Aesth Plast Surg (2014) 38:41–48 DOI 10.1007/s00266-013-0237-7
ORIGINAL ARTICLE
AESTHETIC
Aesthetic Shoulder Augmentation with Silicone Implants Yoon Jae Chung • Hyun Jang
Received: 14 July 2013 / Accepted: 13 October 2013 / Published online: 15 November 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013
Abstract Background Men with narrower shoulders may appear less muscular than other men. Deltoid muscle underdevelopment or atrophy, a condition commonly linked to narrow shoulder issues, may be associated with congenital deformity, trauma, or neoplasm. For some people, regular exercise does not effectively develop the deltoid muscle region. Some people naturally have a smaller build than others. Even with developed deltoid muscles, these people still appear to be small. The authors have performed lateral shoulder augmentation with silicone implants for 4 years. Based on their experience, this procedure stands as a reliable solution for men with narrow shoulders. Methods Lateral shoulder augmentation with silicone implants was developed and used for 81 patients between April 2009 and April 2013. None of the patients had shoulder deformities except for two patients (one patient with Poland’s syndrome and one patient with Sprengel’s deformity). The implants were placed through a horizontal axillary crease incision in a plane dissected between the deltoid fascia and muscle. Results All augmentation or correction procedures have been met with complete patient approval. Five patients had minor complications such as hematoma and implement displacement. However, all these complications were resolved to the satisfaction of the patients.
Y. J. Chung Eve Plastic Surgery Clinic, Seoul, South Korea H. Jang (&) Dopo Branch of Yeongam Public Health Center, Guhak-ri, Dopo-myeon, Yeongam-gun, Jeollanam-do, South Korea e-mail: [email protected]
Conclusion When silicone implants are used to achieve purely aesthetic improvements, successful shoulder augmentation procedures are observed. Level of Evidence IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. Keywords Shoulder augmentation Silicone implant Deltoid implant
In the perpetual pursuit to achieve the idyllic image of a man, among other improvements, some men seek a defining shoulder frame. It is commonly believed that men with comparably broader shoulders are more physically attractive and more masculine overall. For men with comparably narrow shoulders, the head may appear to be large in proportion to the remainder of the body. To compensate for this disparity, the man may wear a jacket or some other outerwear while using shoulder pads. An individual may have narrow shoulders for various reasons including, but are not limited to, congenital deformities, various forms of trauma, neoplasm, or muscle infirmity. To give the appearance of broader shoulders, a man can engage in more rigorous forms of exercise. However, this solution does not always work for everyone. For those that fall into this category, shoulder augmentation may stand as a desirable solution (Fig. 1).
123
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Fig. 2 Intraoperative endoscopic view. Note the cephalic vein (arrow)
Table 1 Average shoulder width of 81 patients before and after surgery Shoulder width (cm3)
Fig. 1 Deltoid implant. The deltoid pocket is located over the muscle and below the fascia
In this report, we submit that the placement of soft silicone implants on the deltoid muscle is both a safe and effective means of broadening a man’s shoulders.
