Q: Dr. Eppley,I’ve recently e-mailed you inquiring about deltoid implants/fat grafting and I was wondering what other areas of the body that fat grafting can be applied to?
I’m 24 years old and have a very thin and bony structure, thin wrists, narrow shoulders, and thin neck which has led to years of insecurity, yet at the same time I have a decent amount of fat on my stomach and chest.Due to severe tendonitis and several joint problems – accompanied with a muscular dystrophic disease in earlier life, I’m entirely unable to engage in hypertrophy training so the option to increase muscle mass through weight lifting isn’t possible, though I have tried for many years to work around it.
I was wondering if somewhat of a comprehensive fat grafting/contouring upper body transformation (increasing forearm, upper arm, deltoid, and neck thickness) is possible. Could it be done and look natural? or is there an alternative surgery that could be more suitable? I just want to feel/look like a normal person.
A: I think the key issue in you, who is very thin most everywhere, is that fat grafting is very unlikely to be successful. This is because most likely you do not have enough fat to harvest to be used and in very thin people the injected fat rarely stays or stays so little that it does not make much difference. The only option for arms, shoulders, chest and calfs are body implants which can look natural as long as they are not overdone. (too big) There is no procedure that can make your neck thicker.
Dr. Barry Eppley
Q: Dr. Eppley, I have narrow shoulders i wander if there is any plastic surgery that can put a small implant to make my shoulders somewhat wider because whatever i wear my body looks like child’s body because of my small shoulders. I drew an imaginary picture about the size of the implant if it is possible to be done.
A: The shoulder implant to which you refer is known as deltoid implants. Making the shoulders bigger/broader requires deltoid muscle augmentation. Implants are available to augment this muscle and the key to their placement is the location of the incision, the position of the implant over the muscle and the size of the implant. The deltoid implant is unique amongst all body implants because it is placed over/near a moveable joint. (shoulder) While deltoid implants can be placed by a direct incision over the shoulder, the prominence of that scar merits it being done from an incision behind the shoulder at the junction of the shoulder and the back.
Dr. Barry Eppley
Q: Dr. Eppley, I would be very interested in getting hip implants. My hips are tiny. I would like to add an inch to both sides of my iliac crest closer to the front part. Too bad there isn’t a good way to secure them to the iliac crest- I would gladly take scars over my little boy hips for that implant to be rigid!
A: Hip implants are so of a vague term as it could imply areas from along the iliac crests to do over the hip joint. (upper thigh) I would call true hip implants as you have defined your hip concerns…up over the iliac crests. Augmentation could be done by fat injections or actual implants and each as their own distinct advantages and disadvantages. For certain volume retention, an implant is the most assured approach. There are no true commercially produced hip implants but the shape of a calf implant would be ideal for placing on top of or along the edge of the iliac crest. As a long cigar-shaped implant that would be almost an inch thick, a one inch increase on each side of the hips could be obtained. This does require a 1 to 2 inch incision at the front end of the iliac crest to create the tunnel and place them. A single screw could be used to secure the implant to the iliac crest if desired. The only question is whether that is absolutely necessary or not. The long-term stability of the implant over the iliac crest has not been established given the rarity of this type of body implant procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in deltoid implants which amongst other procedures as I learned you are very skilled at. I have pictures for my shoulder which are attached. The dimensions for the augmentation are 16cm measured from clavicule down lateral view to end of the deltoid in the center line, the widest part is around 10cms with a projection of 2 cm.
A: Thank you for sending your shoulder augmentation desire and dimensions. Deltoid implants are one of the most uncommon type of body implants but requested for them are becoming more frequent. One of the reasons I asked for them is to have a vision as to where the patient sees the location of the deltoid augmentation and the dimensions that the implants have to be. As there is no off-the-shelf premade deltoid implants, I have to either use an existing style of body implant (usually a calf implant or a custom silicone carving block) or have a custom one made. As it turns out there is an existing silicone carving block with the dimensions of 16 cms long, 9 cms. wide and 2 cms. high. So that does fit the dimensions you have given although although that is probably a bit big. A more appropriate deltoid implant size would be 14cm long, 7 cm wide and 1.5 cm high. The other consideration is knowing the location and the implant size I have think about the incisional location to put it in during surgery. Usually this is done from the back side of the shoulder rather than a direct incision over it.
Dr. Barry Eppley
Q: Hello. Does Dr. Eppley do cosmetic hip implant surgery? I saw this on the website, but I couldn’t find the surgery listed on the drop down menu.
A:I have performed implant procedures all over the body including the rarely done hip implant. It is very infrequently requested (you are only the second inquiry that I have ever had) and I have only performed the procedure one time, on one side, for a traumatic injury problem to get better hip symmetry and provide a ‘ledge’ to hold up their pants better on that side.
Hip implants are almost exclusively done for cosmetic augmentation and, in rare cases as described above, for reconstructive purposes. For those women who feel that their hips are too narrow and want more of an hourglass figure, hip implants can give them more curvature.
Hip augmentation can be done through either an implant placement or fat injections. each has their advantages and disadvantages. Hip implants require an incision to be placed and are a foreign material in a very palpable and prominent area. They are placed down on top of the fascia or aponeurosis covering the iliac crest. They are not placed directly on the bone surface as this requires stripping of attachments off of the crest which is painful. (like an iliac bone graft harvest) Fat injections use your own tissue (which gets a cosmetic benefit also from the harvest site) and are soft with little risk of infection. But their reliability in terms of volume retention is not always assured.
Q: I am interested in getting a deltoid implant but am having a hard time finding out much about it. I know it is not commonly done but have read that it is done. I would like to get my one shoulder to look more like the other rather than deformed and asymmetric. What can you tell me about this type of implant?
A: The deltoid muscle is a bulky triangular muscle that covers the shoulder joint and contributes to movement and stability of the upper arm, particularly when it is lifted away from the body. The rounded curve of the shoulder is due primarily to the bulk of the deltoid muscle. Deltoid muscle atropy is most commonly caused by injury to the axillary nerve or muscle wasting after shoulder surgery or injury.
Placing silicone implants into the arm or shoulder has been historically avoided by plastic surgeons. Besides being rarely done, there is an understandable fear that the complication rate is higher than many other implant locations. To avoid complications, implants are placed beneath the muscle and just on top of the humerus bone. The deep location of the implant then acts as a spacer providing a deep push on the outer contour for volume enhancement. Placement of the implant right under the skin is easier but has a much higher rate of infection and capsular contracture and often results in visible outlining of the implant on the shoulder.
The type of implant used is the same as any other body implant, a soft and flexible form of silicone rubber.
Dr. Barry Eppley