Can You Shave Down A Prominent Tailbone In A Thin Person?

Q: Dr. Eppley, I’m fairly thin and my tailbone is very prominent, even more so when I am bent over. It’s an area I’m Insecure about and experience discomfort when I do certain exercises (like crunchers on the floor). I’m addition to the tailbone area I feel like the lower back area has a weird central divot to it. Would a dermal skin graft work for me? Would you also file down the tailbone some? Is this often paired with fat transfer? If so, what does that process look like? Where do you take the fat graft from? 

Thank you! 

A: In very thin females the tailbone (coccygeal bone) is often exposed due to a very thin subcutaneous tissue layer. This is very evident in you by the central divot in the interguteal cleft area, a manifestation of the lack of fat udner the skin. It is not really that the coccygeal bone is so prominent  (due to a bigger size or angulation but the lack of a thicker fat layer makes it appear so. While many thin people have a prominent coccyx they do not usually have discomfort. You have ‘positional coccydynia’ when your body gets in certain positions.

Ideally the best treatment approach is a partial coccygeal reduction (tailbone reduction) and thickening the subcutaneous cover in some fashion. This is a very tough area for injection fat grafting and sitting on it will just make it resorb. A dermal-fat graft is always best but that requires a harvest site which may be substantial given the surface area to be filled. An alternative is to place a 1 to 2mm thick Alloderm (tissue bank dermis) graft between the reduced coccyx and the skin. That is a stouter tissue graft which is less likely to resorb.

Dr. Barry Eppley

Indianapolis, Indiana