Is there a way to prevent a flat bum after a lower body lift? (Photo)

It is very common to see the total deflation of areas like face, Breast, buttocks or thighs after important weight loss.During Body lift which (in my hands) represents the front: tummy Tuck, Muscle repair, mons pubic lift. Lateral: outer thigh lifting. Posterior: real buttocks lift. It is correct and honest to say the buttocks after the lifting will NOT become any bigger, but the contrary, a bit flatter, so I perform in a 99% (1% are not interested), of my patients (female and male), double buttocks augmentation: buttocks flap which means using your own tissues, those which would've been discarded during the skin resection, to create a little volume and projection to buttocks and also I take advantage of the little amount of fat of the lovehandles to transfer to the buttocks.The volume and projection achieved is never large, but definitely better in shape, more feminine and definitely rejuvenated.The most important in my opinion is to look for a PS who is expert on the After Weight Loss surgery.Be encouraged!!Dr. Cardenas

Although fat grafting is the most popular procedure in the U.S. to enhance the buttocks, rotating local flaps from the tissue that is to be cut off (auto-augmentation) can be utilized to provide some desired fullness when fat transfer cannot be utilized.

Kristi Hustak, MD
Board Certified Plastic Surgeon

Hello. Congratulations on your weight loss. During the lower body lift surgery we usually use your own tissues to fill the buttock area. The tissues we use are located just above the buttock. We don't remove this excess tissue but put it into the buttock area. They support the stretching of the sagging skin as well. Usually the volume slightly decreases over time but undoubtly it becomes much better than now. This is a general approach but of course all the process should be planned specifically for you. You should discuss all the choices with your surgeon and decide together. Good luck. 

Thank you for your question regarding what to do about your flat buttock after massive weight loss. This is not an uncommon problem. I would suggest you have a lower body lift and have excess fat and skin removed from your central torso. After you healed from your lower body lift, I would suggest you consider buttock implants. Brazilian butt lifts or BBLs are still allowed in the US, but I am not sure about in the UK. However, since you do not have much body fat anyway, a BBL may not be a great option for you anyway. Therefore, to maintain a curvy shape after massive weight loss and lower body lift, please consider buttock implants. Buttock implants are very safe. Buttock implants are made of a semi-solid silicone, which does not leak. Unlike silicone breast implants, buttock implants cannot leak silicone. There are three anatomic planes to place the buttock implants.  1) The buttock implants can be placed above the gluteus maximus muscle.  2) The buttock implants can be placed below the gluteus maximus muscle.  3) The buttock implants can be placed in the gluteus maximus muscle.  The position of the gluteal implant placement really depends on you and your plastic surgeon’s preference and your individual anatomy. Thank you for your question about how you save your butt after a lower body lift. 
I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy please contact my office. Since the body lift is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the lower body lift. Do your research.  Make sure they have performed at least 100 circumferential lower body lift surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello, thank you for your question. congratulation on your weight loss.  An in-person consultation is needed, I recommend you to schedule an appointment with a board certified plastic surgeon.

Dear simwasnotfree,
it is hard to tell for sure without an examination. Based on your photos, it looks like you would benefit from lower body lift. Once you are fully healed and if you have loose skin on your buttocks, butt lift might be an option. If you are considering a surgery, I would suggest you to 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

Hello and thank you for your photo's and question.   I would most likely do a gluteal autoaugmentation with the lower body lift .   

