Plastic Surgery for Buttock Aesthetics after Massive Weight Loss

July 8, 2020

As a culture, we are obsessed with buttocks. Turn on the radio, and you will hear Baby Got Back (Sir Mix-a-lot), Fat Bottom Girls (Queen), My Humps (Black Eyed Peas), Bootylicious (Destiny’s Child), or Booty (Jennifer Lopez).

Flip to social media and your screen will be filled with images of Kendall Jenner, Amber Rose, and Nicki Minaj, all viewed from behind. Look on reality TV and find stars such as Kim Kardashian and Kylie Jenner whose celebrity in part has been propelled by the fame of their assets (pun intended!) The influence of our society’s obsession on women’s self-perception cannot be denied and is evidenced in the popularity of aesthetic buttock surgery.

In 2018, the American Society of Aesthetic Plastic Surgeons recorded more than 32,000 procedures that were either buttock augmentation or buttock lifts, a figure that exceeds the number of brow lifts, neck lifts, and thigh lifts performed by members of the society that year. There have been many advancements in weight loss body contouring.

Buttock Aesthetics after Massive Weight Loss

In addition, the demand for nonsurgical buttock augmentation with dilute fillers or biostimulants that increase collagen production has also witnessed considerable growth. Not surprisingly, the bariatric population is not immune to these influences, and patients are increasingly considering buttock rejuvenation and restoration as a part of their post-weight loss body contouring.

In some ways, weight loss patients are particularly vulnerable to these influences as their relationship with their body image throughout their lifetime has been complex, and despite successfully shedding pounds, their body goals are often unfulfilled.

Sadly, the Internet and social media do not necessarily distinguish bariatric body contouring from traditional body contouring surgery.

While the body habitus of weight loss patients varies tremendously, and each patient seems to have a unique genetic program that determines where they gain and lose weight, changes to the buttock with weight loss are nearly universal.

Patients usually present with volume loss and deflation, and the buttock skin rarely demonstrates significant retraction. Consequently, the buttock flattens and the skin sags, imparting the appearance of the senile buttock, or an appearance suggestive of old age. Postural issues frequently make the condition worse.

When patients are gaining weight, they often develop a tilt of the pelvis forward that further detracts from buttock projection. Fortunately, there are a number of ways that improvements in buttock aesthetics can be achieved for the massive weight loss patient.

Circumferential Belt Lipectomy

A circumferential belt lipectomy, referred to as a body lift, is perhaps the most common means to address the buttock during body contouring. The procedure combines abdominoplasty with flankplasties and a buttock lift, excising skin and soft tissue 360 degrees around the torso.

Excision of tissue from the lower back and upper pole of the buttock addresses the skin excess and descent. The result is a tighter, higher buttock. Patients who have residual adipose deposits resistant to weight reduction may also be candidates for a traditional Brazilian Butt lift.

Brazilian Butt Lift

In this procedure, a modified liposuction is performed to harvest fat grafts. The modifications are meant to preserve the viability of the fat cells that are removed. There are several different protocols by which the harvested fat is purified and concentrated, and then those adipocytes are injected back into the buttock with the hope that they will develop a blood supply and survive long term.

The technique has the advantage of improving both donor and recipient sites, but the amount of fat that actually survives can be somewhat unpredictable.

Buttock Auto-Augmentation

Finally, for patients who have limited residual adipose tissue, buttock auto-augmentation could be considered. In this procedure, the skin and soft tissue that would normally be discarded in a traditional body lift is repurposed.

• The blood supply to that tissue is mapped out and preserved.
• The outer layers of the skin are removed, and the tissue is elevated and then rotated and tucked in a pocket that is developed in the buttocks.
• The buttock is then lifted and the body lift incision is closed, burying the soft tissue beneath the buttock skin, and consequently adding volume and projection.

While the technique has been criticized by some for making an already difficult procedure (body lift) more complicated, for properly selected patients, it can be quite rewarding. It should be noted that traditional buttock silicone implants are still available, but have fallen out of favor.

Their use has been plagued by problems with infection, malposition, migration, rotation, and the development of problematic scars around the prosthesis. There are some surgeons, however, that in select cases will determine that the benefits outweigh the risks, and will consider their use. Non-surgical treatments may be the future of buttock volumization and rejuvenation.

Other Buttock Aesthetics Advances

These techniques are growing in popularity, though they currently cannot produce the dramatic changes of surgery.

• Sculptra can be injected to stimulate some collagen growth, and even dilute radiesse is being injected as both a filler and biostimulant.
• Renuva is a fat matrix that seems to recruit fat cells and build volume.
• Emsculpt and Cool-tone are non-invasive devices that can also be used to help build up and shape the gluteus muscle itself.

While not currently a practical means to address the body contour concerns of massive weight loss patients, many surgeons believe that these non-invasive treatments and technologies will improve and play a larger role in our body sculpting armamentarium in the future.

Bariatric patients seeking body contouring represent a diverse and uniquely challenging population. Weight gain and subsequent weight loss often create changes to the body that disappoint and often frustrate patients.

In addition to these anatomic challenges, their tissue is frequently damaged and compromised. With weight loss, the buttock deflates and descends. Fortunately, there are now multiple techniques that be considered to address these concerns and buttock restoration and rejuvenation can be considered as a prominent part of body contouring after massive weight loss.

ABOUT THE AUTHOR Harvard-Trained Board Certified Plastic Surgeon, Dr. Larry Lickstein is in private practice at the Bitar Cosmetic Surgery Institute, a full service cosmetic center in the Washington DC area. A former attending physician at the prestigious Cleveland Clinic, Dr. Lickstein was named a top doctor by Baltimore Magazine and the Castle Connoly Listing for 10 consecutive years. Read more articles by Dr. Lickstein!

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