Expert Doctor

Buttocks Reshaping

Luis Macias, MD

Marina Del Rey, CA

Buttocks Reshaping

Buttocks shaping involves not just augmenting the patient’s buttocks, but reshaping the whole waist to hip area of the body to make it look more shapely and voluptuous. It can be done with either fat grafting or implants.  Most people have enough fat that can be liposuctioned off from around their midsection or inner thigh. 

Most of my female patients desire a hip to waist ratio of about 70 percent, which has become a universal standard. However, some patients are more unique since they want their butt to be more exaggerated. Kim Kardashian, J-Lo, and Nicki Minaj have made it quite popular recently in wanting a very small waist with a larger hip proportion. 



During an initial consultation, my job is to understand the expectations and goals of my patient. While some of my patients are very modest and just want a little bit of volume for really petit athletic-looking buttocks, others may want very large-looking buttocks like Nicki Minaj.

A full physical examination is most important to ensure that the patient is a good candidate for the procedure, since not everyone is healthy enough to undergo this kind of surgery.

Since fat transfers are the best way of providing an increase in volume or enhancement to the gluteal or hips area, an examination is done to make sure patients have the appropriate areas of fat to liposuction from. If the patient is thin or does not have enough fat available, then implants may be the best option.



In the beginning, I will process the fat, place it into syringes, and then use a cannula to inject it into the gluteal area of the patient. I then use the vast majority of the fat to reshape the patient. If they have a square shape, reshaping them to make them conform to an hourglass, or what we call an A-frame, is ideal. The remaining fat is used to make the patient’s buttocks project more, or make it look bigger.  

The vast majority of my patients benefit from reshaping and want to combine this with liposuction that targets their lower back.  This gives some swayback, which combined with the reshaping and the augmentation, make a dramatic difference in the before and after photos.

The patient should be at their optimal weight, or whichever weight they plan on being, when coming in for a consultation. I do not recommend gaining weight for this surgery because if they want to lose weight after the procedure, they will lose it from those transplanted areas since those fat cells gain and lose fat just like before.  Ideal candidates should begin at their ideal weight and be able to maintain it. 



Most of the time, the procedure includes liposuction of the love handles, the back area right above the buttocks, or the lumbosacral area. Recovery depends since patients have fat stored in different areas. That whole area gets really liposuctioned to give that lordosis or that swayback look. As a result, that area will bruise and be tender. The buttocks will be somewhat sore. 

The patient will have to wear compression garments for two to four weeks after surgery. Compression garments, which are similar to Spanx, keep that area tight so that it heals with less swelling and contour irregularity. The biggest risk of any liposuction procedure is contour irregularities or lumpiness in that area. I use a special method called the SAFE technique, which involves the use of a special cannula after the procedure that redistributes the fat cells in the area so it leaves behind a smooth layer of fat.  This technique minimizes the possibility of any contour irregularity. 

Patients cannot sit for at least two weeks so that the fat cells that go to the buttocks can survive.  Not sitting on the buttocks for at least two weeks is essential for maximizing the survival rate of those fat cells. About 60-70% of all the fat that is transferred survives. Most of my patients will try to not sit for longer because they really want the fat to survive and not get reabsorbed. It is also not recommended that patients drive during this time. 

One of the things I recommend is a special roll that patients can lean in using their thigh, which frees up their buttocks to heal. This lets patients recover while being able to sit or do work for short periods of time. 



I do not recommend nonsurgical procedures for buttocks reshaping since it can be very dangerous. There are substances such as hydrogel that unlicensed practitioners are illegally injecting into the buttocks of people, usually in garages or hotel rooms. None of these products have been approved by the FDA. Moreover, there is no sort of oversight as to how these products are produced and whether they are sterile.  Some people are getting injections of industrial grade silicone, or caulking silicone from Home Depot.  

I recommend that people see a fully trained plastic surgeon, who specializes in buttocks enhancement.  These professionals can also recommend alternative treatments.



Most people are interested in buttocks shaping because they want their body to be a little shapelier so it has more of an hourglass shape. However, we are seeing a greater acceptance of bigger waist to hip ratios due to celebrities such as Kim Kardashian and Nicki Minaj. These media personalities have helped this procedure take off in a big way. Buttocks shaping is now the fastest growing plastic surgery procedure in the country.


Written by Cosmetic Town Editorial Team based on an exclusive interview provided by Dr. Luis Macias of Marina Plastic Surgery in Marina Del Rey, CA.