Your Questions

Q: Dr. Eppley, I am interested in a lower buttock lift. I do not want a bigger buttocks or anything put in it, I just want the bottom of it to not sag. I don’t care if the buttocks is a little flatter I just don’t want it to hang down anymore. Since I have lost a lot of weight not only has my buttocks dropped but my outer thighs have dropped as well. My thighs are not heavy but they have some loose skin. When I pull them up they look just fine so I am wondering if some type of thigh lift could be done as well.

A: In regards to your buttocks and outer thighs, a partial solution exists. A lower buttock lift can tuck and tighten the lower buttocks through an elliptical excision along the infragluteal crease. It does flatten the lower buttocks a bit but this is not an issue for you as you have stated. The outer thighs is a more problematic area because any effective skin tightening/lift will create a visible scar that would only be an acceptable trade-off in the extreme weight loss patient who suffers a lot of thigh skin sagging. Whether such a scar would be acceptable to you remains to be determined.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in a reverse tummy tuck, I’m at my goal weight and  I’m 48 years old. I’ve had previous liposuction to tummy, buttocks, and thighs.  I’m interested in just tightening the skin in my upper abs.  I do not want any liposuction as this has already caused uneven skin and a permanent wrinkle in my tummy.  I don’t need my muscles to be tightened as they are already pretty tight.  I just want to tighten the skin. When I pull the skin up under my breasts, it does miracles.  I am not looking for perfection.  Even if it protrudes a bit, I’m fine with it.  I just want to fix the uneven skin and the permanent wrinkle that is there.  

Can this be done with local anesthesia and twilight or IV sedation?  I have a real hard time with general anesthesia. Also, where do you tether the incision? The rib or the muscle?  To keep the scar from stretching or moving downward? Does the scar have to go across the breast bone?  Can it be just under the breasts?  I do have large breasts so they may hide the incisions which would be a bonus.  Again, I am not looking for total flatness.  Just get rid of the bumps or unevenness.

I’m also interested in skin removal from my buttocks and outer thighs.  I don’t want a Brazilian butt lift.  I don’t care if my butt is flat.  I have lost weight in my lifetime and gained and lost again.  This has left me with saggy skin and some dimples, maybe due to liposuction as well.  I don’t want liposuction in this area.  If you think it has to be done then that’s fine.  I just want some even skin with no dimples.  Can you suggest something for this area that I have not been able to find?  The only thing I can think of that would help is a skin removal/tightening.  If it can help my outer thighs then great.  Please see my photos.  I would also like this to  be done without general anesthesia.  Is this possible?  Can this be done the same time as the reverse tummy tuck.

A: Thank you for your inquiry and sending your pictures. As reverse tummy tucks go, you are about as perfect a candidate for it as I have seen. They are for women that have either had liposuction, a tummy tuck or weight loss where the tissues below the belly button are taut. But the skin above the belly button is loose and has some overhang exists onto the umbilicus. By simply pulling up on the abdominal skin a good improvement is seen. By definition a reverse tummy tuck is a more simpler form of a tummy tuck, does not involve muscle plication and is a skin excision only procedure.

The key in a reverse tiummy tuck is the incision location. I have done it either keeping the incisions limited to the inframammary folds or crossing the lower end of the sternum. When it crosses the sternum it produces a better skin lift/tightening (due to the central pull) but does have visible scar location in the very center. When the ellipitical skin excisions are limited to the inframammary folds, the effect is not quite as good but still apparent. One has to decide whether more upper abdominal skin tightening is worth the scar trade-off. The upper abdominal tissues are plicated to the fascia over the ribs at the inframammary fold level.

In regards to your buttocks and outer thighs, a partial solution exists. A lower buttock lift can tuck and tighten the lower buttocks through an elliptical excision along the infragluteal crease. It does flatten the lower buttocks a bit but this is not an issue for you as you have stated. The outer thighs is a more problematic area because any effective skin tightening/lift will create a visible scar that would only be an acceptable trade-off in the extreme weight loss patient.

As uncommon as reverse tummy tucks and lower buttock lifts are, they are not in my practice. I have performed them many times although their frequency is in the range of 3 to 4 per year for reverse tummy tucks  and 10 to 12 times per year for lower buttock lifts. Both can be performed under IV sedation although, because of the prone position and airway security, the lower buttock lift should be done under local anesthesia if one is not having general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been googling all night and saw a picture of my butt! When I followed the link it led me to your site. I have suffered with them embarrassment of my saggy butt for most of my life. Even in my late teens when I got down to 95lbs due to working out three times day I still had a saggy butt! I’ve researched butt implants and fat transfer to my butt (I don’t have enough fat) but I really don’t need a bigger butt. I just don’t want the sag. How many of these procedures have you done? How long would I have to stay in Indianapolis after surgery before I could fly home?

