Inner butt cheeks droop causing a dent/dip in the bottom of my cheeks. What causes this and can it be fixed? (photo)

Allow me to answer your question as best i can based upon your single photo. 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.

The lower buttock dents you describe, are the result of multiple factors: A) this is the area that sustains the most direct pressure when sitting, because there is a underlying bone there, thus the fat layer tends to thin out there first, B) there exist a ligament from this bone to the skin that helps suspend the skin while the surrounding fat pads of the lower buttock cheek descends (sags) over time and aging. Unfortunately, fat grafting to this area tends to fail miserably. When the process becomes more severe, you can consider restoring volume with a buttock implant and/or undergoing a lower buttock tuck.

Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants or lower buttock tucks, 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.

Excellent question. This is an indentation from cumulative time spent on a toilet over your 39 years on this planet. The pressure of your body causes the tissue to compress at the inner ring of the toilet bowl and forces the other tissues to herniate through medially. This can be fixed as part of a Brazilian butt lift procedure if your surgeon recognizes the problem and specifically delivers fat to the area to correct the indentation. In some cases this is so severe that it can't be fully corrected without releasing the scar tissue first but in these photos it appears as though yours would likely correct with just a fat transfer. Hope that helps!