If volume is very lacking or there is a clear left–right size difference, buttock implants come up first; if you want a natural change and have excess fat to remove, fat grafting comes up first. If the buttock sags because of lost skin elasticity, a lifting method is needed. Here we cover why the hip line sags, how the methods differ, and when revision surgery should be considered.
Contents
Why does the hip line sag?
A sagging hip line is not only about fat. Skin elasticity, muscle and shifts in fat position all play a part.
Sagging becomes more noticeable when elasticity declines with age, after repeated dieting, when the gluteal muscles weaken, or when fat distribution or body shape changes after childbirth.
How can a sagging buttock be improved?
| Method | How it works | Best suited for |
|---|---|---|
| Fat grafting buttock augmentation | Fills with your own transferred fat | When you want natural volume |
| Implant buttock augmentation | Fills with a silicone implant | When volume is very lacking |
| Buttock lift | Lifts sagging skin and tissue upward | When sagging is due to loss of elasticity |
Depending on body type, two methods are sometimes combined rather than using just one. The method is decided by first determining whether the problem is a lack of volume or loose skin.
How is implant buttock augmentation performed?
A buttock implant is placed through a vertical incision of about 4–5 cm in the shaded cleft between the buttocks, creating a pocket deep in the middle of the muscle layer. Because the incision is hidden inside the cleft, it is hard to see from outside.
Before surgery, the body shape and development of the gluteal muscles are analyzed to choose the size and shape. Implants are mainly considered when there is almost no curve between waist and hips, when volume is lacking overall, or when the two sides differ noticeably in size.
In a meta-analysis of 32 studies (2,682 patients) on implant buttock augmentation, the subfascial plane had more seroma and wound dehiscence, while intramuscular or submuscular placement had fewer complications.[1]
When should revision surgery be considered?
If the line or body balance after the first surgery is not satisfactory, further surgery may be needed. Typical cases include:
When the left and right hip lines are asymmetric
When the buttock implant has shifted out of position
When grafted fat has been absorbed and volume has decreased
When the line looks unnatural
Related readingHow buttock revision methods differ is covered in "Buttock revision surgery: back to a firm buttock" (Korean).
What is different about revision surgery?
Revision surgery starts with understanding the current state. The plan depends on the previous incision site, the plane where the implant sits, and the condition of the surrounding tissue.
It often combines implant repositioning, fat re-grafting and lifting, so it requires more precise planning than the first surgery.
In a study of 14 buttock revision cases, the implant was removed in 5, moved to a deeper plane in 8, and supplemented with a hybrid approach in 5.[2]
Buttock implants: common myths and facts
| What many people think… | What the evidence shows |
|---|---|
| "A sagging buttock will lift if you just add an implant." | If the skin has stretched a lot, a lift should be considered as well. |
| "It doesn't matter where the implant goes." | Complications differed greatly by placement plane. |
| "Revision can be done the same way as the first surgery." | Depending on the cause, it may involve removal, deeper re-placement or a hybrid approach. |
In buttock implant consultations I look at skin sagging on the lower buttock when you sit. If the sagging is significant, an implant alone gives less of a lifted look.
Buttock augmentation is not just about making the buttock bigger; it is about designing the balance of the whole figure from waist to thigh. Rather than deciding only on the size you want, it is better to choose the method that fits your body and tissue and plan it with a plastic surgeon experienced in body contouring.
🔬 Supporting research
Peer-reviewed international journal articles that support this article. Click a title to open the PubMed abstract.
- Plastic and Reconstructive Surgery 2025 — implant buttock augmentation, 32 studies · 2,682 patients Complications following Primary Implant-Based Gluteal Augmentation: A Systematic Review and Meta-Analysis. Key finding: complications differ by placement plane, removal rate 1.05% In text [1] · PMID 40403281 · DOI
- Annales de chirurgie plastique et esthetique 2019 — 14 buttock revision cases [Secondary gluteal surgery augmentation: Surgical techniques and outcomes]. Key finding: implant removal · deeper re-placement · hybrid In text [2] · PMID 31324505 · DOI
🎬 Watch — Dr. Park Seong-Soo · BongBong Plastic Surgery
Related videos from BongBong Plastic Surgery's official channel and Dr. Park Seong-Soo's channel. Videos are in Korean and play on YouTube.
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5:57 Hip-line trends? What to do when hip-up exercises don't work (Korean) Dr. Park's channel · 2024.03.28 -
0:50 Before and after buttock augmentation: what changed? (feat. BiVOL hip-up) (Korean) Dr. Park's channel · 2026.08.30
Frequently asked questions (FAQ)
Where is the scar from a buttock implant?
Because the incision is made vertically, about 4–5 cm, inside the cleft between the buttocks, the scar lies within it. It is hidden by the cleft when standing, and how quickly it settles depends on your skin type.
Which lasts longer, fat grafting or implants?
An implant keeps its shape as placed, while part of the transferred fat may be absorbed, so volume can decrease. On the other hand, fat grafting also reduces excess fat, so it is best to choose by looking at your whole body shape.
Will a sagging buttock lift if I just add volume?
If lack of volume is the cause, filling alone can lift the line. But if the sagging is due to stretched skin, adding volume increases the weight and can make the sagging more noticeable, so a lift is considered as well. The solution depends on whether volume is lacking or the skin is stretched. If volume is very lacking or the left–right difference is large, buttock implants are a reasonable starting point; if you have excess fat and want a natural change, fat grafting is. If you have already had surgery and are not satisfied with the line, the first step is to bring your previous surgical records to a consultation.
When should I consider revision surgery?
It is best to seek a consultation if the implant has shifted, the left–right difference has grown, or the buttock becomes hard or pain persists.
📖 References
Click a [number] in the text to jump to its source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are listed.
- ↩ Elsaftawy A, Bonczar M, Jagosz M, Ostrowski P. Complications following Primary Implant-Based Gluteal Augmentation: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2025;156(6):894-907.PMID 40403281 · DOI— implant buttock augmentation, 32 studies · 2,682 patients — complications differ by placement plane, removal rate 1.05%
- ↩ Abs R. [Secondary gluteal surgery augmentation: Surgical techniques and outcomes]. Ann Chir Plast Esthet. 2019;64(5-6):653-659.PMID 31324505 · DOI— 14 buttock revision cases — implant removal · deeper re-placement · hybrid
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