A: You are referring to a lower buttock lift or tuck. I have done many lower buttock lifts and it does work well to correct a lower buttock skin sag. Please send me some pictures of your buttocks for my assessment for this procedure. I will have my assistant Camille pass along the cost of the procedure to you later today. You could return home the following day as this is a procedure which is not associated with much pain and all sutures are placed under the skin so there is no need for suture removal later.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m from South America but I’m planning to travel to the US. Because one year ago I had liposuction on my banana rolls and now my butts looks larger and the gluteal fold is very prominent. I have attached pictures. Can you tell me if there’s anything that can be done to correct this? (maybe a lower butt tuck?)

A: Thank you for sending your pictures. What you have is infragluteal fold accentuation due to lower buttock ptosis where the buttock skin hangs over the crease. This is a common problem that develops after liposuction of the lower buttock/banana rolls. My assumption is that you would like the fold to be less distinct and the loose skin on the lower buttocks removed. If these are your goals, these can be accomplished by excision of the skin above the fold, making a new fold that is less deep and a smoother transition between the lower buttocks and the posterior thighs. Some people call this a lower buttock lift or a lower buttock tuck. And that would be the name to call it. But what is really being done is that the loose lower buttock skin and the fold are being removed to create a less deep infragluteal fold and smoother transition between the buttock and the thighs. But so doing it may also make your buttocks look a little less full because its roundness is decreased.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am very petite female 5′ 1″ weighing 1055lbs but have a weird lower body appearance with fat thighs. I got smart lip done on legs (outer thighs and above knees) almost 3 years ago. There was a lot of bruising and scars that diminished a lot after a year but I can never wear anything that is above my knees anymore thanks to the unevenness in the back of my thigh, loose skin and multiple banana roll like appearance right below my buttocks.What can be done to fix this? Looking forward to your advice and guidance. I have attached my picture. Is there any hope for fixing my banana rolls?

A: Your picture shows a triple banana roll on the left side and a double banana roll on the right. I assume this came from the volume deflation from the Smartlipo and perhaps the disruption of the infragluteal crease as well. Regardless of the cause, significant improvement can be obtained through a lower gluteoplasty procedure. (lower buttock excision and tuck = aka lower buttock lift or tuck) The banana rolls can be removed and a single infragluteal fold recreated.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently had lower buttock lifts performed and I am concerned. I had a  banana roll deformity and I had the skin removed and a scar line created. At two months after surgery there are ripples by the incision line. While the incision line is thin I can’t help but notice, feel and see the rippling effect. I am using topical oil and silicone strips but nothing seems to change. I’ve contacted my surgeon and he says everything will be fine but after reading and seeing the pictures of your case studies I can’t help but think that I’ve ruined my body. Would you kindly tell me if this will go away. I’ve been nursing my scars for the past two months and it’s caused me considerable stress. I realize your assistance is a lot to ask so if you can find the time to be honest and realistic I would appreciate a second opinion on the scarring and healing process of these longer than expected incisions. Thank you for your time in advance and thank you for being so diligent in posting the case studies.

A: A Lower buttock lift places scars that should be placed in the infragluteal location. If well done they should not extend beyond the natural buttock crease so it is not visible from the sides. I am not sure why the incision is longer than you expected provided your surgeon was very clear before surgery as to its location and extent. The rippling to which you refer I can not tell based on your description as to whether this is along the incisional closure edges or are from skin ripples that parallel the scar. This distinction is important as one may improve with more time (incisional rippling) while the other (skin ripples) will not. I would need to see pictures of the lower buttocks to better answer your question as to the fate of these ripples.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The shortened version is that I first got lipo on the backs of my thighs 15 years ago about age 20. The surgeon took too much fat out under my buttocks creating banana rolls. I had several corrective lipo surgeries and subsequent three fat transfers. The fat transfers seemed to transfer the fat too low (not in the crease under the buttocks) creating a more pronounced banana roll and more rolls beneath. No exercise will help and I just don’t want to go through life with these legs. It’s hard to even wear pants without the rolls showing. I found you beause I saw a surgery you did removing skin, (more on the lower buttocks I think) and because it seems like you do a lot of body implants. I’m afraid to cut the rolls out because of the scar and particularly because the scar could spread due to my active lifestyle.  I would consider it however. I’m wondering if you think a combination of lipo and some implants in my legs would be a possibility. I don’t care if it makes my thighs bigger I just want them to look even. I have a one year old and am hoping to get pregnant within the next year. 

