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Background: The buttocks are prone to a variety of sagging conditions, most commonly caused by weight loss and age. Besides loss of buttock projection from loss of volume, the lower buttocks can drop. What type of drop or sag that can occur depends on the position of the infragluteal fold.

If the infragluteal fold is intact and at a good level, the buttock sag is marked by the lower tissues hanging over the fold. The other form of buttock sagging is when the infragluteal fold has has lost its attachment to the fascia and drops. This causes a vertical elongation of the buttocks which further contributes to any existing loss of outward projection.

Understanding the type of buttock sag determines what type of buttock procedure is needed for correction and how is performed. Technically a buttock tuck removes overhanging buttock tissue with an intact infragluteal fold. Although looking similar a lower buttock lift raises and re-establishes the infragluteal fold.

lower-buttock-sag-dr-barry-eppley-indianapolisCase Study: This 56 year-old female presented for a lower buttock lift. It could be seen that she had a drop of her infragluteal folds allowing the entire lower buttocks to hang lower.

lower-buttock-lift-design-dr-barry-eppley-indianapolislower-buttock-lift-comparison-dr-barry-eppley-indianapolisIn the upright position the elliptical pattern of the buttock lifts were marked before surgery. Under general anesthesia and in the prone position, an elliptical pattern of skin along the marks as well as a wedge of fat was taken down to the gluteal fascia. Using a three point suture technique, the dermal edges of the skin was sutured down to the gluteal fascia in an elevated infragluteal fold level. The difference between the lifted side and the unaltered side can be appreciated.

lower-buttock-lifts-intraop-result-dr-barry-eppley-indianapolislower-buttock-lifts-intraop-result-oblique-view-dr-barry-eppley-indianapolisThe buttock lifts were closed in a fine line with subcuticular sutures along the new infraguteal fold levels. Glued on tapes were applied as the only dressings.

Buttock lifts and buttock tucks sound very similar and they are in many ways. The difference comes down to management of the infragluteal fold, whether to maintain the one that exists or to re-create a higher one.

Highlights:

1) Lower buttock ptosis is when either the buttock tissue hangs over the infraguteal fold or the infragluteal fold has been lost or dropped.

2) A lower buttock lift is when the inragluteal fold is raised and reattached to the gluteal fascia.

3) A lower buttock tuck is when the excess tissue that hangs over the infragluteal fold  is removed.

Dr. Barry Eppley

Indianapolis, Indiana

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