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Archive for the ‘body implants’ Category

Custom Hip Implants

Sunday, May 28th, 2017

 

Hip augmentation is most commonly done using fat injections. Even for patients that do not have a lot of fat to harvest, enough can almost always be obtained to fill in indentations or divots on both sides of the hips. But when combined buttock and hip augmentations are needed or in a thin body type, fat harvest sites may be inadequate. In addition, not all fat injections to the hips are successful.

When fat injections is not option or has failed for hip augmentation, the only other option is the use of an implant. There is no standard or preformed hip implants. While some surgeons may try and use implants made for other parts of the body, the hip area requires a unique implant shape. This shape is more like that of a shaped buttock implant but with a lower profile at its peak projection.

Because the length of the hip and its indentation is different for each patient, custom hip implants are most ideally used. Using measurements taken from the patient, the length and width of the implant can be created. The higher projection of the implant is on its superior end and usually does not need to be greater than 3 to 3.5 cms. The implant tapers down to a fine edge on its inferior extent.

Hip implants are placed through a posterior incision placed at the upper-posterior margin of the implant pocket. It is usually no more than 4.5 cms in length. The pocket is dissected down on top of the TFL (tensor fascia lata, outer thigh muscle) along the outer implant markings. The iplants are inserted using a no-touch funnel technique. Their low durometer makes passing through the funnel possible. Drains are often used and stay in place for 3 to 5 days. An above the needle girdle or cross-buttock taping with Mefix serves as postoperative compression.

Custom hip implants provide a permanent augmentation to narrow or indented hips. They are an option when there is inadequate donor sites for fat injections or fat injections that have not persisted. When one has enough fat to do injections this should always be tried first as such injections improve the quality of the hip tissues even if its augmentation effect may turn out inadequate.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Bicep Implants

Tuesday, September 20th, 2016

 

Background: Most body implants are done for muscular enhancement. The only exception is that of the female breast implant. In augmenting the muscle size, it is usually most effective if the implant is placed on top of the muscle under its fascial lining. This is certainly true for muscular augmentations that are on the extremities such as the arms and legs. The gliding nature of the muscle inside the fascial sheath allows for a good dissection plane into which the implant can be inserted.

Bicep implants are one of the most uncommon body implants done. While men often seek out larger arm muscles, the appeal of a bicep implant remains limited. This is undoubtably due to the few surgeons that do them and the lack of a good implant which together offers limited public awareness and demand for the procedure. The shape of the bicep muscle is not unlike that of the calfs so the overall implant shape is largely cylindrical.

While there are no true marketed bicep implants, the most common form of them are known as contoured carving blocks. (Implantech) These solid implants come in half cylindrical shapes that go up to 2 cms in length and 6.5 cms wide. The maximal projections are around 2 cms. These implant dimensions will work for most. but not all, patients who seek upper arm augmentation.

custom-vs-standard-bicep-implants-dr-barry-eppley-indianapolisCase Study: This 45 year-old male was to undergo multiple body contouring surgeries, one of which was bicep implants. He was a larger man in stature so even the largest contoured carving blocks were inadequate. Custom bicep implants were made of dimenions 18 cm long, 8 cms wide and 3.5 cm in projection. The attached picture shows the difference between a preformed large bicep implant and that of the custom designed one.

right-biceps-implant-result-intraop-dr-barry-eppley-indianapolisUnder general anesthesia, the custom bicep implants were placed on top of the bicep muscle under the fascia through a high axillary incision.

custom-bicep-implants-result-dr-barry-eppley-indianapolisHis results at two months after surgery show good muscular augmentation with symmetrical implant positioning. The axillary incisions were well healed. He had no restriction of arm flexion or extension. He had just begun back to working out again.

While most bicep implants can be using conventional preformed shapes and sizes, larger men or those that seek more significant arm muscle size may need to consider the custom implant approach.

Highlights:

1) Bicep implants are soft solid implants that are placed in the subfascial location on top of the muscle through an axillary incision.

2) Bicep implants comes in several different sizes but larger dimensions requite a custom implant approach.

