Sagging butt. What can be done to improve this? (Photo)

Buttock “sagging” 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 be shortened but may appear more flat with just a buttock lift. A lower buttock tuck is usually then performed at six months following implants. 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. Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel away from your local area to seek consultation with this particular type of surgeon. Glad to help.

Hi cez,

Thank you for your question regarding a sagging buttock and what can be done to improve this. Thank you for your history and your pictures. The first step in evaluating your case is to determine exactly what you want. In my opinion, there are three key issues: the buttock, the banana rolls, and the lateral thighs or hips.

Regarding your buttocks, you need to decide if you want your buttock bigger, smaller, or just reshaped. If you want it bigger, you need to consider fat transfer (Brazilian Butt Lift or BBL) or Sculptra. If you want your buttock smaller, more buttock liposuction should be considered. If you desire more contour or reshaping, this would likely involve a combination of fat transfer and suction. Concerning your banana rolls, you have excess skin in this region. With no more fat in this area, the best way to remove these banana rolls would be through direct excision. This would involve an incision underneath your buttocks, and a crescent-shaped area of skin would be removed from the upper posterior thigh. The incision would be hidden underneath the buttock.

Regarding your hips, you need to decide which shape you want. If you desire more curves, then consider fat transfer to the hips. If you wish to reduce the hips, consider liposuction.

All in all, you need to create a clear picture of exactly what you want to achieve for your plastic surgeon. Therefore, a custom-tailored plastic surgical plan can be created for you. I hope this helps to answer your questions regarding a sagging buttock and what can be done to improve this.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

I'm sorry to hear about your experience with Vaser liposuction and subsequent fat transfer. It can be frustrating and discouraging to undergo a cosmetic procedure and not achieve the desired results. However, there are options available to help improve your situation.

Based on the opinions you have received, it sounds like there may be different approaches that can be taken to address the sagging in your buttocks and thighs. A banana roll removal surgery or a buttock lift may be possible solutions. It's important to schedule consultations with experienced plastic surgeons who can evaluate your specific situation and recommend the best course of action.

During your consultation, be sure to communicate your concerns and goals clearly and ask any questions you may have. The surgeon will evaluate your anatomy and discuss the risks and benefits of each procedure. They may also recommend combining different procedures to achieve the best possible results.

It's important to choose a surgeon who has experience with the procedure(s) you are considering and who you feel comfortable working with. Be sure to ask to see before and after photos of previous patients to get an idea of their skill and expertise.

Lastly, it's important to have realistic expectations about the outcome of any procedure. While cosmetic procedures can provide significant improvements, they cannot completely eliminate all imperfections. A good surgeon will work with you to achieve the most natural and harmonious results possible.

I hope this helps,
best of luck !

Delivering consistent quality, liposuction and fat transfer result is more difficult than most people believe. The number of plastic surgeons who the master these procedures are in a small minority.
Once someone has had surgery revision becomes extremely difficult. Revision surgery, not only is technically far more difficult than primary procedures, but restoring badly down work is usually very challenging, and often requires having multiple operations.
Each time someone has surgery things are made worse especially if you’re not in the hands of someone who has mastered the procedure.
Starting from your first surgeon, I didn’t do it correctly. That surgeon was not qualified to do revision surgery since revision surgery is many times more complex and difficult and primary Liposuction.
In the end, there are only two variables determine cosmetic surgery outcomes. The first is patient candidacy, and the second is the skill of the surgeon. Typically restoring inappropriately remove fat from poorly done. Liposuction requires multiple rounds of fat transfer. This type of fat transfer work is technically challenging, because patients are generally devoid of sufficient host tissue to support the fat grafts. You cannot control your own fat, distribution based on diet and exercise. Fat distribution is determined genetically, and can only be altered by surgical intervention.
Generally speaking, I recommend all patient start the process of having cosmetic surgery by having multiple in person consultations to find the best providers. This is especially true for complex procedures like liposuction or fat transfer.
Unfortunately, some plastic surgeons have an erroneous belief that our entire Liposuction make the buttocks look larger and fuller. Doing this destroys the contour and destroys the desirable feminine S-curve they should be trying to establish. It appears your providers did not have sufficient skills and experience doing liposuction or fat transfer well, but they also seem to like an understanding of the female torso should look like.
During the process of choosing a provider I recommend, donate consultation patients ask the providers to open up their portfolio and show you their entire collection of before, and after pictures of the procedure you’re interested in. An experienced provider should have no difficulty showing you a minimum of 50 sets of before, and after pictures of commonly performed procedures, like Liposuction, BBL, or any type of fat transfer. And experience plastic surgeons should have hundreds or even thousands of before and after pictures of the regular basis.
Being shown a handful, preselected images, representing the best result of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. Being board-certified and plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered Liposuction or any other procedure.
Doing this procedure well on a consistent basis as people believe.
Once somebody has had multiple operations specially when done by people lacking sufficient skill, the chance of having a quality outcome goes down dramatically. The more complicated the situation is the more important It is to be the hands of the best providers.
To make an assessment and the outcome of a procedure we need to see proper before and after pictures. For individuals who had more than one operation we need to see before and after pictures of every procedure you’ve had.
If you don’t have before, and after pictures and ask your providers to forward, the pictures they took.
Without knowing what you look like before your first procedure, it’s hard to know where to start. Banana role should not be treated with Liposuction. It is a natural skin fold that forms on some people in an upright standing position. It is skin redundancy that happens when you stand up straight. Every part of the body that has significant range of motion like your hips has to have skin laxity to allow for that range of motion. Most people have no problem understanding the concept of getting a folder on their lower abdomen when they sit down. In the sitting position does skin of your lower abdomen is contracted and push together, creating a skinfold. The back of the thigh is the opposite. While sitting, the skin is tight on the back of the thigh, and the contour is ideal. When you reversed, flexing your hips, by standing up straight, the abdomen becomes flatter in the skin on the back of the thigh, punches up and creates a fold just like your lower abdomen did when you were sitting. Because the banana roll as a skin fold it does not respond well to fat removal because it’s not a fat problem.
Liposuction on this area typically only creates problem and you are living proof of that.
Sufficiently experienced surgeons, generally learn to stay away from trying to fix contour problems in the banana role area.
There’s an expression all plastic surgeons are familiar with that hoes “the enemy of good is perfect”.
Whether having more surgery in your case is justified or worth, it depends on the number of variables. The first is how much are you willing to go through to get a partial improvement.
Having had multiple previously failed operation has lowered your candidacy for a quality outcome.
To get a partial improvement will most likely require having multiple procedures. Unless you can find a sufficiently skilled and experienced provider there’s a high chance that any attempt of I’m proving this will once again, simply make it worse.
Finding the right provider generally requires having a lot of in person consultations. This becomes even more important for revision procedures since revision surgery is many times more difficult compared to primary liposuction or fat transfer.
There are no viable non-surgical options to restore your body contour.
Best
Mats Hagstrom MD