Patients come to Southwest Plastic Surgery asking about a Brazilian Butt Lift, and a fair number of them are actually describing something a BBL cannot fix. They point to a second fold below the natural crease under the buttock, a boxy or squared-off lower border, and ask for more volume to smooth it out.
Dr. Frank Agullo’s answer, most of the time, is that adding volume is the wrong move. “The buttock isn’t underfilled in these cases,” he says. “The lower border has dropped and needs to be repositioned, not padded.”
What The Double Butt Crease Actually Is
The condition has a clinical name, double gluteal fold or double butt crease deformity, and a long list of nicknames patients use in the exam room: elephant butt, frog butt, chicken tenders. Whatever the term, the mechanism is the same. The skin and fat of the lower buttock sag and hang toward the upper thigh instead of sitting against it, creating a second crease below the true gluteal sulcus.
Southwest Plastic Surgery sees this most often in four groups: patients after significant weight loss, patients with prior aggressive liposuction of the lower buttock, patients with a genetic predisposition to a weaker lower attachment, and patients whose skin has simply loosened with age. The clinical term for the underlying problem is inferomedial buttock ptosis, meaning the lower, inner portion of the buttock has descended.
Why A BBL Or Implant Makes It Worse, Not Better
Dr. Agullo is direct with patients on this point. A Brazilian Butt Lift adds fat volume. A gluteal implant adds fixed volume beneath the muscle. Neither lifts sagging skin, and added weight in an already-descended lower buttock can push the second crease into sharper relief.
“I’ve seen patients arrive after a BBL performed elsewhere specifically to fix this,” Dr. Agullo says, “and the crease was more pronounced afterward, not less. The problem was excess lax skin on a descended border. Volume doesn’t solve that.”
How The Miami Thong Lift Works
The Miami Thong Lift, Dr. Agullo’s technique for correcting this deformity, excises the excess skin of the lower buttock and lifts the remaining tissue back to where the natural fold belongs. The incision sits within the intergluteal crease and along the thong line, keeping it hidden in swimwear and most clothing.
The result restores one clean lower gluteal border in place of two, correcting the boxy or L-shaped appearance that defines the deformity. It is a repositioning procedure, not a volume procedure, which is the reason it succeeds where a standalone BBL does not.
Candidacy
Southwest Plastic Surgery evaluates each patient individually, but the pattern that predicts a good result is a genuinely descended, lax lower buttock fold combined with overall good health, non-smoking status, and realistic expectations. Patients with good skin quality who simply want more shape are better served by fat grafting or an implant, and the practice will say so directly rather than recommend a procedure that will not solve the presenting problem.
Combining The Lift With Fat Grafting
Many patients want both a corrected border and additional shape. Once the Miami Thong Lift addresses the descended tissue, fat grafting can be added to refine volume in the hip or upper buttock. The practice sequences these deliberately, correcting the structural problem before adding shape, since the reverse order tends to undo itself.
Recovery At Southwest Plastic Surgery
Recovery depends on what procedures are combined with the lift. Patients generally avoid sitting flat on the incision for a period, wear compression garments, and see swelling and bruising resolve over several weeks. Southwest Plastic Surgery’s post-surgical massage program supports that healing timeline. The scar sits inside the natural crease and along the thong line and typically fades to near invisibility within several months.
Why Southwest Plastic Surgery For This Procedure
Dr. Agullo is a double board-certified plastic surgeon (American Board of Plastic Surgery and American Board of Surgery), a Mayo Clinic fellowship graduate, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, a Castle Connolly Top Doctor for thirteen consecutive years, and founding vice president of the World Association of Gluteal Surgeons. Gluteal-specific training matters here because the double crease deformity is routinely misdiagnosed as a volume problem by surgeons without that specific background.
Ready To Talk?
If you’ve been told a BBL will fix a fold that a BBL cannot fix, Southwest Plastic Surgery offers a real assessment before any procedure is booked. 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
