Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘lower buttock lift’

Plastic Surgery Case Study – Lower Buttock Tucks

Tuesday, January 27th, 2015


Background: The shape of the buttocks can take on many different forms. The buttocks have three different sections, the upper buttock, the mid buttock, and the lower buttock. Each buttock section has its own distinct shape. What separates the lower buttocks from the other two sections is the infragluteal fold. This fold makes a usually clear demarcation between the lower buttocks and the thigh below it.

Buttock Shape Dr Barry Eppley IndianapolisThe infragluteal fold or sulcus has been studied anatomically and histologically and has been shown to consist of strong fibrous bands extending from the underside of the skin (dermis) of its medial third to the ramus of the ischium and sacrum forming the letter J. The infragluteal fold, which attaches to both the ischium and the sacrum in a continuous fashion, is an anatomic structure in its medial part and only a crease laterally. It largely disappears in its lateral third as it approaches the outer thigh.

The infragluteal fold is one of the major concerns in reshaping of the buttocks. If an intact infragluteal fold exists with overhanging skin, then a lower buttock lift or tuck is needed. This is often called the butterfly lift if the central part of the buttocks sags with significant obscuring of the infragluteal fold. When the infragluteal fold is lost and the entire bottom of the buttocks sags onto the thighs with skin rolls, then wider excision of sagging skin with recreation of the fold is needed. It is important to remember that these excisional procedures only changes the shape of the lower buttocks and does not increase buttock volume or projection in any way.

Case Study: This 35 year-old female wanted to improve the shape of her buttocks. She was happy with her buttock volume and projection but felt the bottom had ‘fallen down’. She had an intact and defined infragluteal fold but her lower buttocks sagged over it.

Lower Buttock Lift (Fold Effacement) Dr Barry Eppley IndianapolisUnder general anesthesia in the prone position, an excision was done using the existing fold as the inferior aspect. A predetermined and measured line has been previously marked in the standing position to serve as the superior incision line. This wedge of tissue was removed keeping it from extending out too far laterally. Deep dermal sutures attached the superior line down into the existing fold level to rid the buttock overhang.

Lower Buttock LIft (Fold Effacement) back view Dr Barry Eppley IndianapolisThe lower buttock lift when there is an intact and well positioned infragluteal fold is better termed a lower buttock tuck. A true lift is when the nfragluteal fold is lost and has to be recreated.

Case Highlights:

1) Sagging of the buttocks takes on several forms depending on the location and prominence of the infragluteal fold.

2) A prominent infragluteal fold with overhanging lower buttock tissue creates a type 1 buttock ptosis deformity.

3) A lower buttock tuck removes overhanging tissue and creates a smoother transition between the buttocks and the posterior upper thigh.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Lower Buttock Lift for the Sagging Buttocks

Friday, April 26th, 2013


Background: Buttock enhancement surgery has become a primary method of body contouring plastic surgery. Having  a shapely and fuller buttocks has taken on great signficance for a more attractive body form. The buttocks for some now rivals what has been the breasts for many in the past. While most of the notoriety belongs to the Brazilian Butt Lift, a method of buttock augmentation by autologous fat injections, there are other buttock rehaping surgery techniques.

The oldest buttock reshaping surgery is the original buttock lift. Unlike the Brazilian Butt Lift, which really doesn’t lift the buttocks but fills it out, the lower buttock lift really does. By removing skin and fat from the bottom of the buttocks, a reshaping will occur with a more defined buttock-thigh demarcation/crease. The lower end of the buttocks will be tucked up and will be a little rounder.

A lower buttock lift still has a valuable role to play in buttock reshaping for correcting several problems that fat injections can not improve. The ‘banana peel’ deformity is one such problem where a roll of buttock tissue overhangs the existing lower buttock crease. It is also effective for a buttock crease that is too low and ill-defined which creates a vertically long buttock shape. Lastly for buttock asymmetry that is caused by different levels of the lower folds, a lower buttock lift can correct the location of the fold and also creare better symmetry in the buttock shapes.

Case Studies: This 34 year-old female wanted to improve the sagging appearance of her buttocks. While she was not overweight nor had lost any significant weight, her buttocks had always had a roll of skin that ‘fell over the lower buttock crease’ that could not be improved by exercise or any non-surgical skin tightening techniques.

Under general anesthesia, she was placed in the supine position with the hips elevated on a gel roll. The overhanging skin and fat were elliptically excised down to the gluteus muscle fascia in a wedge-type fashion. Using heavy resorbable sutures, the opposing skin edges were swen down to the fascia creating a bit of an inverted fold. The skin was then closed with a running barbed suture in a subcuticular fashion. No drains were used. The incisions were covered with glued-on tapes and required no garment wear.

