[Case Review] Liposuction for Buttock Ptosis (Sagging) and the Exposure of the Fold Line
When I see patients after liposuction for buttock ptosis (sagging), I often hear them say, "I can tell that my buttocks have risen, but the fold under my buttocks looks different from before." Some say that a fold seems to have newly appeared, and others say that the sagging part under their buttocks has become smaller.
Today, through the case of one patient who had liposuction of the buttocks, hips, and sacral back, I would like to explain how the fold line that had been hidden by the sagging buttock becomes visible as the buttock rises, and how its appearance differs from person to person.
Buttock Ptosis and the Fold Line That Cannot Be Seen
Everyone has a horizontal fold line running between the buttock and the thigh. Textbooks describe this fold line as a place where the skin is firmly attached to the deep tissue, and they grade the degree of buttock sagging by the length and depth of this fold line.
In a person with buttock ptosis, the drooping buttock tissue (skin and fat) covers this fold line, so the border fold between the buttock and the thigh cannot be seen. As a result, many people do not know where their fold line is, and they think of the bottom edge of the part that has sagged below the buttock as their fold. But that line is not a fold. It is the bottom edge of the sagging buttock.
How the Buttocks Rise After Liposuction
Buttock liposuction reduces the volume of the buttock, and the skin that had been stretched contracts by the amount of volume that was reduced. The bottom edge of the buttock, which had come down toward the thigh, then moves upward. The lower border that was thought to be the fold before surgery disappears, and a new border between the buttock and the thigh forms higher up. In other words, the buttock rises.
That is, the buttock length decreases and the thigh length increases. And when the buttock becomes smaller and rises, the original buttock fold that had been hidden by the sagging buttock is exposed.
The Fold Line Does Not Appear in Just One Way
How the fold line looks after the buttock rises depends on how much the buttock has risen and on the elasticity of the skin. At Venus Clinic, we see broadly three patterns.
| Case | Appearance of the fold line after surgery |
|---|---|
| Case 1 — A new fold line forms | The buttock rises above the original fold line and a new fold line forms, while the original fold line remains as a trace below it. |
| Case 2 — Only the original fold line is revealed | The buttock rises, but no new fold line forms, and only the original fold line that could not be seen before is exposed. The fold line after surgery and the original fold line are in the same position, and the buttock ptosis is gone. |
| Case 3 — Mild ptosis remains | The buttock becomes smaller but cannot rise much, so mild ptosis remains and the fold line is not visible. The width of the sagging fatty tissue decreases, and the degree of sagging is eased. |
Case 1 — A New Fold Line Forms
When the buttock rises above the original fold line, a new fold line forms between the raised buttock and the thigh. This fold line is one that was formed after surgery, and the original fold line is revealed, remaining as a trace below it. The case I introduced earlier in "How the Buttocks Rise After Liposuction for Buttock Ptosis (Sagging): The Mechanism" was this case.
Case 2 — Only the Original Fold Line Is Revealed
In some cases the buttock rises, but no new fold line forms, and only the fold line that could not be seen before is exposed. The bottom edge of the sagging buttock rises as far as the place where the original fold line lies, so the original fold line itself becomes the border between the buttock and the thigh. The patient I am introducing today is this Case 2, and the illustration below shows this patient's change as seen from behind.
The left side is before surgery and the right side is after surgery. The dotted line running across both drawings marks the height of the original fold line. Before surgery, this fold line is covered by the sagging buttock and cannot be seen, and the bottom edge of the sagging buttock lies below it. After surgery, as the buttock rises, the original fold line is revealed at the same height. The illustration below places the post-surgery appearance of the three cases side by side; this patient corresponds to Case 2.
Case 3 — Mild Ptosis Remains
There are also cases in which the buttock cannot rise much. In these cases mild ptosis remains and the fold line is not visible. This is because, when ptosis is present, the sagging tissue of the buttock covers the fold line. The width of the sagging fatty tissue decreases, and the degree of sagging is eased. The fact that the width of the sagging fatty tissue has decreased means that the buttock has risen to some extent. This is mostly seen in middle-aged women whose buttocks have lost elasticity and have become lax. In such cases the buttock becomes smaller, but because the skin elasticity is weak, the improvement in buttock ptosis is not large. The difference between Case 2 and Case 3 is that in Case 2 the buttock ptosis is gone, while in Case 3 mild ptosis remains.
