130 pound weight loss, sagging skin - what procedures can tighten my skin and lift/round out my butt? (Photos)

Question

I have lost about 130 lbs and my legs/butt have loose skin, but not overhanging lose skin. I sent some photos to a clinic and they said I wasn’t a good candidate for sculptra because it wouldn’t give me the results. I am looking for.they said what they recommend is surgery, but I’m too scared for a BBL and I don’t feel like I Need a whole leg lift. I have some volume loss at the top of my butt and i now have some hip dips (never had them before) saddle bags, and lots of cellulite and texture at the bottom of my butt and saddle bags. what reccomendations do i have that can tighten my skin for my butt and lift/round it out

Dallas Buchanan, MD · Answer

Congrats on your weight loss! The best procedure for you is a circumferential body lift. This will elevate the buttock and eliminate redundant skin from weight loss. It can also help to augment the buttocks through a local tissue transfer (as opposed to fat grafting) to give greater shape and transition from the lower back into the buttock area. Usually this is also combined with some lipo and lifting of the lateral hips as well. There is no other procedure that will remove more skin and create more of a powerful contouring to your shape. Avoid recommendations for "skin tightening" and for BBL (buttock fat grafting). The skin tightening won't work and you will end up wasting your money.  And a BBL will only make a fuller more saggy buttock that you will not be happy with. Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Anna Chacon, MD, FAAD · Answer

Losing 130 pounds is an incredible accomplishment, and I want to acknowledge how much work that represents. What you’re describing is very common after major weight loss: the skin often loses elasticity, and there can be a combination of volume loss in the upper buttocks, hip dips, cellulite, and mild-to-moderate skin laxity without having large overhanging folds of skin.

Based on your description, I would think about this as two separate issues:

Skin tightening / texture improvement
Restoring volume and shape to the buttocks
Why Sculptra May Not Have Been Recommended

Sculptra can stimulate collagen and create subtle volume improvement, but after a 130-lb weight loss, it often cannot provide enough lift or fullness if there is significant tissue deflation. The clinic was likely trying to set realistic expectations rather than saying you have no nonsurgical options.

Non-Surgical Skin Tightening Options

If your skin is loose but not hanging in folds, these are the treatments I would consider most reasonable:

Radiofrequency microneedling (Morpheus8, Potenza, Secret RF)

Helps tighten mildly loose skin
Can improve crepey texture and cellulite appearance
Usually requires 3-4 sessions
Results develop gradually over 3-6 months

Hyperdilute Radiesse

Different from Sculptra
Works more as a collagen-stimulating skin treatment than a volumizer
Can improve skin firmness and texture on the buttocks and outer thighs

Cellulite-specific treatments (Avéli, Cellfina, or RF-based devices)

Particularly helpful for the lower buttock and saddlebag dimpling you described
These target the fibrous bands that create the dimpled appearance
For the Loss of Roundness and Upper Butt Volume

Since you are understandably hesitant about a Brazilian Butt Lift (fat transfer surgery), I would consider:

Radiesse buttock contouring

Provides modest lifting and contour improvement
Better for patients who want natural enhancement rather than a dramatic BBL look

Sculptra combined with energy-based tightening

Even if Sculptra alone would not be enough, it can sometimes be useful in combination with RF microneedling for patients with mild to moderate volume loss.
The Important Question: How Loose Is the Skin?

The fact that you do not have overhanging skin is encouraging. In my experience, patients who have:

loose but retractable skin,
visible cellulite and wrinkling,
flattening of the upper buttocks,
and mild hip dips

often achieve meaningful improvement without a formal thigh lift or lower-body lift, although the results are more modest than surgery.

A Realistic Non-Surgical Plan

If you were my patient, I would likely discuss a staged approach:

Stage 1 – Tighten and improve texture

RF microneedling to the buttocks and outer thighs
Consider hyperdilute Radiesse for collagen stimulation

Stage 2 – Restore shape

Targeted biostimulatory filler (Radiesse and/or Sculptra depending on tissue thickness) focused on the upper outer buttocks to create a gentle lifted and rounded appearance and soften the appearance of hip dips.
What I Would Avoid
Large-volume filler augmentation of the buttocks
Thread lifts for this area (results are generally short-lived and often disappointing)
Assuming that a full leg lift is your only option if the skin is not actually hanging.
My Honest Take

Because you’re scared of a BBL and don’t feel you need a major lift, I would focus on collagen stimulation + skin tightening first. Many post-weight-loss patients are surprised that improving skin quality and upper-pole volume can make the buttocks look rounder, firmer, and more lifted, even without surgery.

The key is having an in-person evaluation to determine whether your laxity is mild, moderate, or severe, because that single factor is what most accurately predicts whether nonsurgical treatments can give you a result that feels worth the investment.

Laser Skin Solutions - Portland · Answer

When addressing post-weight-loss concerns like volume loss, residual skin laxity, and structural definition&mdash;particularly around the gluteal region, thighs, or abdomen&mdash;choosing between EMS RF and VelaShape depends entirely on whether your primary goal is deep muscle building and lifting versus circumferential reduction and cellulite smoothing. Here is a clinical breakdown to help determine which modality best fits specific patient profiles:1. Electromagnetic Muscle Stimulation (EMS) + Radiofrequency.Primary Mechanism: Combines High-Intensity Focused Electromagnetic (HIFEM) technology with synchronized Radiofrequency (RF) energy. The electromagnetic field induces thousands of supramaximal muscle contractions (equivalent to tens of thousands of crunches or squats in a 30-minute session), forcing muscle fibers to hypertrophy and remodel. Simultaneously, the thermal RF component heats the dermal layers to induce collagen remodeling and assist with fat reduction. Best Indicated For: Patients seeking to actively build muscle mass, lift, and round out target areas (such as lifting and toning the buttocks or defining the abdomen) while providing secondary skin tightening from the thermal energy. It is ideal for individuals with minor volume loss or laxity who want an athletic, lifted contour without surgical intervention like a BBL.2. VelaShape (Infrared Light, Bi-Polar RF, and Vacuum/Massage)Primary Mechanism: Utilizes a multi-dimensional approach combining infrared light, bi-polar radiofrequency, and mechanical vacuum rollers to heat subcutaneous fat cells, increase local blood circulation, and stimulate lymphatic drainage.Best Indicated For: Patients focusing primarily on circumferential reduction, smoothing stubborn cellulite, and firming surface skin texture on areas like the thighs, flanks, and lower buttocks. While it improves dermal density and firmness via collagen deposition, it does not actively contract or build underlying muscle tissue.Clinical Recommendation SummaryChoose EMS + RF if your main objective is building underlying muscle volume, lifting flat areas (such as post-weight-loss gluteal flattening), and tightening overlying skin laxity simultaneously.Choose VelaShape if the primary goals are smoothing textural irregularities, reducing localized fatty deposits, and targeting surface cellulite.

130 pound weight loss, sagging skin - what procedures can tighten my skin and lift/round out my butt? (Photos)

Answers (3)

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