Uneven Buttocks and Glute Imbalance: Causes, Exercises and Treatment

In this guide16 sections

1. Key Points
2. What Is a Glute Imbalance?
3. Is It Normal to Have One Buttock Bigger Than the Other?
4. Why Is One Buttock Bigger Than the Other?
5. Glute Imbalance Symptoms: What Do Uneven Buttocks Look Like?
6. How Do I Know If I Have a Glute Imbalance?
7. When Should You See a GP About Uneven Buttocks?
8. How to Fix Uneven Glutes With Exercise
9. How Long Does It Take to Fix a Glute Imbalance?
10. Can You Fix Uneven Buttocks Without Surgery?
11. What Is the Best Surgery for Uneven Buttocks?
12. Uneven Buttocks After a BBL: Why It Happens and How It Is Fixed
13. Am I a Candidate for Uneven Buttocks Surgery?
14. Frequently Asked Questions
15. Uneven Buttock Correction in London
16. References

Uneven buttocks, also called glute imbalance or buttock asymmetry, means one buttock is bigger, flatter, higher or a different shape from the other. A small difference is normal, and most cases come from everyday factors such as a dominant leg, the way you stand or train, or a slight difference in leg length. Where the difference is muscle, single-leg exercise helps; where it is fat, volume or loose skin, the options are non-surgical butt filler, fat transfer with a Brazilian butt lift, liposuction or a buttock lift.

This guide explains why one buttock is bigger than the other, how to tell if you have a glute imbalance, when to see your GP, which exercises help and where their limits lie, and how each treatment corrects buttock asymmetry, including uneven buttocks after a BBL.

What Is a Glute Imbalance?

A glute imbalance is a difference between the left and right buttock in size, shape, height or strength. Uneven glutes, uneven bum cheeks, a lopsided butt and asymmetrical glutes all describe the same thing.

Each buttock is built from four layers, and a difference in any of them can make the two sides look uneven:

• Bone: the pelvis sets the frame. If it is tilted or rotated, one buttock can sit higher or look rounder.
• Muscle: the gluteus maximus gives most of the bulk, while the gluteus medius and minimus shape the upper outer buttock and keep the pelvis level.
• Fat: the layer under the skin gives much of the volume and is not always laid down evenly.
• Skin: looser skin on one side can make that buttock look lower or longer.

It helps to separate a functional imbalance, where one glute is weaker, from a visible one, where one buttock looks different. They often go together, but an obvious shape difference with equal strength usually comes from fat or bone rather than muscle.

Is It Normal to Have One Buttock Bigger Than the Other?

Yes. A small difference between the two buttocks is normal and very common. Most people have a dominant leg, one hip that is slightly higher, and fat that is not distributed exactly evenly.

Leg length is a good example. A 2005 review of X-ray studies in Chiropractic & Osteopathy ↗ found that about 90% of people have an anatomical leg length difference, averaging 5.2 mm, and that differences rarely become clinically significant below about 20 mm^[1]. A more noticeable difference can tilt the pelvis enough to make one buttock or buttock crease sit lower.

Muscle size also varies with use. In an MRI study, healthy people were largely symmetrical in gluteus medius size, while the smaller gluteus minimus showed a trend towards asymmetry that appeared to follow leg dominance^[2]. Some difference from favouring one leg is a normal finding, not a disorder.

Why Is One Buttock Bigger Than the Other?

There is usually more than one reason, and they can add together.

A Dominant Leg

You push off, stand and land on your dominant leg, so over years the glute on that side can become stronger and fuller. The gym can amplify this: in squats, deadlifts and hip thrusts the stronger side quietly takes more of the load, so the bigger glute keeps getting the bigger workout.

Posture and Everyday Habits

Standing with your weight on one hip, always carrying a child or bag on the same side, or sitting for long periods can leave one glute less active. Tight hip flexors from sitting make the glute behind them harder to switch on.

Scoliosis and Pelvic Tilt

Scoliosis is a sideways curve of the spine. The NHS lists one hip sticking out, uneven shoulders, leaning to one side and clothes not fitting well among its signs^[3]. The curve can tilt or rotate the pelvis and pull the muscles unevenly, so one buttock may look higher, rounder or flatter. If you notice these signs, see your GP before considering cosmetic treatment.

