Co-creation with the population at the Bottom of the Pyramid (BOP) was identified as pivotal for realizing the full potential of the BOP proposition, simultaneously creating economic value for companies in BOP markets, as well as social value for the individuals residing in them. However, research on co-creation and its outcomes has remained predominantly simplistic, often assuming that introducing any form of co-creation in company operations will lead to increased social value and economic gains. A more nuanced exploration of the different ways in which companies operationalize the principle of co-creation across their supply-chain and whether these indeed facilitate such a clear win-win scenario for both parties, remains relatively scarce. In this paper we address this gap and delve into the supply chains of 135 micro, small, and medium sized ventures operating in BOP markets. We identify four overarching patterns of co-creation and ten categories of specific practices used to achieve them, and ultimately show how these patterns facilitate very different levels of social sustainability and economic benefits across the supply chain.