What to Know in Advance
It is difficult to know exactly before surgery which case it will be, because the position and shape of the fold line hidden by the sagging buttock cannot be seen before surgery. Liposuction for buttock ptosis is an operation that raises the buttock by reducing the sagging; it is not an operation that removes the buttock fold, and how much the buttock rises varies from person to person depending on the degree of sagging and the elasticity of the skin. At Venus Clinic we do not suction the left and right sides differently, and we leave the remaining fat layer at a consistently even thickness, so the revealed fold line follows the shape the patient originally had.
This Patient's Surgery — Liposuction of the Buttocks, Hips, and Sacral Back
This patient had liposuction of the hips and sacral back together with the buttocks. The word "hip" is often used to mean the same thing as the buttocks, but in body contouring surgery the hips refer to both sides of the upper buttock, where the pelvis projects outward. The sacral back is the lower part of the back below the waist, just above the buttocks.
The outline running from below the waist to the hips, from the hips to the buttocks, and from the buttocks to the outer thighs is one continuous line, so at Venus Clinic we plan the hips and sacral back together when operating on the buttocks. Below are the fat aspirated in this patient's surgery and the fat removed by syringe liposuction.
The aspirated fat
750 mL of fat collected in the canister
Fat removed by syringe liposuction
Seven 60 mL syringes plus 30 mL, 450 mL in all (1,200 mL together with the 750 mL in the canister)
Liposuction is not an operation that removes a large amount of fat; it is an operation that creates balance in the body shape by leaving fat well. In this patient too, the goal of surgery was to raise the sagging buttock and to refine the outline running from the waist through the buttocks to the thighs.
Before-and-After Photos
Below are photos of a patient who had liposuction of the buttocks, hips, and sacral back at Venus Clinic. All of the post-surgery photos were taken one week after surgery. Swelling and bruising still remain at this stage, so this is not the final result, and the shape changes a little more as the swelling subsides. In each pair, the left is before surgery and the right is after surgery.
Surgical Case
Before surgery — rear view (legs together)
The buttock droops downward, so the fold line between the buttock and the thigh is hidden.
One week after surgery — rear view (legs together)
As the buttock rises, the original fold becomes visible.
This is Case 2, in which only the original fold line is revealed, without a new fold line. Before surgery the buttock was drooping and the buttock fold could not be seen; after surgery, as the buttock rises, the original fold becomes visible. Unlike the before-and-after photos of the case introduced in the previous article, in this patient the fold line after surgery and the newly exposed original fold line are in the same position. The bruising seen around the buttocks is part of the recovery process seen at around one week after surgery.
Before surgery — rear view (legs apart)
The hips, on both sides of the upper buttock, project outward.
One week after surgery — rear view (legs apart)
The hips have become smaller, and the outline running from the waist to the thighs has become slimmer.
This shows the outline changed by the reduction in the size of the hips. Both sides of the upper buttock are called the hips. As the size of the hips decreased, the outline running from the waist through the buttocks to the thighs became slimmer, and the figure changed to an hourglass-type body shape. In the legs-apart position, the border between the buttock and the thigh can be seen more clearly.
Before surgery — right side view
The lower part of the buttock droops toward the thigh.
One week after surgery — right side view
The lower contour of the buttock has moved upward.
This is the change in the lower contour of the buttock seen from the side. Before surgery the lower part of the buttock drooped toward the thigh, and after surgery the lower contour of the buttock has moved upward. The bruising around the hips and buttocks fades with time.
Before surgery — left side view
On the opposite side as well, the lower part of the buttock droops.
One week after surgery — left side view
On the opposite side as well, the lower contour of the buttock has moved upward.
This is the change in the lower contour of the buttock seen from the opposite side. On the opposite side as well, you can see that the lower contour of the buttock, which drooped toward the thigh before surgery, has moved upward after surgery.
| Information on the Posted Liposuction Before-and-After Photos | |||
|---|---|---|---|
| - Same person | Surgery performed at Venus Clinic; same person | - Date taken | Taken around 2021; comparison at 1 week after surgery |
| - Same conditions | Edited to the same posture and size as closely as possible | - Side effects | https://en.myvenus.co.kr/should_know/38861 |
In Closing
When buttock ptosis is corrected with liposuction, the buttock rises and the fold line that had been hidden by the sagging buttock is revealed. In some patients a new fold line forms and the original fold line remains as a trace below it; in some, like the patient introduced today, only the original fold line is revealed without a new fold line; and in others the buttock cannot rise much, so mild ptosis remains and the fold line is not visible. At Venus Clinic we explain these differences before surgery, and we plan and operate on the hips and sacral back together with the buttocks.
Dr. Hakjun Kim, Director, Venus Clinic
