Your Questions

Q: Dr. Eppley, Have a saggy butt and slightly saggy inner thighs also. Would a buttock lift incision in the infragluteal fold(under buttock)while pulling up the inner thigh slightly be realistic. I donr think a radical upper buttock lift would be necessary as it is more radical and the inner thighs would have to be done separately. Also could my extra tissue cut off be used as an implant to improve the form of the buttocks.What concerns me is the scar in this operation. Is it eventually not too conspicuous as when wearing a bathing suit esp. when bending over. There is a surgeon close to where I live who would do it that way, as he feels a higher buttock lift would flatten my buttock as it is just slightly saggy with a banana roll. Please give me your opinion.
A: Thank you for your inquiry. I would need to see some pictures of your buttocks to best answer your questions. But I do know the following without seeing any pictures.

1) A direct approach to the lower buttocks and thighs is needed. No far away or upper buttock procedures will work.

2) Buttock lift and inner thigh scars I never consider great in many patients. One just has to choose which aesthetic liability they would like better. (scars vs tissue sag)

3) Any buttock or thigh tissue removed is not going to be enough volume to be successfully used as an implant.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I have lost a lot of weight and the one area that bothers me the most is that of my buttocks. It hangs down with a lot of loose skin onto the back of my thighs. I don’t mind its size now but I can’t stand the loose skin at the bottom. And exercise will not get rid of it. What type of buttock lift do I need?

A: When it comes to large amounts of weight loss, the buttocks like every other area of the body is not spared from an overall deflation effect. The deflated buttocks loses both volume from fat loss and exaggerated amounts of sagging due to such volume loss. Buttock reshaping after weight loss can include either volume addition, tucking or lifting the sagging skin or some combination of both.

Buttock lifts can be separated into a true buttock lift (done from above as part of a circumferential body lift) or a lower buttock lift. (which is really a tuck after excision of overhanging skin.

A lower buttock lift is a lower excision/tuck procedure that is done along the infragluteal crease. (or makes a new one) It removes excess tissues and creates a new higher and more tucked in fold. It is not a difficult procedure to go through nor to recover from it. The biggest issue is to just not stress the incision lines (like bending over far) for a few weeks as the area heals. All sutures are under the skin and dissolvable so no suture removal is needed. The incision lines are heavily taped for support and serve as the only dressing. One can shower the next day and only strenuous activities need to be avoided for awhile until the incisions are more fully healed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in some form of a buttock lift. I I would like to have the extra skin/wrinkles removed from my butt. I have hoped to find a procedure that did not include implants. Do you feel I am I a candidate for this surgery procedure?

A: What you are demonstrating is a severe buttock sag with a lot of folds/rolls of skin around the bottom of the buttocks. This often occurs in  very thin women as they age and may also happen after a significant amount of weight loss. While it it true that buttock augmentation would help pick up some of this loose skin, it would take a massively large augmentation to do so. The better approach is to do a lower buttock lift or tuck which removes all the skin folds on the bottom half of the buttock. This places the scar along what should be the infragluteal fold or lower buttock crease. This will not increase the volume of the buttocks, which will still be very flat but it will get rid of a lot of that saggy skin which makes one’s buttocks look a lot older than they really are.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a sagging buttocks problem that started when I had liposuction done many years ago. No matter how much I diet and exercise the lower buttocks will not  tighten up. I have seen some pictutes of your buttock lift results and they show MAJOR improvement and the scarring seems minimal. Based on my pictures, would you anticipate my having similar results?  Do you have any concerns with my age (47) or the fact I have had previous lipo done?  What is the recovery like? As you can see, I have volume, I work out like crazy.  I want a symmetrical lifted butt.   Please tell me there is hope.

