BBL, pregnancy and weight loss - How to fix a sagging BBL? (Photos)

Question

Hi there! I had a bbl at the age of 22 by as plastic surgeon that I know now is NOT board certified. Over the years I had another child and managed to gain and lose 60 pounds. After this large weight fluctuation my butt has completely lost volume and I am so insecure by my saggy butt. I’m 28 and I want to feel comfortable in my own skin. Are there any procedures in or OUT of the USA I am willing to travel. Thank you in advance!

J. Timothy Katzen, MD, FACS · Answer

Hi, Chreene in Tyler, TX. Thank you for your question regarding a BBL, pregnancy, weight loss, and how to fix a sagging BBL. First, let’s analyze your pictures. And examining your pictures, you have mild to moderate butt ptosis, or butt hang. You also have flattening in the bottom half of the buttock. Most plastic surgeons would agree that the appearance of your buttock is due to your BBL and THEN your 60-pound weight loss. Your buttocks would not look this way without the weight loss. During your weight loss, you have lost some of the fat from the BBL and then some. Also, with the previous BBL, the skin was stretched. With a 60-pound weight loss, some of the fat is lost underneath the skin, leading to sagging buttocks.  What are your goals? If you’re looking for a bigger buttock, I would suggest fat transfer. If you don’t have enough fat to transfer, and it appears that you barely have any fat at this point, you would need to gain weight. If that is not an option, then you may want to consider Alloclae (cadaveric fat) transfer, Sculptra, or buttock implants. If you’re considering just lifting the buttocks, and you are content with the size, then you would need a posterior butt lift. However, this would entail an incision across the top of the buttock to excise skin and fat and thus raise the buttock.
The incision must be placed on the top of the buttocks to pull the buttocks up. The infra-gluteal fold or banana roll incision does not lift the butt. The banana roll incision just flattens the lower portion of the buttock.  A butt lift, buttock lift, or posterior buttock lift would be recommended by the majority of plastic surgeons.  It takes three to four hours to perform a butt lift while under general anesthesia.  The incision starts at the top of the gluteal cleft, also known as the butt crack, goes over the top of your buttocks, and terminates at your hips.  The cut resembles a seagull or butterfly.  Some patients refer to the incision line as a McDonald's incision or a tiny M.  This incision allows for tissue dissection down the buttocks and lifts the skin of the buttocks in a manner similar to a 360 circumferential lower body lift. Give yourself three to four weeks to recover.  It will be crucial for you to stay flat on during your recuperation.  Other ways to firm the buttocks include exercise, StairMaster, and M Sculpt. These are more conservative measures, which may also achieve your goals.   Good luck. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say.  I hope that I have answered your question regarding a butt lift. If you have any more questions regarding a posterior buttock lift, contact an experienced plastic surgeon. Please seek an experienced, board-certified plastic surgeon with significant experience in butt lifts. Make sure they have performed many buttock lift surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf.  If you cannot find an experienced plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen (Plastic Surgeon, President of  the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Oliver Chang, MD · Answer

Based off your photos - there is noted slight deflation of the peak of your buttocks with small noted laxity or sagging of the lower butt onto the upper posterior thigh. There is noted asymmetry in the buttocks (which is normal). The main reason you are seeing this the weight change that happened during your years and pregnancy. When fat was added at the age of 22 yrs old, the fat graft once done healing - was now functioning as normal fat cells - meaning weight gain increase in the fat cell size and vice versa (since you mentioned you lose 60+ lbs). That in turn stretched your skin out and as you lost the weight, the skin tightness didn't keep up with the volume deflation. Your laxity or sagginess is not bad - likely still salvageable. 
1. increase your protein intake while intaking some healthy fats and carbs. 2. Hit the glute muscles with heavy weight lifting to grow your glutes - this will help fill in some of the lost volume from the fat loss in your weight loss. 3. Do the steps above religiously for at least 6-12 months to see positive changes. 4. Then see at that time, if you need to repeat a bbl or add more fat there. 5. There are also other options depending on the surgeon you pick - ie, implants, fillers, some butt skin tightening, alloclae (fat from someone else), etc. 
Most likely you will stop at step 3. Hope this helps.

Daniel Barrett, MD · Answer

Dear Chreene,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can based upon your photos. However, please keep in mind that an in-person, or at least a virtual, consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.

First, just let me say, this is a much more common concern and question than you probably realize.

Buttock “sagging” and/or loose skin 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 most certainly always appear more flat if just a buttock lift from above is performed. On the other hand, an “autologous buttock lift” usually provides very little volume and projection, and almost nothing to the lower 2/3rds of the buttock.

A lower buttock tuck is usually then performed at six months following implants. Coincidentally, a lower buttock tuck also doubles as a thigh lift, removing loose wrinkled skin from this area as well. 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.

Any “non-surgical” treatment or device as well as exercise, unfortunately, will have little to no effect on this problem area. Furthermore, fat transfer and “fillers” perform very poorly in this area and usually result in just a waste of hard earned money.

Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants or buttock tucks you may have to travel away from your local area to seek consultation with this particular type of surgeon.  Getting it done right the first time around is not only the best chance for success, but also will save you from a lot of headaches and money in the future. Glad to help.

Luis A. Mejia, MD · Answer

Hello, thank you for the question, after evaluating your case, you are a great candidate for a ULTRASOUND guided BBL, to improve with direct vision, the buttock area exactly where it needs to have the fat to correct sagginess and give you cack the confidence you deserve.

Mats Hagstrom, MD (license on probation) · Answer

Despite the changes from pregnancy, we need to see proper before, and after pictures to understand how the procedure was done initially to give you a quality assessment of your current outcome.
If you don’t have before and after pictures and ask your provider to forward the pictures they took.
 Doing a second BBL probably isn’t going to do the job.
My best guess is that your problem, stems from skin laxity and potential inappropriate liposuction of the upper aspect of your thigh, though this is just a hunch
I don’t think implants or doing a second BBL is going to get you the results you’re hoping for.
It may also be difficult to harvest sufficient fat to create a bigger bottom.
The sagging isn’t really going to be corrected by adding more volume.
I wish I had a better recommendation for you.
I would be careful moving forward with secondary surgery.
Consider reposting with before and after pictures of your initial procedure.
Best,
Mats Hagstrom MD

BBL, pregnancy and weight loss - How to fix a sagging BBL? (Photos)

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