Leg Length Difference

A shorter leg drops the pelvis on that side, so the buttock can look lower and longer and its crease may sit lower. The difference can be anatomical (the bones differ) or functional (tight muscles or pelvic position make one leg behave as shorter). A physiotherapist can measure it, and a shoe raise is sometimes used.

Hip, Knee or Ankle Injury and Arthritis

After an injury, people shift weight away from the painful side, so an old ankle sprain, knee operation or hip problem can leave that glute weaker and smaller. Hip arthritis shows this clearly: an MRI study found that people with osteoarthritis in one hip had significantly smaller gluteus maximus, medius and minimus muscles on the affected side, and the difference grew with the severity of the arthritis^[4].

Nerve Problems

The glutes are supplied by nerves from the lower spine. A trapped nerve from a slipped disc, or damage to the nerves running through the buttock, can make a glute gradually waste. This usually comes with back pain, leg pain, numbness or weakness, and needs a medical assessment rather than exercise or cosmetic treatment.

Uneven Fat Distribution

One buttock or hip can carry more fat than the other, which is why uneven hip fat often accompanies uneven buttocks. Weight changes can exaggerate the difference.

After a BBL or Fat Transfer

A 2026 systematic review of more than 12,000 gluteal fat transfer patients in Plastic and Reconstructive Surgery ↗ found that asymmetries made up about a quarter (25.6%) of non-embolic complications, second only to contour irregularities^[5]. This is covered in its own section below.

Genetics

Body shape runs in families, and some people have always had uneven buttocks with no habit, injury or medical cause to explain it.

Glute Imbalance Symptoms: What Do Uneven Buttocks Look Like?

A glute imbalance can be something you see, something you feel, or both:

• One buttock looks bigger, rounder or more lifted, especially in leggings, jeans or swimwear.
• One bum cheek sits lower or looks longer and flatter.
• Uneven buttock creases, with the fold under one buttock lower, longer or doubled.
• Clothes twist to one side or the back seam of trousers sits off-centre.
• One glute does not seem to switch on during squats or lunges, or you feel sore on one side only.
• Aching in one hip, the lower back or the outside of one knee.

In adults, uneven buttock creases usually come from a leg length difference, pelvic tilt or uneven fat and skin, and a lower crease often has a fold of fat beneath it, known as a banana roll. Uneven gluteal folds in babies are different, as they can be a sign of hip dysplasia, and should be checked by a GP.

How Do I Know If I Have a Glute Imbalance?

A few simple checks give you a good idea:

• Photo test: stand relaxed in fitted clothing and take a photo from behind in good light. Compare the crease heights, fullness of each side and level of your hips.
• Single-leg bridge: lying on your back, lift one foot and push your hips up on the other leg. If one side tires sooner, cramps in the hamstring or lets the pelvis drop, that glute is likely weaker.
• Single-leg stand: stand on one leg facing a mirror. If the opposite hip drops or the knee falls inwards, the gluteus medius on the standing side may be weak.

These checks show where to focus but not the cause. A physiotherapist can measure strength, leg length and pelvic position. A surgeon assessing uneven buttocks looks at how much of the difference is fat, muscle, skin and bone, which decides what treatment can help.

When Should You See a GP About Uneven Buttocks?

Most uneven buttocks are harmless, but see your GP or a physiotherapist if:

• the difference is new, appeared quickly or is getting worse;
• one buttock is wasting without a clear reason, or there is a lump that is growing, hard or painful;
• you have back pain, pain down one leg, numbness, pins and needles or leg weakness;
• you notice a spinal curve, uneven shoulders or one hip sticking out;
• you have hip pain or a limp.

Call 999 or go to A&E if back pain comes with numbness around the bottom or genitals, loss of bladder or bowel control, or weakness in both legs, as these can be signs of cauda equina syndrome. Cosmetic treatment is only considered once any medical cause has been ruled out or treated.

How to Fix Uneven Glutes With Exercise

When the difference is mainly muscle, exercise is the first step. The key is unilateral training, working one leg at a time so the stronger side cannot take over. Good glute imbalance exercises include:

• Bulgarian split squats and reverse lunges for the gluteus maximus.
• Single-leg hip thrusts and glute bridges to isolate each side.
• Step-ups and single-leg Romanian deadlifts for strength and control.
• Side-lying hip abduction, clamshells and banded side steps for the gluteus medius.

