July 30, 2026 | Brazilian Butt Lift
A patient sat down across from me a few weeks ago and pulled up a photo on her phone, taken in a fitting room mirror the way most of these photos get taken. She wasn’t there for a Brazilian Butt Lift consultation. She wanted to know why the lower part of her buttock had its own separate fold, sitting below her natural crease, giving her a boxy, almost squared-off look instead of one smooth curve into her thigh.
I get some version of that question often enough that I want to answer it here, in full, because the internet’s default answer, “get a BBL,” is usually wrong for this specific problem.
What A Double Butt Crease Actually Is
The medical name is a double gluteal fold, or double butt crease deformity. Above the true crease, called the gluteal sulcus, a second crease forms below it. This happens because the skin and fat of the lower buttock have sagged and are hanging down toward the upper thigh instead of sitting flush against it.
Patients describe it with all kinds of names, elephant butt, frog butt, chicken cutlets. Whatever you call it, what’s actually happening underneath is called inferomedial buttock ptosis. The lower, inner part of the buttock has dropped.
Four things cause it in my experience: significant weight loss that leaves skin without the volume that used to support it, prior liposuction of the lower buttock that was too aggressive or poorly planned, genetics that predispose certain patients to a weaker lower attachment, and ordinary aging, which loosens skin everywhere, including here.
Why Adding Volume Almost Always Makes It Worse
This is the part I want every patient reading this to actually absorb. A Brazilian Butt Lift adds fat. An implant adds a fixed volume beneath the muscle. Neither one lifts sagging skin. If anything, added weight in the lower buttock pulls the descended tissue down further and makes the second crease more obvious, not less.
I have consulted with patients who had a BBL somewhere else specifically to address a double crease, and came away with a more pronounced deformity than when they started. The problem was never a lack of volume. It was excess lax skin sitting on top of a descended border. You cannot inject your way out of that.
How The Miami Thong Lift Actually Corrects It
The Miami Thong Lift removes the excess lower-buttock skin and lifts the remaining tissue back up to where the natural fold belongs. The incision is placed within the intergluteal crease and along the thong line, which keeps it hidden in a bikini, in a thong, and against most clothing.
This restores a single, clean inferior gluteal border where there were two, and it corrects the L-shaped or boxy appearance that a double crease creates. It is a repositioning operation, not a volume operation, and that distinction is the whole reason it works when a BBL alone does not.
Am I A Candidate?
You’re likely a good candidate if you have a genuinely descended, lax lower buttock fold from weight loss, prior liposuction, or age, and you’re otherwise healthy with realistic expectations. You are probably not the right candidate if your skin quality is good and what you actually want is more volume or projection. That patient does better with fat grafting or an implant, and I will tell you that directly in consultation rather than sell you a procedure that won’t solve your problem.
Combining With Fat Grafting, Once The Border Is Fixed
A lot of my patients want both a cleaner border and more shape. Once the Thong Lift corrects the descended tissue, fat grafting can add volume to the areas that benefit from it, hip, upper buttock, whatever the anatomy calls for. I sequence this deliberately. Correct the structural problem first. Add shape second. Doing it in the other order is how patients end up back at square one.
Recovery, Scar, And What To Really Expect
Recovery depends on what is combined with the lift, but in general you’ll avoid sitting flat on the incision for a period, wear compression, and see swelling and bruising resolve over several weeks. Most patients are back to light activity within one to two weeks and cleared for exercise closer to four to six. The scar sits inside the natural crease and along the thong line, and in my patients it fades to essentially invisible within several months.
Why I Trained For This Specific Problem
I completed my plastic surgery fellowship at Mayo Clinic and serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Gluteal anatomy has been a specific focus of mine for years, including ultrasound-guided fat grafting technique, and I serve as founding vice president of the World Association of Gluteal Surgeons. Most surgeons see a flat or divided buttock and reach for volume by default. This deformity needs a different read, and gluteal-specific training is what teaches you to see it.
Why Choose Dr. Agullo For A Double Butt Crease Correction In El Paso?
I am double board-certified, American Board of Plastic Surgery and American Board of Surgery, a Mayo Clinic fellowship graduate, a Castle Connolly Top Doctor for thirteen consecutive years, and founding vice president of the World Association of Gluteal Surgeons. I perform the full range of gluteal procedures, from Brazilian Butt Lifts to BBL revision to the Miami Thong Lift, which means I see the full spectrum of what can go right and wrong in this area and plan accordingly.
Ready to talk?
If you’ve been told to add volume for a problem that volume can’t fix, come in for a real assessment before you book anything. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful
