Your Questions

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, 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 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