Gluteal deformities encountered in patients who have lost a massive amount of weight are unprecedented in body-contouring surgery and plastic surgeons need uncommon techniques when contouring and augmenting the gluteal region in these patients. Following massive weight loss, a lot of patients show atrophy in their buttocks. In addition to the skin laxity and the volume loss relaxation of the superficial fascial apron contributes to gluteal ptosis as well. To restore a youthful gluteal contour, part of the tissue normally resected in circumferential lower body lift can be used enhancing gluteal contour with autologous tissue augmentation. Gluteal aesthetics in massive weight loss patients can be achieved also with large volume autologous fat transfer or alloplastic implants. Adjunctive techniques such as resection and tightening of the gluteal superficial fascia system (gluteal SMAS), posterior thigh lift and infragluteal diamond lift can refine the results.