How to fix shape after butt lift dermal flaps? (Photo)

Question

I had 360 tummy tuck 15 months ago. My butt was lifted and I had dermal flaps, However I'm not sure if my shape is normal. Before surgery I had a nice silhouette and now i have like a 3 shape and it doesn't look as nice. From certain angles the dermal flaps stick out. My bum cheeks look too small and even though the lift meets at the top of the buttock at the back, theres a line above it. Im considering 360 lipo, lipo to front and outer thighs and fat transfer to bum. Any advice?

Ryan A. Stanton, MD · Answer

I personally have never been a big fan of dermal flap buttock auto-augmentation because I have never really seen a great outcome from this particular type of procedure. The buttock silhouette never seems to be fully augmented/enhanced from top to bottom. Additionally the amount of augmentation is usually relatively minuscule compared to other procedures. In this particular situation, I have found the only relatively safe, reliable, and permanent option is to enhance this result using buttock implants. Buttock implants should give you a much improved smoothed and rounded-out silhouette, for the entire surface area of the buttock, from the lower back to the thighs.

Please do not let anybody talk you into using dermal fillers to correct this problem. Guaranteed, it will be the biggest waste of money you have ever had.

Finally, “360 liposuction” can still be performed at the same time of buttock implants to help better carve out your waist line and contour the rest of your body.

Please do not let anybody talk you into using dermal fillers to correct this problem. Guaranteed, it will be the biggest waste of money you have ever had.

Finally, “360 liposuction” can still be performed at the same time of buttock implants to help better carve out your waist line and contour the rest of your body.

J. Timothy Katzen, MD, FACS · Answer

Hi 34HTOB,
Thank you for your question about how to correct the shape of your buttocks after a 360 tummy tuck or circumferential lower body lift that involved dermal flaps. I appreciate you sending your pictures and query regarding this issue.
The step-off you're experiencing, which is where the dermal flaps were rotated, is not uncommon. To address this indentation, the best solution is to use your own fat. Since you mentioned undergoing a 360 Liposuction, I recommend using the fat harvested during this procedure to fill the indented area. Fat grafting can effectively correct and fill this indentation.
However, after analyzing your pictures, it seems you don’t have a substantial amount of body fat available. For optimal results, more fat would be needed. Therefore, I suggest considering fat harvest from areas such as your mid-back, lower back, abdomen, and possibly even the inner thighs.
I hope this information assists you in understanding how to fix the shape issue following your butt lift with dermal flaps. Wishing you the best with your procedure.
Sincerely,
Dr. Katzen

Zoran Potparic, MD · Answer

Unfortunatelly, your butt incision is placed too low, accross the upper 1/3 of the buttock, what affects the shape of the cheek. You should discuss with your surgeon whether the scar can be placed higher, so the butt cheek stays as a single/well defined unit. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

The dermal fat flap buttocks augmentation is kind of an awkward procedure and has inherent flaws.
 It does give autologous volume but unfortunately often lacks in reach only to the upper part of the buttocks and limits how much does subcutaneous fat layer can be thinned in the lower back.
Any skin laxity will always limit liposuction and fat transfer results to some degree and despite having had the skin tightening procedure massive weight loss patients typically still have skin laxity in a horizontal direction and in other parts of their body.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe and for that reason I recommend patients be very selective in choosing the right provider.
Do that by having multiple in person consultations at which time you should ask providers to show their entire collection of before and after pictures or at least as many as they are willing to show you.
Ideally you should ask to see as many pictures as possible of patients with similar body characteristics to your own. In your case that may be slightly challenging in regards to seeing lots of samples. Still, an experience provider should be able to show you at least 50 sets of quality before and after pictures of BBL patients and for sure some of those should be patients who’ve had at least previous tummy tucks.
Look carefully at all areas treated to make sure there are no skin irregularities. Ask the surgeon to go over specifically what areas were treated and what areas were not treated and look carefully at transition zones between treated and untreated areas.
Are usually view the torso as a single anatomic unit when it comes to liposuction and prefer to do a liposuction of the entire torso if I’m going to do a liposuction of any part of the torso.
A full torso includes upper abdomen, lower abdomen, love handles, waist, full back and under arms all the way to the side of the breast.
There are of course exceptions and this definitely includes people who’ve had previous procedures.
The goal is to leave people with a natural thin fat distribution that is consistent without transition zones.
Continue having consultations until you feel like you found the most talented or appropriate provider for your needs.
Best,
Mats Hagstrom MD
Ideally patients should be well-versed in what procedures can and can’t deliver through thorough in person consultations before deciding on the correct procedure or surgeon.
Liposuction and fat transfer may be appropriate.
I have not done a BBL and someone who has had your procedure previously despite having done over 8000 liposuction and fat transfer procedures to date.
I’m not sure if having had the flap procedure inhibits the ability to get a good BBL result but it’s probably worth trying and I would imagine in the hands of a talented provider you should get at least a modest improvement.

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