Dr. Eppley, I have just learned of fat injections to help narrow small shoulders. Could you help me learn more about it? I have a lot of fat around my abdomen and obliques. Could that fat be used to make my shoulders bigger (broader and thicker)? If I were to diet, does that mean I would lose fat in the shoulders and they would shrink and I would have to repeat the fat transfer procedure? A lot of stomach fat has been something I always had. Even at 125 lbs. even when I do lose weight, I still have a big stomach. Would that fat be as difficult to lose in my shoulders as it is my stomach? How much broader could I make my shoulders with the fat transfer procedure (half inch, full inch)? Sorry to bombard you with questions.
A: Deltoid augmentation by fat injections can be a successful method for shoulder enhancement. The key is whether one really has enough fat to do the procedure or, more relevantly, to make it worthwhile. While you may think that you have enough fat, and you may very well do, that is somewhat hard to imagine at a 125lb weight. Whatever stomach fat you think you may have by appearance, that protrusion may be from an intraperitoneal basis (behind the abdominal muscles) rather than in front of it. (intraperitoneal fat is inaccessible from liposuction) This is obviously an issue that requires further assessment/examination even if only by pictures.
But for the sake of discussion let us assume you could have the procedure. Abdominal fat transfer to the shoulders (or anywhere else) is going to behave like the donor site and not the recipient site. Meaning if you lose weight the fat cells will get smaller as well as the reverse. These transferred abdominal fat cells have depot behavior with higher metabolic activity. Thus they are more sensitive to weight changes that normal shoulder subcutaneous fat would be. How much increased shoulder definition you could get would completely depend on how much fat is capable of being transferred…and how much survives the transfer process. Thus it could be anywhere from a very modest change to a more robust 1/2 inch or so.
Dr. Barry Eppley
Q: Dr. Eppley, I have extremely narrow clavicles which have caused years of insecurity. I’m very interested in the deltoid implant surgery that you offer. I think I read that the maximum amount that you can add to each shoulder in width is 1.5cm. Is this figure correct and does it apply to both the method of silicone implant as well as the fat grafting technique?
A: Deltoid augmentation (aka deltoid muscle augmentation) can be done by either fat injections or actual deltoid implants. If you have adequate fat, fat injections would be preferred since they are the most natural and are scarless to perform. While not all the fat will survive, fat injections would always be the first choice. If one does not have enough fat than only an implant can be used. This is placed through an incision in the skin crease at the back of the axilla (armpit) and the implant is placed in a subfascial location over the central segment of the deltoid muscle.
Both deltoid augmentation approaches take about the same amount of time in surgery and both have about the same recovery. Neither deltoid augmentation technique will create a full 1.5 cm per side, close but not always.
Dr. Barry Eppley
Q: Dr. Eppley, my clavicles on both sides stick up. Have you dealt with this surgery before – do you recommend anything (would deltoid implants resolve this)? I don’t want huge shoulders, just bones not so prevalent and I don’t want scars. Appreciate any feedback.
A: I have seen and treated prominent clavicles before and they are not rare. From an anatomical standpoint, the clavicle or collarbone is the only long bone in the body that lies horizontally as it connects the medial sternum to the lateral scapula. The knob at the acromial end of the bone can be felt in anyone but in some people this bony bump is very prominent as a bulge underneath the skin on top of the shoulder. This occurs due to either more bone in some people or less surrounding fat in others.
Cosmetic camouflage can be done by bony reduction by burring but this creates a scar which you have eliminated as an option. Deltoid implants are not appropriate for camouflage as this type of implant fits over the larger muscle belly of the deltoid which is more to the side of the shoulder. The only scarless treatment option would be injectable fat grafting. Since a thin fat layer is one reason why a prominent clavicular knob is seen, fat grafting around the knob and out into the deltoid muscle belly provides the best treatment option. While fat graft survival is unpredictable and survives least in areas of thin fat with tight overlying skin, it is the one true scarless camouflage method. What may be helpful is deltoid augmentation by fat grafting not implants.
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