Will A Lower Buttock Lift Provide Long Term Stability Of The Elevated Infragluteal Folds?

Q: Dr. Eppley, I am contacting you now because I have come across your case report about correction of sagging buttocks: https://exploreplasticsurgery.com/plastic-surgery-case-study-long-term-persistence-of-the-infragluteal-fold-in-lower-buttock-lifts/

I have one patient with a double fold after liposuction in the dorsal thigh area about 18 months ago. She has tried thread lift, fillers and some skin tightening at other clinics with no result. We have been discussion a surgical procedure similar to what you have described in your case report.

In my experience it is always difficult to elevate tissues against gravity long-term, and I have told her that there is a risk that the native gluteal fold with time will appear lowered even though if we can correct the double fold. However, you seem to have overcome this; your results are not only nice but also are long-lasting.

Therefore, I wonder if you could elaborate a bit on which sutures that you use (permanent?), and if there are any other pearls/caveats that could be useful to know.

A:One of the most common reasons for lower buttock lift surgery is when liposuction is done for the banana roll deformity. Having done many lower buttock lift surgeries I have never found descent of the re-created fold to be a problem.. Technically the excision creates the elevation of the fold and efforts to deliberately lift the fold are not really needed. By definition it is the overhang that is being removed and the excision merely re-establishes the original fold which was not visible because of the overhang. This is what you see when liposuction suction has created the problem which is really a form of pseudo ptosis. Why all of the other trial procedures do not work is because they simply cannot get rid of what is a tissue excess.  That concept of a lift through threadlifts and skin tightening is an erroneous concept for the problem. You can’t lift or skin tighten away tissue excess

With the excision I secure the dermal edges of the excision down to the gluteal fascia. I don’t use permanent sutures, rather In use long lasting resorbable sutures.

The biggest postoperative problem i lower body lifts, as defined by the need for revision on surgery, is not the descent of the fold but some hypertrophic scarring which may require a secondary scar revision.

Dr. Barry Eppley

World-Renowned Plastic Surgeon