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Background: The tricep muscle primarily creates extension of the upper arm through three heads of the muscle. Despite being comprised of three muscles two of them (the long and lateral head) comprise most of what we see and run the full length of the back of the arm. In the upper arm  the close proximity of the long and lateral heads of the muscle creates the horseshoe shape seen when the muscle becomes extremely well developed in body builders.

Tricep muscle asymmetry can occur from muscle rupture or from loss of neural input from various nerve injuries. Once the muscle volume is lost from these causes it is impossible to build it back up from exercise. Aesthetic camouflage can be done by fat injections or implants. But once the fascia around the muscle constricts down around the reduced muscle volume fat will not re-expand this tightened facial sleeve.

Tricep implants can be placed in either the subfascial or submuscular location. There are arguments to be made for both locations but given the long lengths of the tricep muscle the subfascial location offers the ability to place a long implant that is aesthetically more compatible with the shape of the muscle in both extended and flexed arm position.

In tricep muscle asymmetry due to injury, when both arms are to be augmented, this requires two differently sized implants with expected difficulties in implant placement in the smaller shrunken muscle.  

Case Study: This older male who was a regular weightlifter suffered left tricep muscle atrophy due to a cervical nerve compression. Circumferential arm measurements shows minimal change in the upper arm between the two sides (36.5cm vs 36.0cm, a 0.5cm difference) but a more significant change in the distal half of the muscle. (33cms vs 29cms, a 4cm difference) He desired to augment both tricep muscles.

Under general anesthesia and in the prone position the triceps were approached through posterior axillary incisions. In the left smaller side an additional small incision was made above the elbow to help with the dissection through the tight distal fascia of the muscle. This also required some lateral fascial releases was well. A 21.5cm long x 8.5cm wide x 1.6cm high ultrasoft solid silicone implant (235ccs) was implanted with a drain underneath it.

Once the left implant was placed it could be seen that the distal half of the tricep area now look fairly symmetric. The upper arm on the normal size now was a bit smaller now than the left. Thus through a posterior axillary incision only, the same implant was used but reduced in size so that only an upper tricep augmentation was done.

At the end of the prtopcedure the symmetry between the two tricep sides looked much improved using two different implant sizes and locations between the two sides.

Key Points:

1) Tricep muscle asymmetry is usually most evident in the distal half of the muscle near the elbow.

2) Implant augmentation of part or all of the atrophic tricep muscle depends on what is being down with the other tricep…if anything.

3) Tricep muscle augmentation is most commonly performed by subfascial implants.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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