3) Custom bicep implants are made based on measurements of the patient arms in the partially flexed position.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Trapezius Muscle Implants

Wednesday, February 3rd, 2016

trapezius muscleBackground: The trapezius muscle is a large superficial muscle in the upper back. It extends from the occipital bone superiorly down to the spine to the lower thoracic vertebrae and then out laterally to the shoulder blade. (scapula) Muscular development of the trapezius muscle by male body buillders and exercise enthusiasts is focused largely on the upper portion of the muscle as it is the most visible from the front as it ascends up the sides of the neck.

The superior or upper portion of the trapezius can be most effectively enlarged through exercises that elevate the shoulders. Maintaing persistence of this type of muscle hypertrophy requires diligence to muscle training. For those men who are unable or do not desire to achieve trapezius muscle enlargement, there are several surgical options to bypass these efforts.

Fat injections can be done into the trapezius muscle provided one has enough fat to do so. While a viable muscle augmentation method, the take and persistence of the injected fat is not assured. Like many other muscle areas of the body (pectoral, biceps, triceps, gluteus and gastrocnemius) implants can be used to achieve an assured and permanent enlargement effect.

TrapeziusMuscle Implants preop Dr Barry Eppley IndianapolisCase Study: This 50 year-old male desired to have larger upper trapezius muscles. He had adequately built up his arms and chest muscles but could not get his upper ‘traps’ to proportionately match.

Trapezius Muscle Implants Markings Dr Barry Eppley IndianapolisTrapezius Muscle Implants surgical technique Dr Barry Eppley IndianapolisTrapezius Muscle Implants surgical technique 2 Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, 3.5 cms skin incisions located at the base of the neck/upper shoulders were made. The trapezium fascia was identified and incised. Subfascial pockets were made along the outline of the desired implant locations. Soft solid silicone carving blocks were fashioned in the desired shape and inserted into the pockets. The size of the trapezius muscle implants measured 10 cms long, 4 cms wide and 1.5  cms in height. The fascia was closed separately from that of the skin closure.

Trapezius Muscle Implants immediate result Dr Barry Eppley IndianapolisHis immediate intraoperative results shows the dramatic increase in the upper trapezius muscle projection. Short of some initial postoperative discomfort, he can be back exercising in 7 to 10 days after surgery.

The upper muscle fibers of the trapezius muscle run from the bottom of the occipital bone out to the posterior border of the lateral third of the clavicle. While not traditionally thought of as a muscle that can be augmented, the upper portion of the trapezius can be. Increasing its visible height from the front by placing a small implant at its most superior fiber level is a straightforward technique that can be done in an hour of operative time for both sides. The key is to place the implants in the subfascial plane to prevent their visible outlines.

Highlights:

  1. Trapezius muscle augmentation can be done surgically done by fat injections or the use of trapezius implants.
  2. Trapezius muscle implants are placed in the subfascial plane of the upper trapezius muscle.

3) Small contour solid silicone implants produce an immediate  augmentation of the upper trapezius muscle.

Dr. Barry Eppley

Indianapolis, Indiana

Implants for Quadricep/Thigh Augmentation

Tuesday, December 31st, 2013

 

Quadriceps Muscle WastingMuscle wasting of the upper thigh can be the result of a number of different medical problems. Thigh muscle shrinking can occur from lack of use, severe weight loss and malnutrition or can be the result of a nerve injury from trauma or other neurologic  disorders. One cause of thigh muscle wasting can be from HIV infection and the development of a full blown presentation of AIDS. The pharmacologic treatment of AIDS through retroviral therapy can create a series of well known body wasting and lipodystrophic problems. One such effect of the AIDS-related cachexia is muscle loss or thinning of the lower extremities. While the contemporary treatment of muscle loss may be fat injection grafting, that is not an option in most AIDS patients. The alternative would be muscle implants. While numerous body implants exist for muscular enhancement, none exist for augmentation of the quadriceps or thigh region.

