If you have noticed a dimpled texture on your backside, you are not alone. Dr. Michael Baumholtz, a dual board-certified Plastic and Reconstructive Surgeon in San Antonio, Texas, discusses this concern with patients every week. Many people want clear explanations and options that fit their anatomy and lifestyle. There are treatments that can help.
What is the “dimpled backside” look?
The term usually refers to cellulite. It appears as small pits or uneven patches on the buttocks and thighs. Cellulite forms when tight fibrous bands, called septa, tether the skin down while surrounding tissue pushes up. This creates the familiar dimpling. It is common in many body types, including lean and athletic individuals. It is not a sign of poor health.
Why it happens
Several factors can play a role:
- Genetics that affect skin quality and how tissue is arranged
- Hormonal changes during puberty, pregnancy, or menopause
- Aging with gradual loss of collagen and elasticity
- Lifestyle factors such as limited activity or higher-sodium, highly processed foods
These elements can make the tethering more visible, especially where the skin is thin.
How Dr. Baumholtz evaluates this concern
Evaluation focuses on what is present on examination, not on a single tool or promise. For the backside, Dr. Baumholtz does not use VECTRA body imaging. He relies on a detailed physical exam, standardized photographs, and a discussion of goals. He separates findings into three groups:
- Discrete dimples caused by septa
- Surface waviness from fat distribution or mild laxity
- Skin excess and descent that suggest laxity as the main issue
This helps match each person to the most appropriate option.
Treatment options
There is no single method that suits everyone. The plan depends on whether the main problem is dimpling, laxity, or both.
✓ Avéli for cellulite dimples
- What it treats: True dimples created by tight fibrous bands.
- How it works: Through tiny entry points with local anesthesia, a specialized device is passed just under the skin. Dr. Baumholtz identifies and releases the individual septa that pull the skin inward. Each treated dimple is addressed in a targeted way.
- Who is a candidate: People with visible pits and otherwise reasonable skin quality. Avéli targets structure. It does not tighten loose skin.
- What to expect:
- Often a single focused session
- Temporary bruising and tenderness
- Results become clearer as swelling subsides
- Aging continues over time, so future touch-ups may be considered if new dimples form
- What it does not do: Avéli does not remove skin, raise tissue that has descended, or change buttock size.
✓ Subcision with small-volume fat grafting
Some isolated depressions benefit from limited subcision and conservative fat micrografting to soften edges. In Dr. Baumholtz’s practice, gluteal fat is placed only in the subcutaneous layer, not in muscle. This subcutaneous-only approach reflects current safety guidance for the gluteal region.
✓ Energy-based devices as adjuncts
Radiofrequency, acoustic wave, or certain laser platforms may support collagen and improve surface smoothness. These are typically done in a series. They can complement Avéli or subcision but are not a replacement for treatment of true septa or excess skin.
✓ Buttock lift when laxity is the primary issue
If the exam shows skin excess with descent, especially after major weight loss, a buttock lift may be more appropriate than a dimple-only treatment.
- What it addresses: Extra skin and soft tissue that has stretched and dropped over time.
- What it involves: Excision of excess skin and repositioning of the tissue for a firmer contour. The incision is designed to sit along the lower back or upper buttock crease so that typical underwear or swimwear can cover it.
- Who is a candidate: People whose main concern is laxity rather than a few isolated pits. Avéli can still be used later for any remaining dimples.
- Planning and staging: Large body procedures are often staged. Dr. Baumholtz frequently addresses the front of the body first, then plans thighs and backside about three months later. This approach can simplify recovery and allow more focused aftercare.
Brazilian Butt Lift Before and After Photos
Putting the plan together
Common pathways include:
- Mostly dimples with good skin quality: Avéli as the primary step, with occasional spot subcision or micrografting
- Dimples plus mild laxity: Avéli combined with a limited series of energy-based treatments
- Significant laxity after weight loss: Buttock lift, with optional Avéli later for residual pits
Safety priorities in this practice
- Gluteal fat grafting is confined to the subcutaneous plane. Intramuscular fat injection is avoided.
- Nicotine products are stopped well before and after surgery to support healing.
- Combined and extensive operations are staged when appropriate to reduce physiologic stress and to streamline recovery.
FAQs About Dimpled Backside
Can a dimpled backside worsen over time if I do nothing?
It can become more visible as skin thins and loses elasticity. Hormonal shifts may also change how tissue behaves.
I am in good shape. Why do I still see dimples?
Cellulite relates to the structure under the skin, not only to weight or fitness.
Is one treatment enough?
It depends on the findings. Avéli often addresses the targeted dimples in a single session. Other issues, like skin laxity, may need different steps.
Will fat transfer make the buttocks look larger or only smoother?
It can be used in very small amounts to blend a contour. The aim is shape refinement, not large volume change.
How do I know if my concern is structural dimples or laxity?
A physical exam will clarify the cause. The plan is based on what is seen and felt on exam and what you hope to change.
Will treatment change how clothing fits?
Smoother contours can be noticeable in fitted garments. The degree of change depends on the treatment performed and your baseline anatomy.
Are professional treatments different from at-home methods?
Yes. Office procedures reach the structures beneath the skin. Topicals and home devices act on the surface and usually offer temporary effects.
What to expect at consultation
You will review your exam findings, photographs, and goals with Dr. Baumholtz. For backside concerns he uses an exam-based approach, not VECTRA body imaging. The plan may include Avéli, adjunct energy devices, limited fat micrografting, or a buttock lift. Choices are tailored to anatomy, health, and recovery needs.
Medical References
- Sacral dimple - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sacral-dimple/symptoms-causes/syc-20377353
- Cellulite - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cellulite/symptoms-causes/syc-20354945
- Spina bifida - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860
- Evaluation of sacral dimple association with urodynamic findings in children with recurrent urinary tract infection. Journal of Renal Injury Prevention. https://journalrip.com/Article/jrip-9622
- Sacral dimple: Symptoms and complications. Medical News Today
https://www.medicalnewstoday.com/articles/319177 - Ultrasound. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/ultrasound/about/pac-20395177
- Cellulitis - Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762
Further Reading
- Read more about Body
- Read Dr Baumholtz's Blog on How to Get a Natural-Looking Belly After Tummy Tuck Surgery
- Read Dr Baumholtz's Blog on What is Body Contouring: Benefits, Risks & Recovery