A: This is precisely the improvement I would expect. When you cut out the buttock overhang and tuck it, that is always the result one will get. It is an operation that just works. As long as one keeps the side part of the scar no further than the lateral edge of the lower gluteal crease, the scar is not visible. The fact that you have had liposuction previously is probably what may have contributed to the problem and, if anything, is more helpful than harmful as it enables the tuck to be done more effectively due to the loose skin that it has created. I have seen women have this procedure from age 30 to 72, but I don’t think age as anything to do with the success of the procedure. It is all about the anatomy of the problem. If there is overhang, it can be removed and tucked at any age. The recovery from a lower buttock lift is fairly easy. It is not a painful procedure afterwards, just a feeling of tightness in the lower buttocks. (which, of course, one should have if the procedure is done adequately) The only destruction in the first month after surgery is that one has to be careful about bending over which pulls on the incision line…but one is well aware of that because of its tightness. The biggest restriction of that is that one will not be doing any significant exercise that involves the legs.

Otherwise, this is a one hour procedure done under general anesthesia

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a lower elliptical buttock lift in late December.  It looks similar to the procedure that is shown on your website.  Is it normal to still have swelling around and below the incisions 3 months later?  My PS says yes, but I would like a second opinion.  The ‘swelling’ is significant to the point that it looks like a ‘banana roll’ on the back of my thigh, below the incision and buttock crease.  Can you comment?  Any information would be appreciated.  Thanks.

A: All I can say is that this has not been my experience with the lower buttock lift. From what I have observed there usually is very little swelling with this procedure and a quick recovery. The only long term issue is how well does the scar do and the stability of its location. I would suspect that this is more related to the amount of tissue removed rather than swelling at this point.  The very act of sitting on it and the lack of any tissue undermining done in a lower buttock lift limits how much swelling can occur and how long it persists. But this comment is made without seeing pictures of what you look like so this is just speculation for now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I weighed around 95 pounds before I had ovarian cancer.  After my cancer treatments, I gained 130 pounds.  I ended up have gastric bypass surgery and now have lose skin that needs to be taken off. Had a tummy tuck in 2001 so, don’t have too much loose skin in the tummy area. I am interested in my butt, arms and legs…can you help me with this?

A: Thank you for your inquiry. I am going to assume that you need a traditional arm lift (brachioplasty) and an extended inner thigh lift, which would be standard for many extreme weight loss patients after gastric bypass surgery. While every patient is different, I will assume these issues as a starting point. Your butt concern is harder to figure as I am uncertain whether an upper buttock lift or a lower buttock tuck tuck needs to be done. I will assume for now that an upper buttock lift (lower back lift) need to be done as this would be most common in the bariatric surgery patient. It is also a way to finish off a circumferential lower body lift as a second stage procedure to your initial tummy tuck done previously.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hi, I’m interested in getting a buttocks lift with the fat injection procedure. I am currently a student and therefore do not have a lot of money, I’ d like to know if you offer payment plan options and, if so, what would be an approximate monthly payment. Thank you.

A: Fat injections are one of the two options for buttock augmentation. Often referred to as a buttock lift or the Brazilian buttock lift, it ‘lifts’ the buttocks by adding volume and expanding the buttock skin. Probably calling it a lift is a bit of an exaggeration. It is really a buttock augmentation, any lifting is purely coincidental.

As for financing of any cosmetic procedure, there are few if any plastic surgeon’s and their practices that would directly do the financing. Many patient’s ask about whether we finance and it is an understandable question. But plastic surgeon’s are not experts in banking or lending and therefore do not do it directly. It is also not prudent to provide a non-returnable service upfront and then hope to be paid until completion later. For this reason, plastic surgeons use outside financing companies to which they refer their cosmetic patients. There are numerous ones and each plastic surgery practice has one or two that they have had good experience using. In my Indianapolis plastic surgery practice, we have used many over the years and currently use Care Credit. Once patients have the quote for surgery, they can go online and see if they qualify. They have many different financing options which allows patients to choose the length of the loan and their monthly payment.

Dr. Barry Eppley

Indianapolis, Indiana