The appearance of a secondary fold below the natural gluteal crease, often called a “double butt,” is a common aesthetic concern following body contouring procedures. This contour irregularity can be frustrating for individuals who sought a smoother, more defined gluteal profile through surgery. Addressing this issue requires a targeted approach, as simply repeating the original procedure may not resolve the underlying structural problem. The solution often involves a combination of techniques designed to restore a single, smooth transition between the buttocks and the upper thigh.
Defining the Contour Irregularity and Its Origin
The natural gluteal fold is the distinct line where the buttock meets the upper thigh. The secondary fold that creates the “double butt” look is a contour irregularity, typically manifesting as a horizontal crease positioned below this natural fold. This second line can make the lower buttock appear deflated or boxy.
A primary cause of this irregularity after surgery is often the technique used in previous procedures like liposuction or a Brazilian Butt Lift (BBL). Overly aggressive liposuction in the “banana roll” area (the fat pad beneath the gluteal crease) can remove too much fat and compromise the support structure. Similarly, uneven fat grafting during a BBL or the formation of internal scar tissue can create abnormal tethering points that pull the skin inward, forming a new crease.
Natural anatomy, genetics, and significant weight fluctuations also contribute to the appearance of a double crease, especially when combined with post-surgical changes. As skin loses elasticity, the soft tissue of the lower gluteus may descend slightly, accentuating existing irregularities. When the initial surgery did not account for these factors, the resulting volume displacement or skin laxity can manifest as a permanent secondary fold.
Non-Surgical and Minimally Invasive Treatments
For minor irregularities or in patients seeking to avoid another surgical recovery, non-surgical options can offer noticeable improvement by addressing skin laxity and small volume discrepancies. Dermal fillers, such as poly-L-lactic acid, can be strategically injected into the depressed area to add volume and smooth out the sharp transition of the crease. These fillers work by stimulating the body’s own collagen production, gradually improving skin thickness and contour over several months.
Injections designed to dissolve small, localized pockets of excess fat may be utilized if the secondary fold is caused by a small, persistent fat deposit. These therapies target and break down fat cells, effectively reducing the volume of the “banana roll” section. A careful assessment is necessary, as reducing fat in an already compromised area can sometimes worsen the appearance of skin laxity.
Energy-based devices offer another avenue for tightening and remodeling the skin and underlying soft tissues. Technologies like radiofrequency (RF) or high-intensity focused ultrasound (HIFU) deliver controlled thermal energy beneath the skin’s surface. This heat prompts the contraction of collagen fibers and stimulates new collagen growth, leading to gradual skin tightening around the crease. These non-invasive methods typically require a series of treatments, spaced several weeks apart, and are most effective for mild cases where the contour problem is due to skin laxity rather than a deep, fibrous tether.
Surgical Revision Options
For moderate to severe contour irregularities, especially those caused by significant internal scarring or substantial volume deficits, surgical revision is often the most definitive solution. The goal of revision surgery is not simply to remove or add tissue, but to re-establish a natural, smooth curve and a single gluteal crease.
Revision liposuction must be performed with precision, often using specialized techniques to feather or blend the edges of the existing crease. This involves removing a small, targeted amount of fat from the secondary fold while carefully sculpting the surrounding tissues for a seamless transition. Aggressive removal must be avoided, as this can exacerbate skin laxity and worsen the irregular contour.
Fat grafting is a frequently employed method to correct depressions and smooth sharp transitions. Fat harvested from other areas is purified and then injected strategically into the areas adjacent to the crease, filling in depressions and blending the contour. When the double crease is caused by a volume deficit or an abrupt drop-off from the buttock to the thigh, adding volume with fat can stretch the overlying skin and soften the appearance of the fold.
If the secondary crease is caused by deep scar tissue or fascial bands tethering the skin, a procedure known as subcision or suture release may be required. This involves surgically releasing the fibrous attachments that pull the skin inward, allowing the tissue to spring back and smooth out the depression. For cases with significant skin excess, a lower buttock lift, sometimes called a gluteal crease remodeling, may be performed. This procedure involves excising the excess skin and fat directly within the natural gluteal fold, effectively removing the secondary crease and tightening the tissue, though it results in a strategically placed scar.
Managing Expectations and Choosing a Specialist
Successfully correcting a double gluteal crease requires realistic expectations, as revision surgery is often more complex than the initial procedure. Patients must understand that the primary goal is significant improvement and restoration of a harmonious contour, rather than achieving absolute perfection. The results of surgical revision, particularly those involving fat grafting, will continue to evolve over many months as swelling subsides and the transferred fat settles.
Choosing a specialist with extensive experience in revision body contouring is paramount. The surgeon should be board-certified and demonstrate a deep understanding of gluteal anatomy, particularly the complex interplay of fat, skin elasticity, and fibrous attachments in this region. During the consultation, the surgeon should utilize tools like 3D imaging to accurately map existing volume discrepancies and outline a precise surgical plan.
Recovery typically includes wearing a compression garment for several weeks to support the newly contoured tissues and manage swelling. Patients are advised to limit strenuous activity and avoid direct pressure on the treated area for a period to ensure optimal healing and integration of the transferred fat. A specialist’s ability to correctly diagnose the underlying cause of the double crease will determine the ultimate success of the correction.