Most commonly and effectively, saddle bags are treated with liposuction.
Sagging of the Bottock may require a buttocks lift/tuck but in younger patients (<60 y.o.) it is usually best to plump the butt back up with either autologous fat transfer or buttock implants and ovoid the unsightly scars of a lift/tuck procedure.Both are very good options so what it comes down to, like any surgery, is proper patient selection. Indeed because at least 50+ % of the fat transferred will melt away within a year, most patients are not good candidates because they lack an adequate amount of fat to harvest. Thus buttock implants become a very good, safe, and long term reliable option for most patients seeking buttock augmentation (at least in my practice). The implant should always be placed under or within the gluteus maximus muscle. In this position, the implant is less palpable, less visible, and does not sag over time unlike implants placed on top of the muscle. Therefore it is extremely important to seek consultation with a board certified plastic surgeon who specializes in this procedure. Best of luck...RAS