There are plenty of patients who have had a lap-band or a gastric sleeve or some other surgical procedure to lose weight. When you lose weight, a lot of the fat in your body will disappear but the excess skin will stay, and the buttocks are not an exception. Many patients want buttock augmentations because their buttocks are deflated and need extra volume. The problem is that, when you lose volume, the excess skin will stay, and when you perform an augmentation on a saggy buttock, you will have a big saggy buttock. Looking at this diagram, let’s assume that your buttock is a semicircle and the yellow is the fat. When you lose weight, the fat will decrease, but the amount of skin will stay the same. If a surgeon starts injecting fat in this setting, the fat injected will not be sufficient to expand the skin pocket to the level where the buttock gets rounder for a nice result. In other words, excess skin will negatively impact the result of any buttock augmentation surgery. So, what can we do? If you have excess skin, the foundation of the buttock needs to be fixed before surgery. In other words, the excess skin needs to be removed prior to fat injection. There are many ways of removing excess skin, depending on its location. If you have significant excess skin in all the different areas of your buttocks, then an incision is made above the buttock and the excess skin removed and incision closed. Typically, this is what is called a buttock excisional lift, where the skin is removed and nothing is done to shape or augment the buttock. It is just cutting away the excess skin in order to subsequently perform an augmentation with either an implant or fat. You have lost weight before surgery; that is a great thing for your health, but if you have excess skin, additional procedures may be required to have those nice round buttocks that you desire.