Losing weight is what every chubby woman dreams of and, when they succeed, the sagging is often so significant that a plastic surgeon has to help recover and firm several areas of the body. Often, the buttocks sag and become so droopy that a plastic surgery engineering job is required to lift and reshape them. A single technique may not be enough to provide the desired effect and, in such cases, associating lifting and implant may bring about spectacular changes.
Thanks to his experience with both techniques, we invited Dr. Raul Gonzalez, from São Paulo, to clarify Plástica e Beleza’s readers on the subject.

What are the indications for buttocks lifting?

There are two kinds of buttocks lifting. In one of them the incision is made on the bottom of the buttocks, while in the other a higher incision is made on the bikini line. It all depends on the amount of skin to be removed. When a small amount of gluteal tissue sags over the thigh, the incision can be made at the lower gluteal crease to remove this extra tissue by means of a simpler surgery. However, if there is sagging skin on the lateral thigh or saddlebag, the result of significant weight loss like more than twenty kilos, a higher incision is required.

In some of the more dramatic cases, is it necessary to associate both types of lifting?

Yes. If the weight loss is more significant, it is often necessary to associate both procedures. In some cases, if the patient already had a “long butt” before losing weight, a lower incision is often necessary to round off the butt, pushing the crease up and correcting the graceless aspect produced by the long butt.

Can a lifting be associated to an implant?

Yes, in both kinds of lifting: lower and higher incision. Very often an implant is indicated in those cases, since there can be such significant sagging not only of the skin but also of the muscle that exercises alone are not enough. Therefore, the association of both procedures is quite common to provide a round and perky butt.

Can the implant be replaced by the bioplasty technique?

Absolutely not. A lifting requires detachment and in those cases, no material other than the implant can be applied. Anyway, I strongly discourage the use of bioplasty to shape a butt. It is a very good product to be used in small amounts; in large amounts, however, we could be repeating the old drama of liquid silicone injections that had frequent complications such as chronic infection, inflammation and others more difficult to address.

Is an implant necessary in all weight loss cases?

No. Quite often, the local tissue may be tucked under the lifting and shaped like an implant forming what we call a “natural implant” which can replace one. As paradoxical as it may seem, the saggiest the buttock the easier to build this “natural implant” thanks to the greater amount of extra tissue.

Can does procedures be used even in people who lost more than fifty kilos?

Yes, certainly. The more loose skin there is, the less a patient will complain about a scar hidden by the bikini. Changing a flabby, sagging butt full of loose skin for a firm, perky and smooth one is such an amazing thing that even a scar is not too bad.

What about the post-op recovery?

These are not “weekend procedures”. The patient must not go back to work for at least 20-30 days, and may not resume activities at the gym until after two or three months. They are not minor surgeries and should, by no means, be performed by inexperienced surgeons. It is, therefore, important to look for a plastic surgeon, avoiding “miracle workers” that promise to solve this kind of problem with the so-called “Bulgarian thread” technique or injections which will necessarily ruin the chance of a successful future surgery.
And since I mentioned the “Bulgarian thread”, I don’t want to miss the chance to say it is absolutely inefficient although its benefits have been unscrupulously advertised.

How to choose a plastic surgeon to perform this kind of surgery?

First, the surgeon must be a member of Brazilian Plastic Surgery Society.
The higher incision lifting technique, for example, is a major surgery in which most of the times we remove about 20cm of skin which requires not only an experienced surgeon but also a good team in order to achieve good results.