Her postoperative course had the typical tightness of the lower buttocks but no significant pain. She was not placed on any specific physical activity restrictions other than to not bend over more than 90 degrees and no physical exercise or working out. She could shower daily and get the tapes wet. Her tapes were removed one week later. After three weeks she returned to light exercise and regular exercise after 6 weeks. She had no wound healing problems and the scar was inset perfectly into her lower buttock crease. Her buttock skin overhang was completely gone and she had a more pleasing lower buttock shape.

The lower buttock lift still has a valuable role in buttock reshaping surgery even if it is largely forgotten by some. As a standalone procedure, it redefines the lower buttock crease, removes any overhang and tucks up the lower buttock shape. It is also useful in conjunction wih the Brazilian Butt lift for a more complete buttock reshaping.

Case Highlights:

1) The sagging buttocks is when the edge of the lower buttocks falls over the lower buttock/thigh crease, creating an overhang. The lower end of the buttocks may also have little shape and be positioned too low.

2) The lower buttock lift removes the overhanging buttock tissue and creates a new and more defined buttock crease.

3) The lower buttock lift also tightens the lower pole of the buttock and creastes a deeper buttock fold/crease.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Lower Buttock Lift for the Saggy Derriere

Friday, July 20th, 2012

Background:  Buttock enhancement has become a popular contemporary procedure, offering improvements to a body part that historically has been thought of as having few choices. People have numerous aesthetic buttock concerns including size, shape and tone/firmness issues. Buttock augmentation with fat injections (aka Brazilian Butt Lift) is most well known today as it has become fashionable to have a rounder fuller buttock, particularly amongst Hispanic and African-Americans.

But not all buttock concerns are about size. The saggy buttock  is an unflattering shape that is associated with being flat and having skin that has slide off of the gluteal muscle onto the posterior thigh area. This happens as the buttock is affected by weight loss and aging. Weight loss causes the skin to fall as the volume support vanishes with fat absorption. Aging has its own  volume loss but the skin sags as it loses elasticity after having been exposed to repetitive stretching over a lifetime.

One important aesthetic feature of the buttock is the inferior gluteal fold. Like the inframammary fold in the breast, it serves as the transition point between two anatomic structures…the buttock and the thigh. It exists because there are attachments from the underside of the skin along the crease to the muscle below. This allows the more fibrofatty tissue to remain over the buttock where it is needed for padding support. Loss of the inferior gluteal fold attachments allows the buttock skin to sag down onto the thighs.  

Case Study: This 35 year-old female wanted to improve the shape of her buttocks. She had adequate volume but did not like the lower end of her buttocks because it was ‘saggy’. She wanted the bottom part to tuck in more and have a well-defined crease. She was willing to accept a scar for that improvement.

Under general anesthesia she underwent a lower buttock lift using an ellipitical excision technique. The underside of the skin was sewn to the fascia overlying the gluteal muscle to help create a well-defined crease and invert the incisional closure. All sutures were under the skin in a subcuticular fashion. Her only dressing afterward was surgical tapes that were glued over the incision line. This was an outpatient procedure with few restrictions afterward other than avoiding strenuous activities that involved bending over greater than 90 degrees at the waistline for three to four weeks after surgery.

She had an uneventful recovery with no wound separation problems. She had fine line scars along the natural inferior gluteal crease that faded to white by six months after surgery. In profile she had a well-defined break at the crease between the buttocks and the posterior thigh.

Of the available buttock enhancement procedures, the lower buttock lift is the least commonly performed. While it is the one buttock procedure that has the longest history in plastic surgery, it is less desired than buttock augmentation that provides volume by an implant or fat injections. But for the patient who has effacement of their inferior gluteal fold and a saggy lower buttocks, this simple lift procedure can provide a significant improvement. It can also be performed in conjunction with either of the buttock augmentation procedures since its surgery site is away from where implants or fat are placed.  

 Case Highlights:

1)      A common buttock deformity is ptosis or the sagging buttock due to skin falling over the gluteal  crease or descent of the gluteal crease itself.

2)      Excision of loose and overhanging skin can recreate the inferior gluteal fold and create a clear transition between the buttocks and the posterior thigh.

3)      Inferior gluteoplasty or lower buttock lift requires a minimal recovery other than avoiding severe stretching of the incision line.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

Read More

Free Plastic Surgery Consultation

*required fields

Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits