Like the rest of the body after a great weight loss, the gluteal 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 higher priority areas are addressed, such as the abdomen, arms, and breasts.
Under the normal aging process, the buttocks sag over time, more in some people than others. After extreme weight loss, this flab is greatly exaggerated. Buttock deflation creates folds of loose skin that fold over the lower buttock crease or cause the buttocks to roll downward as a complete unit. In women, this flab effect is usually much greater than in men, since they generally have more skin and fat on their buttocks to begin with.
The buttock lift can be performed with several different methods, approaching the problem from above or below, depending on the problem with the buttocks and what other simultaneous procedures are being performed. One of the most effective methods is the upper or upper buttock lift, which is the back half of a circumferential body lift. Skin and fat are trimmed around the waist above the buttock area as part of the 360 degree cleavage of a body lift. While not as much skin can be removed on the lower back as on the front of the abdomen, the buttocks can be lifted a significant amount. Think of this procedure as ‘rolling up your pants’, if you will. This butt lift can also be done alone, without the front half of a body lift, but it would be unusual to have significantly sagging buttocks after weight loss without an abdominal lift as well.
While the body lift or upper butt lift lifts sagging skin, it will not ‘re-inflate’ the buttocks or resolve their loss of volume from weight loss. In essence, the sag of the buttocks will be improved, but it will still be quite flat. Some plastic surgeons do a ‘self-lift’ at the same time using some skin and fat that would normally be discarded by trimming. 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 fails to place it where the volume is actually needed. (lower, not higher) I’m still not too enthusiastic about this approach even though it’s its own weave. If someone eventually wants a bigger buttock, I’ll usually get butt implants later on.
Another type of butt lift is from below or a lower butt lift. This is an “old” approach that removes the skin on the lower half of the buttocks that bulges out of the buttock crease. This is usually not helpful in cases of extreme weight loss, as it pulls the buttock down by cutting into the skin. This is pulling in the wrong direction for most patients. In cases of mild buttock sagging without significant volume loss, this type of butt lift may be acceptable.
