We had an extensive discussion about buttock lift surgery, which is designed to correct excess skin and tissue laxity in the buttock region. This is common after major weight loss, aging, or volume loss. A buttock lift elevates, tightens, and reshapes sagging tissues to restore a more youthful, lifted contour. The goal is a natural, firm, aesthetically improved shape while preserving buttock volume and projection.
How a Buttock Lift Works
A buttock lift uses two main incisions to remove excess skin and reposition the remaining tissue:
- Upper incision: A horizontal incision placed across the lower back at the upper border of excess tissue.
- Lower incision: Below the lax, sagging skin of the lower buttock area.
De-epithelialization Technique
The key to this surgery is the section of tissue between the two incisions. Instead of removing it entirely, the outer skin layer (epidermis) is removed while leaving the underlying dermis and fat attached and vascularized. This preserved tissue provides:
- Natural padding
- Improved projection
- A longer-lasting lifted contour
- Better integration and blood supply
When the sagging lower buttock skin is elevated, it is laid over this preserved tissue, enhancing fullness without the need for implants. This produces a more natural and durable augmentation effect.
Liposuction in Buttock Lift Surgery
Liposuction plays a very limited role in buttock lift surgery. Unlike arm or thigh lifts—where significant liposuction precedes skin excision—the buttock region requires volume preservation to avoid a flat appearance.
Selective, Conservative Liposuction
- Tumescent infiltration: Fluid containing saline, epinephrine, and anesthetic improves safety and reduces bleeding.
- Power-Assisted Liposuction (PAL): Used only in targeted lateral areas for precise contouring with minimal trauma.
- No deep liposuction to central buttock: Volume here must be preserved.
Techniques involving heat or cold such as ultrasound-assisted, laser-assisted, or cryolipolysis-assisted liposuction are avoided due to higher skin injury risk.
Why Volume Preservation Matters
The buttock must maintain natural fullness to create an attractive, youthful contour. Aggressive liposuction would create a flat, deflated result. Preserving tissue—especially the central and upper buttock—is essential to achieving:
- Better projection
- Natural curvature
- Balanced proportions
The de-epithelialized tissue acts as a built-in augmentation, providing durable shaping without using implants.
Recovery From Buttock Lift Surgery
Drains
Drains may be placed to prevent fluid accumulation. They typically remain for 1–2 weeks depending on drainage levels.
Compression Garments
Compression garments are worn for about six weeks to reduce swelling, support healing tissues, and help shape the final contour.
Sitting Restrictions
Patients must avoid sitting directly on their buttocks for the first couple of weeks. A special cushion may be used when sitting is necessary. Following these restrictions protects the healing tissues and incision lines.
Activity Restrictions
- Avoid strenuous exercise, lifting, and bending for two weeks.
- Walking is encouraged early to reduce blood clot risk.
- Movement should be careful to avoid tension on the incisions.
Time Off Work
Most patients need 1–2 weeks off, with physically demanding jobs requiring more time.
Understanding the Scars
A buttock lift creates significant, permanent scarring across the lower back and upper buttock region. These scars:
- May widen during the first year
- Are more visible than liposuction-only incisions
- Are influenced by tension, movement, healing characteristics, and compliance with post-op instructions
Scars can often be concealed by certain undergarments or swimwear, but complete concealment is not always possible.
Setting Realistic Expectations
Buttock lift surgery can dramatically improve contour, but several truths accompany the procedure:
- Scars are permanent and can be substantial.
- Results depend on weight stability.
- Sitting restrictions are strict and essential.
- Volume must be preserved to avoid flattening.
- Final results take several months as swelling resolves.
Potential Complications
Possible risks include:
- Delayed wound healing or wound separation
- Scar widening or thickening
- Asymmetry or irregular contour
- Seroma or hematoma
- Infection
- Skin sensation changes
- Skin necrosis in stressed areas
- Scar migration or descent
- Blood clots
- Fat necrosis if preserved tissue loses blood supply
- Potential need for revision surgery
Meticulous surgical planning, preserving blood supply, careful patient selection, drain use, compression garments, and strict adherence to activity restrictions all reduce the risk of complications.
Making the Decision
The key trade-offs are improved contour and projection versus permanent scarring and a recovery period involving lifestyle changes, including sitting restrictions. The technique using preserved de-epithelialized tissue offers the most natural projection without implants and is central to achieving good results.
Key considerations include:
- How much sagging impacts your confidence and comfort
- Willingness to accept substantial scars
- Commitment to sitting and movement restrictions
- Weight stability
- Understanding of healing time and scar behavior
- Realistic expectations regarding final appearance
Photos were taken, a quote was provided, and the patient will return in a week for follow-up discussion.
