More is not always best…Butts are really a matter of proportion

  • Peak Rejuvenation   •   January 14, 2016

Enhanced booties seem to be all the rage right now. Thank you Kim Kardashian.

I have had numerous patients over the years request enhancement of their posterior. In fact, Buttock Augmentation has been one of the fastest growing trends in plastic surgery.

But first, let’s talk but about physical proportions.

Butts come in all shapes and sizes, and any treatment aimed at changing the shape of the buttock region should be individualized. Here are some examples:

  1. Normal butt, large flanks
  2. Large butt, large flanks
  3. Small butt, small flanks
  4. Saggy butt, saggy flanks (from massive weight loss)

So how do we change the shape of our butt?

Well, one of the best ways to enhance your buttocks is to so exercises that enhance the gluteal muscles. There are all sorts of exercises that you can find online for buttock enhancement. The primus behind all of these exercises is the same…enlarging the gluteal muscles will make what you have stick out more, thus increasing the size of your butt.

For the example #1 above, a person with a normal butt may think they have a small butt simply because they are disproportioned. They lack a defining line between the flanks and the back. To change this, one of the most satisfying approaches is to simply perform liposuction of the flanks and back. I call this the subtraction method. Instead of adding to the butt, you subtract the area above the butt (i.e., flanks, back) and this gives a more proportional appearance of the butt without actually doing surgery on the butt itself. The subtraction technique can always be enhanced, of course, by taking that liposuctioned fat and re-injecting it into the butt through a process called fat grafting. This will add a WOW factor to the results. A butt implant may be performed, but in my opinion, is not necessary.

In example #2 above, the subtraction technique can also result in a very aesthetic appearance. Simply subtracting fat from the area above the butt will make the large butt look even larger. I, as a surgeon, may not even need to address the butt itself. These are the types of folks that, if an implant is added, the implant will simply make them look even more overweight.

In example #3 above, I am describing a person who has a fairly lean physique. In this patient, there is often very little fat to harvest in order to perform fat augmentation. So, these folks would be good candidates for buttock augmentation with an implant.

Lastly, in example #4, I described a person who has lost a lot of weight from diet, exercise, and/or surgery. These folks typically have a lot of extra skin due to the fact that have lost a lot of underlying fat and the skin no longer has the ability to recoil. For these folks, the best method to enhance the buttocks may be to perform an auto-augmentation. For this procedure, paddles of de-epithelialized skin are harvested from the back and flanks, rotated down to the buttocks and secured underneath the existing buttock skin. I could put an implant in these folks, but why? They typically have plenty of tissue to perform the augmentation without the cost or foreign body effects of implant.

So what’s the surgery like for implants?

Buttock augmentation with a silicone implant is only one step in the surgical process. You, the patient, must now heal! And this is where the trick comes in. Imagine getting breast augmentation with silicone implants and then going home and sleeping on your breasts for 18 hours per day. If you did that, the breast implants would migrate laterally and you would find them under your arms. Well, this is essentially what happens when you get butt implants. As with breast implants and any foreign body, the body will try to form a normal capsule around buttock implant. During the formation of the capsule (which takes at least 3 weeks), a person must very careful not to displace the implants. So what does this mean practically? You have to sleep on your stomach and be very careful when sitting.

Bottom Line:

So as you can see, buttock augmentation is not as simple as putting in an implant. And MORE
butt is not necessarily the best fix.