Like the rest of the body after a lot of weight loss, the buttock area is not spared. While this is usually not at the top of the list of desired body changes, it can become the focus after other more higher priority areas such as the abdomen, arms, and breasts are addressed.

 Under the normal aging process, the buttocks do sag over time, more in some people than others. After extreme weight loss, this sagging is greatly exaggerated.  The deflation of the buttocks creates folds of loose hanging skin that either fold over the lower buttock crease or cause the buttocks to shift lower as a whole unit. In women, this sagging effect is usually much greater than in men as they generally have  more buttock skin and fat to begin with.

Lifting of the buttocks can be done with several different methods, approaching the problem from either above or below depending upon  the buttock problem and what other simultaneous procedures are being done. One of the most effective methods is the superior or upper buttock lift which is the back half of a circumferential body lift. Skin and fat is cut out around the waistline above the buttock area as part of the 360 degree excision of a body lift. While not as much skin can be removed in the lower back as the front part of the abdomen, the buttocks can be lifted a significant amount. Think of this procedure as ‘pulling up your pant’s’ so to speak. This buttocks lift can also be done alone, without the front half of a body lift, but it would be unusual to have a significantly sagging buttocks after weight loss without an abdominal overhang as well.

While the body lift or superior buttocks lift raises up sagging skin, it will not cause the buttocks to ‘re-inflate’ or solve its loss of volume from the weight loss. In essence, the buttock sag will be improved but it will still be fairly flat. Some plastic surgeons do an ‘auto-augmentation’ at the same time using some skin and fat that would normally be discarded with the cutout. Essentially using your tissue to serve as an implant. While this is a clever use of tissue flaps, it rarely adds significant volume and often does not  put it where the volume is really needed. (lower not higher) I remain not overly enthusiastic about this approach even though it is your own tissue.  If someone ultimately wants a buttocks that is bigger, I will usually do buttock implants at a later time.

Another type of buttock lift is from below or a lower buttock lift. This is an ‘old’ approach  that removes skin from the lower half of the buttocks that overhangs the buttocks crease. This is not usually helpful in cases of extreme weight loss as it pulls the buttock down further in cutting off skin. This  is pulling in the wrong direction for most patients. In cases of mild buttock sagging without a significant loss of volume, this type of buttock lift may be acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

Buttock Reshaping by Lifting Techniques

The shape of the buttocks can be altered by liposuction, implants, fat injections, and lifts. Buttock lifts are reserved for those cases in which the buttocks sag, with skin overhanging the lower buttock crease. This condition is most common today after significant weight loss after bariatric surgery. In the past, buttock lifts were synonymous with the term, ‘fanny tuck’, which implied the cut out of skin along the lower buttock crease.

Today, buttock lifts are of two types, upper and lower buttock lifting. An upper buttock lift is really part of a circumferential body lift, which is now commonly performed in bariatric surgery patients who have had a lot of weight loss. In severe weight loss, the buttocks sag considerably and a circumferential body lift is like pulling up one’s pants after cutting out a lot of skin along the lower back. The back cutout is only half of the 360 degree cutout which includes a frontal tummytuck as well. This leaves a scar along the lower back and does do a tremendous job of lifting severely sagging buttocks. It will not, however, provide any volume to the buttocks which will remain quite flat. In some cases, the skin and fat from the back is rotated on a vascular pedicle to add volume to the upper buttocks as the lower buttock skin is lifted over top of it.

The lower buttock lift is done along the lower buttock crease which is at the junction of the buttocks and back of the leg. An elliptical cutout of skin and fat along this crease does remove any skin overhang and ‘hides’ the scar in this crease area. It will not, however, add any volume or add any rounder shape to the buttocks.

While lower buttocks were the only option in the past, upper buttock lifts today are done as often, if not more so, than lower buttock lifts. Either way, buttock reshaping is done more often by liposuction, fat injections, or implants than excision and lifting procedures. Buttock lifts are just one option of many in buttock sculpting options.

Dr. Barry Eppley

Indianapolis, Indiana