My view of the BBL is quite a difference. My goal is always to accentuate and make the S-curve smooth and harmonious.
To work your way back towards having a more natural figure is going to be complex and difficult. Inappropriately remove fat from your thigh needs to be slowly restored, and the grafted fat to your hips and buttocks needs to be reduced. There is great degree of uncertainty when doing a revision surgery because the anatomy is not natural.
Any attempts at improving your outcome from here on has to be done by someone who understands how the procedure should be done in the first place and has a proven track record.
Finding the right provider for revision surgery is more or less the same process as finding the right provider for primary procedures. I suggested patients to begin the process by scheduling a significant number of in person, consultations coming in with an active approach towards vetting providers regarding their skill and experience.
For primary procedures, I generally recommend patients start the process by having at least five in person consultations before scheduling surgery. I do not recommend patients of virtual consultations, and I do not recommend traveling long distances for elective surgical procedures, unless absolutely necessary.
I’m sorry you find yourself in the situation. I’m sure it is beyond upsetting.
Every day I post answers on this website, encouraging people to be far more selective when choosing plastic surgeons. In the end, there are only two variables that determine cosmetic surgical outcomes. The first one is patient candidacy, and the second one is the skill and experience of the provider. Generally speaking, there isn’t that much that people can do regarding their own candidacy, but what people do have control over his choosing the right surgeon. Being board-certified and plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered any one single procedure especially not difficult procedures, like Liposuction and fat transfer. 
Best,
Mats Hagstrom, MD

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