Dent on glute following hard fall. Will this go away on its own or am I looking at a surgical procedure? (Photo)

Question

I slipped on our staircase in October and fell extremely hard onto the corner of one of the stairs resulting in an indented area and a lump above the dent. It got a little smaller than it used to be but is still very prominent/noticeable all these months later and I’m super self conscious about it since you can see it through clothing. Will this go away on its own or with any sort of massaging or am I looking at a surgical procedure? Pics of the initial bruising & how it looks today.

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.

There are currently only two FDA approved surgical options for augmenting/enhancing the buttock area:  1) Buttock and Implants (which are soft semi-solid silicone rubber implants that cannot rupture &/or leak) and 2)Brazilian Butt Lift (aka BBL) - which utilizes the patients own fat from liposuction then transfers this fat into the buttock. On the other hand, BBL using fillers like Sculptra are a dangerous, guaranteed waste of money, and NOT FDA approved. So what it comes down to, like any surgery, is proper patient selection and long-term results. Implants provide the only guarantee for a sustained permanent result and tend to be ideal for perking up not only lean or deflated buttocks but also providing substantial projection to any butt, which is what every single patient wants.

Unfortunately, fat typically melts away leaving disappointing results after 12 months, often sooner.  Unless your BBL surgeon is injecting only 200 to 300 ccs of fat into each buttock cheek, a large percentage of that fat is going to die.  Dead fat leads to dents and dimpling like cellulite, unevenness, loss of projection, and fatty necrotic oil cysts which are hard marbles and can be very tender 
Unfortunately, because ~70+ % of the fat transferred will melt away within a year or two, most patients are not good candidates for BBL because they lack an adequate amount of fat to harvest. Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, the fastest, and the most...so please do not fall victim to this recommendation. Even those patients that had adequate amounts of fat pre-operatively, still end up seeking buttock implants after a year or so because most of the fat transferred melted away leaving them with minimal result.

In your case with a buttock dent resulting from trauma, there has been loss of fat +/- some muscle mass and undoubtedly scar tissue left behind. Fat grafting would otherwise be a good option except within a bed of scar tissue. Unfortunately, this may be the rate limiting factor when considering fat grafting as an option.

So, if you're looking for a reliable, predictable, and long-term permanent option that also provides projection in the central buttock, buttock and hip implants are your solution. Please note that an extremely few number of board certified plastic surgeons specialize in buttock or hip implants, so you may need to travel far and away from home to find this particular surgeon.  Glad to help.

Daniel Barrett, MD · Answer

Dear coffeeandchaos,
it is hard to tell for sure without an examination. Based on your photo, it looks like you probably would benefit from fat transfer to fill the dent. 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

Mats Hagstrom, MD (license on probation) · Answer

That fall must’ve been pretty painful.
The fact that it left indentation means that the trauma was sufficient to create tissue necrosis.
During the healing process, your body has cleared out dead tissue and has created scar tissue.
The indentation is based on those two variables.
A loss of fat and contractile scar tissue. That’s pulling in on the skin.
 For that reason correcting this is going to be challenging.
Most likely volume restoration alone will not correct the contour.
The procedure will need to address the scar tissue as well.
There is no non-surgical treatment that’s going to improve the contour of your bottom.
The best approach is going to be fat, transfer, a.k.a. fat grafting.
This will most likely need to be done in conjunction with releasing the scar tissue.
Releasing the scar tissue is not easy or straightforward.
There are some devices on the market that may potentially be helpful such as a Aveli. Some people may refer to releasing the scar tissue as Subscission.
If you want to consider surgical correction, then you going to need to spend some time to find the right plastic surgeon. Who has experience doing this kind of work.
Be careful of providers who view this as a fairly simplistic problem that can be easily corrected.
It is most likely going to be a bit challenging and you may need to accept a partial correction as the best possible outcome.
There is some uncertainty with unusual situations.
As I mentioned previously, there are two tissue variables involved. One of them is a lack of volume and volume restoration with fat transfer is your best option for this. The second is how much scar tissue is pulling down on the skin.
Look for plastic surgeons, who have proven track wreckers with both liposuction and fat transfer.
The most common body contouring procedures, using fat transfer is breast, fat, transfer or gluteal fat transfer often referred to as the BBL or Brazilian but lift.
I think it would be important for surgeons during the consultation to mention both tissue variables as being hurdles to overcome.
Usually, I recommend people ask providers to show them as many before and after pictures as possible during the consultation.
For your unique situation. It may be difficult for them to give you representative work because your situation is unique.
 it is a bit like treating cellulite in some way 
To find the right provider, you should probably consider having multiple consultations before selecting a surgeon.
Start by looking for those who do a lot of fat transfer as part of their practice.
I recommend you rely exclusively on in person, consultations and avoid virtual consultations.
Start by having three or four consultations and see what each provider has to say.
 You may need to continue having consultations until you feel very certain you found someone who knows what they’re talking about.
I would probably not schedule surgery after only one consultation.
There are substantial differences in skill and experience for this type of work among plastic surgeons.
 Best,
Mats Hagstrom, MD

Dent on glute following hard fall. Will this go away on its own or am I looking at a surgical procedure? (Photo)

Answers (3)

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Dent on glute following hard fall. Will this go away on its own or am I looking at a surgical procedure? (Photo)

Answers (3)

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Recommended reading

Everything you need to know about Butt Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.