In major weight-loss patients we use local tissue (flaps) to achieve buttock augmentation. The excess fat is folded back into the buttock area to provide a replacement of the missing buttock volume. If excess fat (hips, thighs, lower back) is available for donor tissue, fat grafting into the gluteus muscle can provide excellent buttock augmentation. No scars are necessary, recovery is quick, and wound complications are uncommon. If there is inadequate fat donor site, silicone implants can provide an option for augmentation, but the potential for problems with scar, symmetry and wound healing are higher than with fat grafting. Calf augmentation with silicone implants is a more consistently effective procedure, and our experience with this procedure has been excellent.