Like the rest of the body after a major weight loss, the buttocks area is not spared. While this is not usually at the top of the list of desired body changes, it may become the focus after other higher priority areas such as the abdomen, arms, and breasts are addressed.
Under the normal aging process, the buttocks sag over time, more in some people than others. After extreme weight loss, this sagging is greatly exaggerated. Buttock deflation creates folds of loose skin that fold over the lower buttock crease or cause the buttocks to roll down as a complete unit. In women, this sagging 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 using several different methods, approaching the problem from above or from below, depending on the buttock problem and what other concurrent procedures are being performed. One of the most effective methods is the upper or upper gluteal 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 a 360-degree excision of a body lift. While not as much skin can be removed in the lower back as in the front of the abdomen, the buttocks can be lifted a significant amount. Think of this procedure as ‘pulling up your pants’, so to speak. 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 glutes after weight loss without an abdominal overhang as well.
While a body lift or upper butt lift lifts sagging skin, it will not ‘re-puff’ the buttocks or resolve their volume loss from weight loss. In essence, the sag of the glutes will be improved, but it will still be fairly 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 bulk and often fails to place it where the bulk is really needed. (lower, not higher) I’m still not too excited about this approach even though it’s its own fabric. If someone ultimately wants bigger buttocks, 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 fashioned” approach that removes skin from the lower half of the buttocks that protrudes from the buttock crease. This is usually not helpful in cases of extreme weight loss as it pulls the buttock down as it cuts through 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 buttock lift may be acceptable.