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.