Best solutions for getting rid of double crease butt?

The normal crease at the bottom of the butt is known as the infra gluteal fold.  This fold is very often duplicated or triplicated with weaker but prevalent folds going down onto the posterior thigh.  If the second fold is on the back of the thigh and has fat in between the first and second folds, we refer to this fat filled area below the buttocks as the "banana".  I and several other authors have written papers on this particular phenomenon.This fat, whether it is connected to the bottom of the buttocks or else even on the upper posterior thigh, can be suctioned out leaving one with a single crease on the buttocks.  Liposuction of this area is tricky to say the least.  These folds keep the buttocks intact and, if the primary fold is injured, it can lead to distal migration of the infra gluteal fold, i.e. your butt can drop.Diagnosing your particular congenital anomaly requires an experienced plastic surgeon who has dealt with liposuction of the banana in the past and who understands the dynamics of this particular portion of the body.  To find a good Board Certified plastic surgeon in your region, I suggest visiting the American Society for Aesthetic Plastic Surgery website to find surgeons in your area, then look them up on RealSelf, Health Grades, Vitals, etc. to see what other patients have said about them.  At that point, I would seek consultation with two or three of these experienced surgeons and see what they say after an in person, physical examination.

One method of approaching this problem is to consider subcision of the dermal fascial attachments combined with fat transfer to smooth your contours.  Post-op massage and even negative pressure devices may be needed over the following weeks to ensure proper balance of the new tissue structures.

Thank you for the question and photos. I would be careful to avoid liposuction of this area. A poor result is common and can be very difficult to correct. This crease is a challenging problem, but my recommendation would be fat grafting to the area. Fat is removed from unwanted areas and then transferred to the buttocks. The goal being to decrease the creases by increasing the volume of the buttocks. Increasing buttock volume will put the skin on more stretch and hopefully soften the creases. It will also improve the shape of your buttocks. Make sure you're seeing board certified plastic surgeons. 

The best way to decrease this is with a high definition procedure like VASER liposuction. I use VASER with ThermiRF and fat grafting to get the most fat removal, but also provide lift for the butt and improve the shape. I recommend getting a formal evaluation with a high definition physique expert. Sometimes non invasive options such as sculptra, ultherapy, PDO threads or renuva adipose matrix can help.  you need a formal consultation. Best, Dr. Emer.

The double crease you are referring to is very difficult or impossible to treat surgically.
Before coming up with the surgical or medical treatment plan one must first understand the inherent problem.
The lower part of the buttocks or upper part of the back of the thigh a push together when you're in a standing position.
Just like when we sit down the lower abdomen is folded together so it's the lower buttocks when we stand up straight.
When we stand up straight the abdomen becomes flat and when you lean forward just like leave the double crease on the lower buttocks will go away. I've seen numerous attempts from other doctors trying to treat this with liposuction with either no results or disfigurement.
It's possible for transfer could add enough volume to minimize the crease but I would not recommend that or any treatment option for this.
This is simply a function of the skin being pushed together when you're in an upright standing position.
The reason I do not recommend any treatment is because any surgical intervention has a low chance of making this go away and that's a fairly high chance of causing problems.
Anyone who claims they can treat this and make it go away should be able to show you multiple before and after pictures with successful results.
My best advice for you is to except this and realize when you lean forward slightly it goes away.
Best,
Mats Hagstrom M.D.