Congratulations, Simwasnotfree on your weight loss!  I recently addressed this topic in a write up for the Obesity Help website.  I am copying it for you here, as I think it explains your options.  Best of luck!As a culture, we are obsessed with buttocks. Turn on the radio, and you will hear
Baby Got Back (Sir Mix-a-lot), Fat Bottom Girls (Queen), My Humps (Black Eyed Peas), Bootylicious (Destiny’s Child), or Booty (Jennifer Lopez). Flip to social media and your screen will be filled with images of Kendall Jenner, Amber Rose, and Nicki Minaj, all viewed from behind. Look on reality TV and find stars such as Kim Khardashian and Kylie Jenner whose celebrity in part has been propelled by the fame of their assets (pun intended!)
The influence of our society’s obsession on women’s self perception cannot be denied, and is evidenced in the popularity of aesthetic buttock surgery. In 2018, the American Society of Aesthetic Plastic Surgeons recorded more than 32,000 procedures that were either buttock augmentation or buttock lifts, a figure that exceeds the number of brow lifts, neck lifts, and thigh lifts performed by members of the society that year. In addition the demand for non- surgical buttock augmentation with dilute fillers or biostimulants that increase collagen production has also witnessed considerable growth.
Not surprisingly, the bariatric population is not immune to these influences, and patients are increasingly considering buttock rejuvenation and restoration as a part of their post weight loss body contouring. In some ways, weight loss patients are particularly vulnerable to these influences as their relationship with their body image throughout their lifetime has been complex, and despite successfully shedding pounds, their body goals are often unfulfilled. Sadly, the internet and social media does not necessarily distinguish bariatric body contouring from traditional body contouring surgery.
While the body habitus of weight loss patients varies tremendously, and each patient seems to have a unique genetic program that determines where they gain and lose weight, changes to the buttock with weight loss are nearly universal. Patients usually present with volume loss and deflation, and the buttock skin rarely demonstrates significant retraction. Consequently, the buttock flattens and the skin sags, imparting the appearance of the senile buttock, or an appearance suggestive of old age. Postural issues frequently make the condition worse. When patients are gaining weight, they often develop a tilt of the pelvis forward that further detracts from buttock projection.
Fortunately, there are a number of ways that improvements in buttock aesthetics can be achieved for the massive weight loss patient. Circumferential belt lipectomy, referred to as a body lift, is perhaps the most common means to address the buttock during body contouring. The procedure combines an abdominoplasty with flankplasties and a buttock lift, excising skin and soft tissue 360 degrees around the torso. Excision of tissue from the lower back and upper pole of the buttock addresses the skin excess and descent. The result is a tighter, higher buttock.
Patients who have residual adipose deposits resistant to weight reduction may also be candidates for a traditional Brazilian Butt lift. In this procedure, a modified liposuction is performed to harvest fat grafts. The modifications are meant to preserve the viability of the fat cells that are removed. There are several different protocols by which the harvested fat is purified and concentrated, and then those adipocytes are injected back into the buttock with the hope that they will develop a blood supply and survive long term. The technique has the advantage of improving both donor and recipient sites, but the amount of fat that actually survives can be somewhat unpredictable.
Finally, for patients who have limited residual adipose tissue, buttock auto-augmentation could be considered. In this procedure, the skin and soft tissue that would normally be discarded in a traditional body lift is repurposed. The blood supply to that tissue is mapped out and preserved. The outer layers of the skin are removed, and the tissue is elevated and then rotated and tucked in a pocket that is developed in the buttocks. The buttock is then lifted and the body lift incision is closed, burying the soft tissue beneath the buttock skin, and consequently adding volume and projection. While the technique has been criticized by some for making an already difficult procedure (body lift) more complicated, for properly selected patients, it can be quite rewarding.
It should be noted that traditional buttock silicone implants are still available, but have fallen out of favor. Their use has been plagued by problems with infection, malposition, migration, rotation, and the development of problematic scars around the prosthesis. There are some surgeons, however, that in select cases will determine that the benefits outweigh the risks, and will consider their use.
Non-surgical treatments may be the future of buttock volumization and rejuvenation. These techniques are growing in popularity, though they currently cannot produce the dramatic changes of surgery. Sculptra can be injected to stimulate some collagen growth, and even dilute radiesse is being injected as both a filler and biostimulant. Renuva is a fat matrix that seems to recruit fat cells and build volume. Emsculpt and Cool-tone are non-invasive devices that can also be used to help build up and shape the gluteus muscle itself. While not currently a practical means to address the body contour concerns of massive weight loss patients, many surgeons believe that these non-invasive treatments and technologies will improve and play a larger role in our body sculpting armamentarium in the future.
Bariatric patients seeking body contouring represent a diverse and uniquely challenging population. Weight gain and subsequent weight loss often create changes to the body that disappoint and often frustrate patients. In addition to these anatomic challenges, their tissue is frequently damaged and compromised. With weight loss, the buttock deflates and descends. Fortunately, there are now multiple techniques that be considered to address these concerns and buttock restoration and rejuvenation can be considered as a prominent part of body contouring after massive weight loss.