In the December 2013 issue of the Journal of Cosmetic Surgery an article was published entitled Quadriceps Implant: Cosmetic Improvement to the Anterior Thigh Region in a Patient Suffering From HIV Muscle Wasting.  In this case report the authors describe a single patient with HIV induced muscle wasting who underwent quadriceps augmentation with a solid silicone implant. A custom-designed silicone thigh implant was placed through an incision in the anterior thigh beneath the fascia of the quadriceps muscle. outcome was reported as excellent at three months after surgery.

Because of HIV and the medications used to treat it, a patient may suffer from wasting in the legs and placement of a soft solid silicone implant can help improve the cosmetic appearance of the anterior thigh/quadriceps region. Putting the implant beneath the fascia of the muscle is common practice for any body implant and the thigh muscles woud be no exception. While this is just a single case report (one patient) and the follow-up is short, the use of implants in the anterior thigh for cosmetic augmentation could have application beyond HIV thigh muscle wasting.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Body Implant Augmentation Surgery

Sunday, May 26th, 2013

 

Muscular enhancement of certain body parts can be done through the use of synthetic implants. Everyone knows about breast implant augmentation although this is not a true muscular enhancement but a breast tissue enlargement. Historically the most recognized body implants were for the chest, buttocks and calfs. The number of such implants combined pale in comparison to the number of breast implants that are placed but that makes them no less useful.

The number of body implant surgeries that are performed have continued to increase over the past decade. Greater awareness and acceptance of body augmentations has fueled demand as well as improvement in  implant materials and surgical techniques. Body implants, unlike breast implants, are made of a solid but very soft and compressible silicone elastomer material. This makes them capable of being inserted through small incisions and to have a feel that is similar to what they intended to enhance…muscle. Because they are a completely polymerized non-liquid material they will never rupture, degrade or need to be replaced.With these better materials has come an expansion of body implants to new and innovative areas of augmentation. These have included such areas as the arms, shoulders and even the hips to create muscle prominences and increased curves.

Muscle implants are used to surgically build-out an underdeveloped area of muscle in the body. These muscle deficiences can be caused by a birth defect, a traumatic injury, or an aesthetic desire for body shape improvement. Aesthetic desires for body implants (pectoral, calf, arm implants) comes from an inability to build up the muscle adequately from exercise. There are also recent fashion and body image trends for an increased gluteal size. (buttock implants) Birth defects can also drive the need for implants and include club foot and Spina Bifida for calf implants, chest wall deformities from Pectus and Poland’s syndrome for pectoral implants and Sprengel’s deformity for deltoid implants.

An overview of old and new body implants includes the following.

PECTORAL IMPLANTS Male chest enhancement is done by transaxillary implant placement under the pectoralis major muscle but staying within the outline of the muscle. (unlike breast implants) They are available in different oval and more square shape forms.

BUTTOCK IMPLANTS Intramuscular or subfascial pocket placement in regards to the gluteus maximus muscle is used for implant location. I prefer the intramuscular location to reduce the risk of potential complications even if it poses size limitations (< 400ccs implant volume) and a longer recovery.

CALF IMPLANTS Being the smallest of all body implants, they have a cigar-type shape that are available in different lengths, widths and thickness. They may be used to build up the inside of the leg (medial head gastrocnemius muscle) or combined with outside of the calf augmentation as well. (lateral head gastrocnemius muscle)

ARM IMPLANTS The top (biceps) and bottom (triceps) of the arm can be build up for those men that either can’t get enough muscle bulk by exercise alone or want to maintain a more muscular arm shape with less long-term exercise maintenance.

DELTOID IMPLANTS While there are no true shoulder implants, they can be made by either modifying existing body implants used for other areas or hand making the implants from performed silicone blocks.

HIP IMPLANTS Placing implants placed below the muscular fascia below the prominence of the greater trochanter of the hip can build out an otherwise straight leg line.

Body implant surgery is both safe and effective when done by a surgeon who has good experience with these  materials and has anatomical knowledge of the different and varied parts of the body where these implants go. While fat injection augmentation has a valuable role in the enhancement of certain body areas also, synthetic implants offer a permanent and assured solution to body augmentation that has the trade-off of an implanted material and a longer recovery.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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