To make it work:

• Start with the weaker side and match the reps on the stronger side.
• Give the weaker side an extra set until the gap narrows.
• Feel the right muscle working. If a lunge is mostly in your thigh or back, adjust your position.
• Increase the load gradually and change the habits behind the imbalance.

Exercise has clear limits. It can build muscle, but it cannot move fat from one buttock to the other, tighten loose skin or change the shape of the pelvis, and you cannot spot-reduce fat on the larger side. If several months of consistent training have not changed the difference, the cause is probably not muscle. Our article on BBL vs squats explains what glute training can and cannot change.

How Long Does It Take to Fix a Glute Imbalance?

Strength often improves within a few weeks as the weaker glute learns to switch on. Visible change in muscle size takes longer: usually at least two to three months of training two or three times a week, and six months or more for a large imbalance. If an injury, arthritis or a nerve problem is behind it, a physiotherapy programme built around that cause works better than a generic routine.

Can You Fix Uneven Buttocks Without Surgery?

For small volume differences, yes. Hyaluronic acid body filler can add volume to the smaller or flatter side, with a different amount injected on each side. In a 2025 prospective study of a hyaluronic acid filler for buttock contouring, 30 women received an average of about 44 ml; satisfaction was 90% at one month and 62% at 12 months as the filler was absorbed, with no serious adverse events^[6].

At Centre for Surgery, the liquid BBL uses HYAcorp hyaluronic acid filler, injected by surgeons in a sterile theatre under ultrasound guidance with local anaesthetic. Each session takes 45 to 60 minutes, one to three sessions may be needed, there is no downtime, and results last around 12 to 18 months. It can be reversed with hyaluronidase. Filler gives a modest change, so it suits a small difference, and it does not slim a fuller side. Our guide to HYAcorp fillers for buttocks explains more.

What Is the Best Surgery for Uneven Buttocks?

There is no single best operation. The right procedure depends on the cause, many people need a combination, and each side is planned separately.

Fat Transfer (BBL) to Add Volume to the Smaller Side

For a smaller or flatter buttock, fat transfer is usually the most precise option. Fat is taken by liposuction from areas such as the abdomen, flanks or back and injected into the buttocks, with the volume for each side and each zone decided independently. More fat can go into the smaller buttock, its upper pole or its side, so the two sides end up closer in shape as well as size.

Safety depends on where the fat goes. The 2017 ASERF Task Force report in Aesthetic Surgery Journal ↗, covering almost 199,000 gluteal fat grafting cases, linked injection into the deep muscle with a significantly higher rate of fatal and non-fatal fat embolism^[7]. After surgeons moved away from muscle injection, a follow-up survey found estimated mortality fell from around 1 in 3,448 to 1 in 14,952^[8]. At Centre for Surgery, fat is injected only into the layer above the gluteal muscle, never into or beneath it, with a blunt cannula under real-time ultrasound guidance on every BBL.

Around 50 to 70% of transferred fat survives, which the surgeon plans for. For a modest difference, a mini BBL uses around 800 to 1,000 ml of fat from two donor areas, while slimmer patients may suit a skinny BBL.

Liposuction to Reduce the Larger Side

If one buttock or hip carries more fat, liposuction can reduce the fuller side to match. It is often combined with fat transfer, reducing one area and adding to another in the same operation.

Buttock Lift for a Lower or Sagging Side

When one buttock sits lower because of loose skin, adding volume will not raise it. A buttock lift removes loose skin and can be tailored to each side. It does not add volume, so it is sometimes combined with fat transfer, and it leaves a permanent scar that sits in the swimwear line.

Buttock Implants

Buttock implants can suit people without enough fat for a BBL, but they are less adjustable for asymmetry. A systematic review of almost 6,000 patients found an overall complication rate of 21.6% with silicone buttock implants against 9.9% for fat transfer^[9]. Fat can be added around an implant to fine-tune each side.

Does a Thigh Lift Fix a Glute Imbalance?

No. A thigh lift removes loose skin and fat from the thighs; it does not change the strength or size of the glutes. It can improve overall lower-body shape after major weight loss, but it does not treat a glute imbalance.

Uneven Buttocks After a BBL: Why It Happens and How It Is Fixed

The buttocks often look uneven in the first weeks after a BBL, as swelling settles at different rates and sitting or sleeping can press on one side. The skin softens at around 6 to 8 weeks, most of the result is visible at 3 months, and the final shape is seen at 3 to 6 months.

