Buttocks tend to sag when they lose volume, muscle tone or skin elasticity, most often with age, after significant weight loss or because of genetics. Strengthening the gluteal muscles can improve shape and firmness, while surgery can restore volume with fat grafting or remove excess skin with a buttock lift, depending on the cause.
Why do buttocks sag?
The shape of the buttocks depends on three layers: the gluteal muscles, the fat that sits over them, and the skin. Sagging (ptosis) happens when one or more of these changes.
- Ageing: collagen and elastin in the skin decrease, fat may redistribute and muscle mass declines with age.
- Weight loss: after major weight loss, including after bariatric surgery, the skin may be left stretched with less fat to fill it.
- Genetics: skin quality and the natural shape and height of the buttock crease are inherited.
- Reduced activity: long periods of sitting and little exercise reduce gluteal muscle bulk.
- Sun exposure and smoking: both damage skin quality over time.
Is it normal?
Yes. Some flattening and descent of the buttocks is a normal part of ageing and of body changes after weight loss or pregnancy. It is not a medical problem. Rarely, loss of muscle bulk on one side can reflect a nerve or back problem; if you notice new weakness in a leg, numbness, or difficulty walking, see your GP.
What exercise can do
Building the gluteal muscles is the most effective non-surgical way to improve buttock shape. Hip thrusts, glute bridges, squats, lunges, step-ups and resistance band work target the gluteus maximus and medius. A stronger, larger muscle lifts and projects the buttock from underneath. Exercise cannot tighten loose skin, however, so it works best where the problem is mainly loss of muscle or volume rather than excess skin.
Non-surgical treatments
Skin-tightening devices using radiofrequency or ultrasound may give a modest improvement in mild skin laxity, and results vary. Collagen-stimulating injections are sometimes offered, but evidence for meaningful lift is limited. UK plastic surgery bodies have warned against large-volume filler injections into the buttocks (‘non-surgical BBL’) because of the risk of infection, lumps, migration and other complications.
Buttock fat grafting (BBL)
Where sagging is mainly caused by loss of volume, buttock fat grafting can help. Fat is removed by liposuction from areas such as the abdomen, flanks and back, processed, and injected into the buttocks in the layer of fat under the skin. Adding volume can improve projection and give the appearance of some lift, while liposuction of the lower back and flanks sharpens the waist. Fat grafting does not remove loose skin, so it is less suitable where there is a large overhang. Not all the fat survives, and results vary between individuals.
Surgical buttock lift
Where there is significant loose skin, usually after major weight loss, a surgical buttock lift removes a band of skin and fat, typically through a scar across the lower back above the buttocks. It may be combined with fat grafting or with tightening of the thighs and abdomen as part of a lower body lift. The trade-off is a long scar. Whether this is appropriate depends on your skin, weight history and goals, and Mr Nassab will advise on the best approach, or on an appropriate referral, at consultation. Cosmetic surgery is for adults aged 18 and over.
Recovery, risks and cost
After fat grafting, you will usually be advised to avoid sitting directly on your buttocks for several weeks, with a gradual return to normal sitting as your surgeon advises, and to wear a compression garment for about six weeks. Many people return to desk-based work after about two to three weeks. Risks include bleeding, infection, blood clots, fat necrosis, irregularities, asymmetry and fat embolism, which is why fat is kept above the muscle. Buttock fat grafting (BBL) is from £12,500. A surgical buttock lift is quoted at consultation. The consultation fee of £150 is separate.
Frequently Asked Questions
Can exercise fix saggy buttocks?
Glute exercises can improve shape and firmness by building muscle, but they cannot tighten loose, stretched skin.
Does a Brazilian butt lift actually lift the buttocks?
It mainly adds volume and projection, which can give the appearance of lift. It does not remove excess skin.
What is the difference between a BBL and a buttock lift?
A BBL adds your own fat to the buttocks; a surgical buttock lift removes loose skin and leaves a longer scar.
Will my buttocks sag again?
Ageing and weight changes continue after surgery, so some change over time is expected. A stable weight helps maintain the result.
