October 27, 2026 | Body Contouring
A second fold under the buttock is not a volume problem. It is a position problem, and a regular BBL does not fix it. What follows is a video consultation from my El Paso office with a patient in her late twenties who had a lipo 360 with fat transfer two years ago elsewhere, nearly as it happened, identifiers removed.
“Can You Get Rid of the Second Crease?”
Me: “Let’s talk about what we want to achieve. I know that you want to get rid of the, kind of like this double butt crease, this area right here. So for this, we would do the thong lift, the Miami thong lift. It’s an incision that goes right here. I do a little bit of lipo here, and then we tuck that in so it kind of does a circle inside. So that would be the fix for that.”
“Can You Put Fat at the Bottom to Make It Rounder?”
Her: Could we move fat around? Because I have no crease. You know this crease? I don’t have that, so I was wondering if we could put fat here.
Me: “So the crease here is actually good, it’s good when it’s short. If you look at very sexy buttocks, this crease is short. When it gets long, it’s because the buttock has fallen down, so it folds. So you actually, you’re good with that. I think that part’s fine.”
Me: “I do see that this is a little flat, like here, and you’re full here. Your projection is good. So really it’s just giving it a little bit of shape. So maybe removing a little here, adding a tiny bit here, and the rest for projection. And then lifting this up would make it look really nice.”
Me: “Some people say like frog butt or elephant because of this, but we can fix that. I’m one of the few surgeons that does this procedure, the Miami thong lift.”
“Where Is the Scar?”
To another patient the same year, who had hip implants placed elsewhere and the same second fold: “On the posterior view, you do have a little bit of a double butt crease deformity. So to make this kind of go up and look more rounded instead of having that second bump, it would be the Miami thong lift. The incision goes right in the middle, on either side, but it hides completely when you are standing in the nude.”
“It is actually gonna pull up almost like a wedgie, so it will pull up everything and make it up and rounded. And it usually ends right about here, so you really don’t see any scars on the outside. And then I’ll usually do just a little light pull on those two areas so that we can get it to move a little bit better.”
“They’re gonna be just like the liposuction incisions, except for the Miami thong lift, which is an incision about this long, but it is gonna be on the inside.”
“I Want a Pear, Not an Hourglass”
Her: Would it be possible to add fat to my outer thighs? I want to look like a pear rather than an hourglass.
Me: “I just don’t think you have enough, because we’re taking from your upper back and your arms. So we can add whatever fat we get there, or if we don’t have enough, we can use the allograft, which is the donor fat, and we can inject that into the saddlebag area to create more curviness lower down. So more like a heart shape.”
Her: A lot of other BBL doctors I asked, they declined to do that area.
Me: “We do it routinely because sometimes, you know, I get patients that have very skinny thighs. And if we just do the buttock, it looks funny, it looks like a chicken. So routinely we add to that area.”
“What Causes Fibrosis?”
Her: I have pretty bad fibrosis on my stomach from my second round of lipo.
Me: “So a lot of times it’s, number one, when they do too much lipo. Number two, if any of the fluid gets caught and it doesn’t come out, it creates like a capsule and scar tissue. So that’s why I really recommend doing lymphatic massages after the liposuction.”
Her: I didn’t also wear my faja. Is that also why?
Me: “That’s another one, yeah. It’s a lot of the aftercare. Number one, if you do too much lipo, then you get that really bumpy look. And number two is the aftercare. It really prevents the fibrosis.”
“Why Have I Never Heard of This?”
“That’s a procedure that very few surgeons do and very few people know about. And sometimes the surgeons just don’t know how to make it better.”
Recovery, the Short Version
Surgery is about three to three and a half hours under general anesthesia, outpatient, no drains. Five to seven days to light activity and driving, about four weeks to exercise, a compression garment for four weeks. You avoid sitting for the first two weeks and use a cushion to sit on your thighs. Out of town patients stay about five days to a week with two or three lymphatic massages. “Most of what we’re doing is kind of minor, so I don’t think everybody’s gonna be like, whoa, you had something done, because a lot of it is just details. So really in about four to six weeks you should be able to put on a bathing suit.”
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of plastic surgery at Texas Tech University Health Sciences Center. If you have a second fold under your buttock that no fat transfer has fixed, come in and let me look at it.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.
#StayBeautiful