Lasting asymmetry happens when fat survival differs between sides, after fat necrosis, or with uneven pressure during recovery. Rates vary with technique: in a 2025 cohort of 114 patients treated with an ultrasound-guided technique, asymmetry was reported in 5%^[10]. Following the sitting and sleeping guidance gives the fat its best chance to settle evenly, as our article on preventing dents after a BBL explains.

A BBL cannot be fully reversed, as transferred fat develops its own blood supply, but it can be revised: a smaller side topped up with more fat, a larger side reduced with liposuction. If you are concerned after a BBL at Centre for Surgery, you can be seen sooner for assessment, and a revision BBL is usually discussed at the 6-month review.

Am I a Candidate for Uneven Buttocks Surgery?

You may be suitable if:

• any medical cause, such as scoliosis or a hip or nerve problem, has been assessed;
• you are 18 or over, healthy, and not pregnant or breastfeeding;
• your weight has been stable for at least 3 months, or 6 to 12 months after major weight loss;
• for fat transfer, you have enough donor fat, usually a BMI of around 23 to 28;
• you can stop smoking and vaping for 4 weeks before and after surgery;
• you want better balance, not perfect symmetry.

A BBL at Centre for Surgery is a day case under TIVA (total intravenous anaesthesia) taking around 3 to 4 hours. You avoid sitting on your buttocks for 2 weeks, wear a compression garment for 6 weeks and take 1 to 2 weeks off work. Our BBL cost guide explains what affects the price.

Frequently Asked Questions

Uneven Buttock Correction in London

Treatment for uneven buttocks at Centre for Surgery is carried out by GMC-registered surgeons at our CQC-regulated Baker Street hospital, rated Good overall by the CQC. Your surgeon will assess how much of the difference is muscle, fat, skin and bone, check whether anything needs medical assessment first, and explain honestly whether exercise, filler or surgery is the right route. Options include ultrasound-guided fat transfer, liposuction, buttock lift and HYAcorp filler, with each side planned individually. The consultant who assesses you performs your surgery, further consultations before surgery are free, and we recommend a two-week cooling-off period. Your initial consultation is £100, redeemable against the cost of surgery if you go ahead. Finance isn’t available for BBL, buttock implants or the non-surgical butt lift at Centre for Surgery, so these treatments are self-funded.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy 2005;13:11. doi:10.1186/1746-1340-13-11 ↗
2. Grimaldi A, Richardson C, Stanton W, et al. The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles. Manual Therapy 2009;14(6):605–610. doi:10.1016/j.math.2009.07.004 ↗
3. NHS. Scoliosis. Reviewed 12 April 2023. nhs.uk ↗
4. Zacharias A, Pizzari T, English DJ, et al. Hip abductor muscle volume in hip osteoarthritis and matched controls. Osteoarthritis and Cartilage 2016;24(10):1727–1735. doi:10.1016/j.joca.2016.05.002 ↗
5. Domínguez-Millán R, Hoyos A, Cárdenas-Camarena L, et al. Non-embolic complications of gluteal fat transfer: a systematic review of the literature. Plastic and Reconstructive Surgery 2026. doi:10.1097/PRS.0000000000013408 ↗
6. Bussade M, Faria G, Barros M, et al. Assessment of hyaluronic acid filler in gluteal augmentation and contouring: a 1-year prospective study. Journal of Cosmetic Dermatology 2025;24(12):e70600. doi:10.1111/jocd.70600 ↗
7. Mofid MM, Teitelbaum S, Suissa D, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthetic Surgery Journal 2017;37(7):796–806. doi:10.1093/asj/sjx004 ↗
8. Rios L, Gupta V. Improvement in Brazilian butt lift (BBL) safety with the current recommendations from ASERF, ASAPS, and ISAPS. Aesthetic Surgery Journal 2020;40(8):864–870. doi:10.1093/asj/sjaa098 ↗
9. Sinno S, Chang JB, Brownstone ND, et al. Determining the safety and efficacy of gluteal augmentation: a systematic review of outcomes and complications. Plastic and Reconstructive Surgery 2016;137(4):1151–1156. doi:10.1097/PRS.0000000000002005 ↗
10. Durán Vega HC, Sieber D, Magallanes S, et al. The linear retrograde infiltration (LiRi) technique for buttock fat infiltration: a cohort evolution. Aesthetic Surgery Journal 2025. doi:10.1093/asj/sjae254 ↗

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