Flat Butt

What a flat butt is

A flat butt is a lack of roundness and volume in the buttocks. Genetics, low muscle tone, and a sedentary life can each produce that shape. People often want a rounder contour and try exercise or diet first. Surgery comes into the conversation only after those have not changed the part of the buttock the patient actually wants changed.

The same loss of roundness is sometimes called a pancake butt when the buttock is flat and also sagging. Loss of fat, loss of muscle, or both can do it. Long sitting, poor posture, and little use of the glutes make it worse. The names gluteal amnesia and dead butt syndrome describe glute muscles that have gone quiet, not a missing implant or a missing fat graft.

Why a flat butt loses fat, muscle, or both

Dormant butt syndrome is the name used here for gluteal muscles that become inactive after prolonged sitting. They weaken, they lose tone, and the buttock looks flatter. During pregnancy the gluteal muscles can be under extra strain and grip, so they look tight and flat and support the pelvis less well. After childbirth, a stretched abdominal wall can leave the core unstable, and the glutes then work in a compensatory pattern that keeps the buttock flat.

Men and women both notice the change in ordinary movement. Weak glutes cut power for running and jumping, and they make walking, standing, and posture harder. Stronger glutes support the pelvis and the lower back and help with walking, running, and squatting. That is a muscle problem. It is not the same problem as a buttock that never stored much fat.

The photograph above is a surgical case, not an exercise result. It combined lipo 360, using VASER, of the middle back, the lower back, the lower lateral buttock, and the lateral thighs, with a fat transfer that filled the mid-buttock vertical height, plus a full tummy tuck. The transfer is what added the roundness. The liposuction changed the frame around it.

The muscles under a flat butt

Three muscles make up the buttock: the gluteus maximus, the gluteus medius, and the gluteus minimus. They move the hip and they hold the pelvis. A flat butt can be any one of them underused, or it can be a volume problem sitting on top of muscles that already work.

Gluteus maximus

The gluteus maximus is the largest and most powerful muscle in the body. It runs from the pelvis to the upper femur and originates from the posterior ilium, the sacrum, and the coccyx. It extends and externally rotates the hip, and it stabilizes the hip. Standing, walking, and running use it to propel the body forward and upward and to keep the pelvis aligned. Squats, lunges, deadlifts, hip thrusts, and glute bridges are the loaded movements used for that muscle.

Gluteus medius

The gluteus medius sits over the smaller minimus. This article ties it to gluteal amnesia: when sitting turns the muscle off, the buttock loses tone from the side as well as from the back. The movements named for it are side-lying leg lifts, clamshells, and lateral band walks. The pigeon stretch and the figure-four stretch are the mobility work named with them. A foam roller along the side of the hip is the release named for tightness in this muscle. Those tools change tone. They do not move fat into a buttock that has little fat.

Gluteus minimus

The gluteus minimus is a small fan-shaped muscle under the medius. It stabilizes and moves the hip. It abducts the thigh, taking it away from the midline, and it internally rotates the thigh. It also helps keep the pelvis level in walking, running, and jumping. It works with the medius and with the tensor fasciae latae. Repeated abduction and internal rotation, as in running, cycling, or lifting, can irritate its tendon, which is a tendinopathy, or strain the muscle itself.

Exercise for a flat butt that is mostly muscle

When the shape problem is an inactive muscle, the nonsurgical path is to load the glutes and to stop leaving them off all day. Uphill walking, stair climbing, and sprinting engage them. Squats, lunges, hip thrusts, and deadlifts load them. The work starts with body weight and adds load as form holds. Two or three sessions a week are enough to change tone. None of that deposits new fat in the buttock.

The butt tuck here is an exercise, not an operation. Lie on the back with the knees bent and the feet flat, lift the hips, squeeze the glutes, hold, and lower. The dose is 3 sets of 15 repetitions. It is a hip lift for the gluteus maximus. It is not a surgical buttock lift, and it does not add volume.

A surgical buttock lift is a different procedure. The American Society of Plastic Surgeons describes it as removal of sagging skin and fat to improve tone, and states that the lift itself does not make a buttock larger. Volume, when it is missing, comes from fat grafting, an implant, or tissue left under the skin. Liposuction can be added for contour. That split is the one used here: exercise for a quiet muscle, and an operation only when volume or extra fat is the actual finding.

Surgery chosen for a flat butt

The operation follows the finding. Missing projection with little donor fat is not the same case as a buttock that is flat because fat sits in the hip and the lower back instead of in the mid-buttock. Three tools are used here.

• A silicone gluteal implant, when the goal is a clear increase in size and projection.
• Fat transfer, a Brazilian butt lift, when the patient's own fat can supply the volume.
• Liposculpture, which is liposuction, when extra fat has to be removed to change the proportion.

A silicone implant is placed to add volume and projection for a patient who wants a definite increase in size. The risks named for that implant are infection, shifting or migration, rupture, and discomfort. Recovery includes a compression garment and a hold on strenuous activity for a few weeks. Fat transfer is not an implant. It is a separate operation, and it is the one chosen when there is donor fat to harvest. The comparison of the two is laid out on the implant and fat-transfer page, and the implant operation itself is the gluteal implant.

Fat transfer takes fat from another area, often the abdomen or the thighs, purifies it, and injects it into the buttock. The donor site gets slimmer while the buttock gains volume. The graft is the more natural look and feel, because it is the patient's own fat, and it is the operation that filled the mid-buttock vertical height in the photograph. It is not a substitute for liposuction of a buttock that is already too full in the wrong quadrant. A Brazilian butt lift is that transfer.

Liposculpture removes fat. Used on a flat butt, it changes proportion by taking fat from around the buttock, including the lower lateral buttock and the lateral thigh, the way the photograph's VASER liposuction did. It can be done alone or with a transfer. Suction without a transfer does not add roundness. If the buttock is flat because fat is missing, removing more fat makes it flatter. Liposuction is the removal step, and a pancake butt that is mostly sagging skin is a different finding from missing volume.

The same society page describes buttock augmentation as implants, fat grafting, or a combination of the two, which matches the choice above. A Brazilian butt lift is the fat-grafting form of that augmentation. The implant is the choice when there is not enough fat to move.