1. Would thigh implants be possible or would skin need to be removed?

2 . Should I wait until I have recovered from my next child? I only want to have two.

A: Thank you for sharing your story and pictures. You now have a double roll lower buttock deformity. There is a defined roll both above and below the infragluteal crease. Without knowing your history one would say to just try liposuction…but that is of course how you got here in the first place. The only way you are going to eliminate those rolls is to treat the problem which is too much skin and fat through excision. (lower buttock tuck/lift) This is not a problem that is amenable to implant augmentation or further liposuction. By removing a horizontal wedge of skin and fat both above and below your existing crease line the rolls can be eliminated and a more defined infragluteal crease can be obtained. While this does create a scar, I have not found it to be problematic for any patient. Significant scar spreading has been seen even in active patients. One does have to avoid strenuous exercise that pulls the gluteal crease apart for about 6 weeks after surgery. Whether this is something that is done before or after your next pregnancy is a personal issue. I don’t think pregnancy has any affect on the scar or the long-term outcome.

I hope this is helpful,

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had liposuction in buttock area  which was a big mistake and it has sagged and become loose. The lower crease has gone down and is asymetrical. I am not a big person and the amount should not be that much. I am interested in a buttock wedge excision. I have several questions:

1)) Does this require general anesthesia or can it be done just by local? Is IV sedation needed and can that make it riskier? I had general for the surgery initially and did not like it at all.

2) When the tuck is done can I still run and do aggressive exercises?

3) How permanent is the result? I want to make sure if I stay within 5 pounds of current weight the results don’t evaporate over time and follow up procedures are needed.

4) What are the risks involved? Since it is in the legs is it more riskier to get embolisms? Can this be fatal?

5) How long is the recovery? If out of town how long do i need to stay there and any flight restrictions?

6) I did check here locally and they told me the total procedure is 1 hour with Local and IV sedation. I was interested as you have more experience and they have not done it before and how long does it take?

7) If i am out of town how are complications handled if any?

Thank you a ton, and look forward to your response!

A: I am not a fan of liposuction to the buttocks and your outcome is exactly why. A lower buttock lift, what you call a wedge excision, can be a very effective solution ot ptosis or sagging of the lower buttocks. In answer to your questions:

1) It could be done under IV sedation. While it could be done under local anesthesia that is not how I would have it done.

2) You can return to all forms of exercise but you should wait 4 to 6 weeks before doing so.

3) It is a permanent result.

4) Embolisms are not a concern with lower buttock lifts.

5) You could fly home the next day or two.

6) I have done many lower buttock lifts over the years and I find the results very effective and satisfying in the properly selected patient. The procedure will take one hour to do.

7) The biggest ‘complication’ in buttock lifts is suture extrusions or small openings…all self-resolving problems. If any questions, send pictures of concerns by e-mail. That is how we handle all postoperative concerns from afar.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in having the surgery of gluteal crease correction. I do not need a buttock lift per se but a correction of buttock crease. I am 5 ‘9″ tall & very thin & had a thigh lift years ago which was not done very well & gave me a lower uneven shaped buttock crease which makes my buty look loger than it should and the crease needs to be higher. I want to make the crease more even and have it round and higher. I have sent you pictures to study. I just recently had the crease corrected three weeks ago but this surgeon made the same mistake and just followed the original surgeon’s incision marks which were completely wrong and so it has not been corrected and still pretty much looks the same and the right cheek is also lower than left. I should have much better results for what I paid. I am so very disappointed. The top portion of my butt looks normal and  round, but now I have loose skin and square/pointy shape at side view hanging down lower than the butt. The incisions/scars needed to be redone in the right position and be made more even, rounder and higher and the bit of loose skin on back of thighs needs to be excised and lifted. Have you ever seen anything like this done before? Do you have experience correcting this issue and think you could correct it and make it look much better and completely normal? This disfigurement has made me very self conscious & sad.

