55 years old, 5’9, 180 lbs. How can I fix my sagging butt? (Photos)

Question

55 years old, 5’9, 180 lbs. I started taking photos of my body about 8 years ago. My buttocks have not changed dispite diet and exercise. I am not happy with the sagging, dimples, and banana roll. Can this be corrected?

Ryan A. Stanton, MD · Answer

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

Buttock “sagging” and/or loose skin is usually a combination of loss of volume or deflation (after weight loss, liposuction, or post-BBL) and/or the effect of aging and gravity. So,  I personally first treat patients like you by restoring volume to the buttock with a buttock implant. This will create a more desirable smooth and rounded perky buttock profile. If not adding volume with an implant, the buttock will most certainly always appear more flat if just a buttock lift from above is performed. On the other hand, an “autologous buttock lift” usually provides very little volume and projection, and almost nothing to the lower 2/3rds of the buttock.

A lower buttock tuck is usually then performed at six months following implants. Coincidentally, a lower buttock tuck also doubles as a thigh lift, removing loose wrinkled skin from this area as well. In this sequence, the implants have fully settled into final position so that any remaining loose skin can be most accurately identified and removed with the lower buttock tuck.

Any “non-surgical” treatment or device as well as exercise, unfortunately, will have little to no effect on this problem area. Furthermore, fat transfer and “fillers” perform very poorly in this area and usually result in just a waste of hard earned money.

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.

Gary M. Horndeski, MD · Answer

You may benefit from a buttocks lift (posterior thigh lift). A transverse incision is made and the excess skin and fat is used to make a flap that is rotated downward to give more projection. This may take in the slack skin and improve the contour of your buttocks. Fat transfers are an alternative as well as buttock implants. However, buttock implants can have complications as well as fat transfers.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

George Marosan, MD · Answer

Thank you for your question and photo. First of all, you do not have a saggy butt. You do have significant cellulite of both buttocks, worse on one side and buttock asymmetry secondary to this. You also have deep scarring of the posterior upper thigh (what you call a "banana" roll). The scar needs to be released and your banana rolls will disappear. Liposuctioning this area will not solve your problem, it will aggravate it! If you were my patient, I would do the GoldIncison procedure to release the cellulite and use biostimulators. You might need more than one procedure to achieve the best results. This is done under local anesthesia only. Patients from outside my geographic area initially do a virtual consultation first. After the procedure, they can fly home in 1-2 days. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

The primary problem in your case is connective tissue creating cellulite.
This is not an easy or straightforward condition to treat.
Doctors have been attempting to treat cellulite successfully for many decades.
The best treatment I’ve seen so far is a device called Aveli. The device is particularly useful because it not only cuts the connective tissue, but it can isolate the specific connective tissue band. That’s causing the problem creating minimal risk of complications from over treatment. Attempting to do too much in a single session increases the chance of a fluid buildup under the skin called a seroma. If this happens, the fluid collection needs to be drained with a needle on a daily basis until it’s gone good
This can’t take a few weeks.
It can be avoided by limiting the treatments done in a single session.
Sometimes small amounts fillers can be injected or fat can be grafted in conjunction with the release of the tethering connective tissue. 
The banana roll is also created from bands of connective tissue.
The main thing about this area is that it should not be treated with Liposuction.
Attempting to treat the banana roll with Liposuction can make the problem worse or can create new problems that are almost impossible to correct.
Some plastic surgeons have experience with these type of treatments and others don’t care.
It may be challenging to find someone who has the expertise to give you a quality outcome.
Regardless of who does it I think it’s going to require a few treatments. 
I generally encourage people to avoid virtual consultations in instead rely on in person consultations.
This is generally better, but sometimes virtual consults are needed because of geographic distances.
Regardless of what type of consultation you have the most important aspect is to see an impressive collection of previous patients who had similar situations.
 As providers to open up their portfolio and show you their entire collection of previous patients who had similar characteristics.
Always have pictures of yourself to use as a reference when reviewing before, and after pictures, whether in person or online.
Always ask how many treatments each outcome required And what percentage of patients had what complications.
When complications are discussed, you should also ask and talk about what the outcome was of the complication and what it required to treat it.
The wrong approach to treating your condition can lead to undesirable outcomes.
Provider selection is in the end going to be the most important variable and where you should focus your efforts.
I’m guessing the Aveli website may have lists of providers that performed the treatment.
It’s not the only device to treat cellulite, but it is in my opinion currently the best option we have.
Best,
Mats Hagstrom MD

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