Dent on buttock from a fall - What do you suggest to improve it? (photos)

Question

I suffered from a nasty fall about 10 years ago and it has left a permanent dent on my right buttock. I have tried fat grafting with no improvement. Should I try fat grafting again? Does anyone have any other suggestion? Thank you!

Semih Yildiz, MD, FEPOBRAS · Answer

The photos show a localized depression on the right buttock, and after a fall this can be caused by scar tethering as well as loss or displacement of fat.

If one round of fat grafting gave no improvement, repeating fat grafting alone may not be enough. The key question is whether the dent is simply a volume deficit or whether the skin and deeper tissue are stuck down by scar tissue. When tethering is present, the usual approach is to release the scar band first, then add volume with fat grafting, sometimes in more than one stage. In selected cases, a structural fat graft, small local tissue rearrangement, or carefully placed filler may be considered, but the plan depends on thickness of the overlying tissue and how the area moves when you stand, flex, and sit.

A consultation with a plastic surgeon experienced in post-traumatic contour deformities would be worthwhile. If there is pain, a firm mass, numbness, or progressive change, imaging such as ultrasound or MRI may also help define the scar and soft tissue before another procedure.

Gianfranco Frojo, MD · Answer

This dent might be from fat / muscle necrosis (death) from the initial injury. I would recommend trying fat grafting again as sometimes it requires multiple attempts to address certain deformities.

Emmanuel Mallol Cotes, MD · Answer

Thank you for your question. Based on the picture what you need is DBL to reshape and fill that dent to improve the butt projection. I would suggest to be treated by board certified plastic surgeon with experience in this procedure, to get the best desired results.

Respectfully,
Dr. Emmanuel Mallol Cotes.-

Respectfully,
Dr. Emmanuel Mallol Cotes.-

Alan Gonzalez, MD, FACS · Answer

Hello @katarinaferreira, thank you for your question. To make an informed recommendation, more information is needed. A consultation is vital to establishing a surgical plan that meets your needs, meets your expectations, and takes into account what is possible. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Daniel Barrett, MD · Answer

Dear katarinaferreira,
it is hard to tell for sure without an examination. Based on your photos, it looks like you had fat necrosis so fat transfer is probably the best option. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Randal Haworth, MD, FACS · Answer

Hello,

Based on your pictures, it looks like you would greatly benefit from SurgiWire + fat transfer/filler to the area.

SurgiWire effectively separates the fibrous connections of a depression from the underlying tissues, releasing it without causing any harm. This breakthrough can be used alone or in combination with fat transfer or dermal filler injections to achieve optimal results.

I recommend to consult with an experienced board certified plastic surgeon for the best results.

I hope this helps,
best of Luck !

Leland Webb, MD · Answer

I think he would probably do really well with another round of Fat grafting to the buttock. Fat grafting can have some variable results, however, we have used this approach in the past, due to similar sorts of injuries or steroid injections that have left people with contour abnormalities. They have had amazing results. It may take one or two more attempts at getting this divot to resolve, however, I think it is worth a try and it is one of the safest options for you. Have a conversation with your board-certified plastic surgeon about the surgery and anticipated scars. Additionally, discuss postoperative avoidance of compression as well. We are happy to help in any way we can.

Douglas Taranow, DO, FACOS · Answer

It appears you may have two things going on.  First, you have a post traumatic depression.  This is most commonly from scar tissue under the skin with damage to fat cells which appears later in life as you gain weight and the other normal areas get larger leaving the damaged area noticeably dented)
You should have release of the scar tissue and may require fat placed under the released skin.  There also seems to be an excess outpouching of fat above the dent which may require liposuctioning.

Mats Hagstrom, MD (license on probation) · Answer

Gluteal indentations are either cost by connective tissue, pulling on the skin in a condition called cellulite, or when there’s a history of previous procedures or trauma it is usually scar tissue pulling on the skin. The contour issue is generally not related to loss of volume and this is why simply adding volume typically fails. There are instances where volume is the primary issue, and then those cases adding volume should fix the problem. 
Most likely your indentation weather the pool on the skin is from connective tissue or scar tissue the treatment would be the same.
The tissue that’s pulling on the skin needs to be released by some type of Subsicion procedure. adding some volume with grafting fat at the same time often gives the best results and the best long-term outcome.
Simply adding volume, especially on this part of the body is a simplistic way of thinking of the problem, which does not recognize what causes contour irregularities on the buttocks. You can think of cellulite or contour irregularities due to contractile tissue forces like tufted furniture. If you have a tufted sofa with texture created with buttons sewn in Creating a purposeful pattern stuffing the sofa further is going to make the indentations where the tufts are look even more accentuated. The way to create a smooth contour is to cut the thread, holding the button down, which is creating the tufted appearance.
Treating contour, irregularities and cellulite is not easy and lots of people have had disappointing outcomes from plastic surgeons, trying various treatments for years. It would be helpful if providers would learn from the past and not take the simplistic approach of simply just adding volume. This is especially true if the provider is a board-certified plastic surgeon.
Look for providers who have a proven track record treating cellulite with long-term success with enough before, and after pictures to confirm their track record.
Best,
Mats Hagstrom, MD

Dent on buttock from a fall - What do you suggest to improve it? (photos)

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