A: Thank you for sending your pictures and describing your concerns. I think you are spot on and  I am completely bewildered as to what was actually done doing your recent procedure. I am going to assume that the size of the fresh incisions/scars that I see are the extent of the skin resection/crease creation? I will assume for now they are. If so, they are far too limited to adequately address the creation of a more complete lower buttock crease, create a distinct break between the lower buttocks and the upper thighs, and get rid of the bulge or overhang that you have. Perhaps you were unreceptive to a more complete or longer incision ??? At any rate, the lack of a distinct buttock/thigh demarcation, improved lower buttock crease/shape symmetry and elimination of the transitional bulge can be done by a longer and more wide excision of skin and fat with a tuck down to the gluteal fascia. This can be trememdously effective for your type of problem provided you can accept a longer but well placed scar. One of the keys to a lower buttock lift/crease creation is to not have the side part of the scar extend into the visible lateral thigh area.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am writing in reference to what I have read in a posting on your site: Case Study: Lower Buttock Lift for the Saggy Derriere from Friday, July 20th, 2012. It seems as if the procedure you perform is one that sutures de-epthelialized dermal flaps to the gluteal fascia, thus redefining the infragluteal  fold. My situation is that I lost about 15 pounds a few years ago, resulting in a saggy buttock. This is also likely age related as I am 45 years old. I am happy enough with my buttock per se, which although small might be redefined by the removal of the offending skin, I’m thinking. If I send you pictures would you be able to tell if this procedure would work for me? Thank you in advance for your time and responses to my question.

A: Pictures of your buttocks will do quite nicely in determining your eligibility for a lower buttock lift. Please send a picture from a full back and side view of your buttocks. You are correct in how a lower buttock lift is performed, de-epithelization of the excess buttock fold skin in a horizontal orientation and then suturing the skin edges down, if possible, to the buttock fascia. All skin sutures are placed in a subcuticular location and are of the barbed dissolveable variety so no suture removal is necessary. The only dressing used is glued on tape. There usually is very little discomfort after this procedure. One just needs to avoid bending over at the waist beyond 90 degrees and strenuous exercise for 3 to 4 weeks after the procedure.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I would like to know of you can take fatty tissue from another part of your body and inject it into your butt to make it rounder where it has dropped due to loss of elasticity. I am a 50 year old lady and I am a diabetic.

A:  Transferring fat, usually from the abdomen and flanks, into the buttocks is a very common procedure today. Known by the name of a Brazilian Butt Lift, fat is obtained by liposuction, concentrated and then injected into the gluteal muscle and subcutaneous tissues for an augmentative effect. While the inadvertent body contouring benefit from the procedure is assured (fat reduction), how well the fat that is transferred into the buttocks is not. Survival rates vary widely from 10% to 90% with most patients having an approximate 50% survival rate. What factors affect survival of the injected fat is not precisely known. But having diabetes may be a factor that adversely affects survival, particularly if you have insulin-dependent diabetes. Diabetes that is treated by oral medication is less likely to have a significant impact on fat graft survival.

Another treatment consideration besides fat injection is a lower buttock lift. When the buttock falls over the lower skin crease where it meets with the upper thigh, it may be better treated by excision and re-establishment of a well-defined skin fold. This can also be combined with fat injection for volume increase for an enhanced effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: The procedure that interests me is the one that will reduce the size of my buttocks.  I am in good shape and target workouts to the area, but my  buttocks hangs down over the gluteal crease and no matter how much I strengthen those muscles, I am not getting the results I want. I would like to somehow reduce the area.  I have already had liposuction on pther areas but my my doctor did not want to treat my buttocks as she feared there was a risk that the buttocks would droop more after liposuction.  I will continue to workout my glutes to raise them by strengthening the muscles, but I think that I will still want to reduce it by removing excess tissue because it is still too large in proportion to the rest of my body.  What are my options for this surgery?

A: Your description describes perfectly a lower buttocks lift. Used for correction of buttocks ptosis, it removes the part of the buttock (skin and fat) that overhangs the gluteal crease. Your plastic surgeon was wise to avoid liposuction of the lower buttocks as that would accentuate the problem, creating what is known as the ‘banana peel’ buttock deformity. This is a very effective procedure but you are correct in assuming that it leaves a residual scar.

The biggest issues with a lower buttocks lift is the scar location and what one was must refrain from after surgery for up to a  month. The scar will be at your existing lower buttocks crease, maybe ending up just a smidge higher. To prevent wound healing problems, such as incisional separation, one needs to avoid 75 to 90 degree bends particularly during exercise. I have never seen problematic scars or patients unhappy with the scar results. But I certainly have seen wound separation issues.

Dr. Barry Eppley

Indianapolis, Indiana