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Background: The buttocks, like any other bodily structure, is subject to the changes of aging, use and gravity. Buttocks lose volume and develop sagging with age and more prominently with large amounts of weight loss. This flattening effect may occur in isolation but often involves the infragluteal fold as well. Buttock tissue can fall over an intact infragluteal fold or can descend downward with the loss of the fold’s attachment. This creates two different shapes to the lower buttocks but neither one is not deemed aesthetically desirable.

A buttock lift is a broad term that today usually means a brazilian butt lift or fat injections to the buttocks. This is a volumizing procedure and not a true lift. But the original buttock lift procedure was an excisional one that removes tissue from the lower buttock region and was designed to re-establish the lost or displaced infragluteal fold. It has been around for decades but is very uncommon perform today by most plastic surgeons.

Case Study: This thin middle-aged female did not like the look of her buttocks. It was flatter than she liked but what bothered her the most was the sagging tissues on its inferior area with no defined infraguteal folds. It was like the bottom of her buttocks had fallen down.

Under general anesthesia and in the prone position, an ellipse of skin and fat was removed from the inside to the outside of the lower buttocks. It was removed in a curved elliptical fashion along an axis of the desired infragluteal crease location. The dermal edges of both sides of the excision were sutured down to the gluteal fascia, creating a slight inversion of the closure along the desired infragluteal crease line.

Her six month followup showed a well healed scar along the infragluteal crease with elimination of the buttock ptosis and a resultant shortening of the vertical length of the buttocks.

A lower buttock lift could also be called a lower buttock tuck as it actually achieves both.


1) Buttock ptosis or sagging is when the lower buttock tissue falls over an existing fold or the infragluteal fold attachment is lost.

2) A lower buttock lift can either remove overhanging buttock tissue or restore the position of the infragluteal fold.

3) Excision of skin and fat with dermal fold attachment to the gluteal fascia are the key techniques for restoring the shape of the lower buttocks.

Dr. Barry Eppley

Indianapolis, Indiana

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