Before surgery
42.7
After surgery
48.2
Materials and Methods Patients From April 2009 to April 2013, we placed soft silicone implants into 81 male patients. The patients ranged in age from 20 to 53 years (mean 26 years). Two patients had shoulder deformities (one patient had Poland’s syndrome and one patient had Sprengel’s deformity). The remaining patients had no shoulder traumas or deformities. Surgical Techniques All the operations were conducted with the patient under local anesthesia (using sedation) in the supine position. A 6-cm parallel incision line was drawn following the natural axillary crease. The surgeon drew an outline of the place where the implant was to be positioned. It should be noted that the size of a patient’s implant was determined after the surgeon had ascertained the size of the patients’ deltoid muscle with the arms in an half abduct position. The implants were to be 3 to 5 mm thicker than the measurement of the pinch test. This selection recognizes the presence of both subcutaneous tissue and surrounding skin. Next, the incision line was connected to the pocket outline. Starting from the incision, a subcutaneous dissection
123
Fig. 3 Increased shoulder width using the silicone implants
Table 2 Satisfaction assessment of 81 patients Very satisfied
15
Somewhat satisfied
53
Neither satisfied nor dissatisfied
13
Somewhat dissatisfied
0
Very satisfied
0
Aesth Plast Surg (2014) 38:41–48
43
Fig. 4 Left: Preoperative view. Right: View 18 months after surgery
Fig. 5 Sprengel’s deformity case. Left: Preoperative view. Right: View 2 weeks after surgery
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Fig. 6 Top left: Preoperative view. Top right. View 8 days after surgery. Bottom left: Preoperative view of patient clothed. Bottom right: View of patient clothed 2 weeks after surgery
Fig. 7 Left: Preoperative view. Right: View 13 months after surgery. The implant contour is visible for the thin skin/tissue patients
was performed to the anterior border of the pocket. Beyond the anterior border, another dissection was performed just above the deltoid muscle layer with an endoscope (Fig. 2). Once the silicone implant was inserted in the deltoid region,
123
the wound was closed in standard fashion. Prefabricated, carved Allied Biomedical (Ventura, CA) silicone elastomer implants (very soft grade, 8–12 on a firmness scale) were used. The patient’s shoulders were bound tight with tape and
Aesth Plast Surg (2014) 38:41–48
45
Fig. 9 Poland’s syndrome case. Top: Preoperative view. Center: Preoperative design. Bottom: View 10 days after surgery. The thickness and size of the silicone implants differ for each side. The deltoid and pectoral implants are delivered through a single axillary incision Fig. 8 Top: Preoperative view. Center: View 2 months after surgery. Bottom: View 2 months after surgery. Abducted arms show the entirety of the implants’ upper borders
elastic bandages for a period of 4 days after surgery. Moreover, the patients were advised to limit their shoulder activity for a minimum of 2 weeks.
Results The shoulder contours of all the patients changed from narrow and round to broader and more angular. Overall, they appeared to give off a more masculine and healthy look. Because an incision was made in the axillary crease, surgical scars were nearly, if not entirely, invisible. The average distance between the lateral margins of the acromion tip (point A) of both shoulders, measured at
42.7 cm, represents a patient’s original shoulder width (Table 1). The new lateral end point of the shoulder (point B), measured after surgery, represents an increased shoulder width, averaging 48.2 cm. The distance between points A and B represents an increased maximum slope of the deltoid muscle region to point B. In our study, this increase on the average extended the overall shoulder width for all the patients by 5.5 cm (Fig. 3). Most of the patients expressed satisfaction with the results of their surgery. Their satisfaction ratings ranged from ‘‘very satisfied’’ to ‘‘neither satisfied nor dissatisfied’’ (Table 2). The postsurgery follow-up periods ranged from 6 to 48 months (average 20 months). The study had two cases of complications involving hematoma and three cases involving implant displacement. The hematoma complications were resolved by either spontaneous absorption or punctured drainage. The implant displacement complications, occurring within 2 weeks
123
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Fig. 10 Left: Preoperative view. Right: View 1 month after surgery
Fig. 11 Left: Preoperative view. Right: View 11 days after surgery
after the surgery, were resolved by creating a new pocket or by applying an external suture fixation to the original pocket. At this writing, the patients have experienced no limitations in motion, no remarkable malpositions, and no aesthetic restrictions. The postsurgery follow-up evaluations have shown no obvious capsular contractures. In the event of a visible implant, as is the case for patients with thin skin and subcutaneous tissue, a supplementary fat graft is performed 3 months after the initial surgery. In short, satisfactory augmentation of the shoulder width was achieved through this simple procedure (Figs. 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13).
Discussion Shoulders have a large impact on how others view remaining parts of the body such as the head, arms, and legs. Consequently, improved shoulders can cause the face to appear smaller and give the body an inverted triangle shape, making the waistline appear smaller. If a man has this inverted triangle shape, his clothes appear to fit better, and he thereby gives off a healthy and attractive image. With round-shaped shoulders, men appear to be feminine and soft, whereas with angled shoulders, men appear to be strong and more masculine.
123
To date, most medical articles and other academic literature report on shoulder surgeries occasioned by the aforementioned causes and tumor removal. Few reports describe shoulder augmentation for cosmetic enhancement. Since the 1980s, when Menick and Brody [1] published the first of their several reports on shoulder augmentation, shoulder augmentations with silicone implants have been available. A report presented the case of significant right shoulder deformity after the Tikhoff–Linberg procedure, an en bloc proximal humeral, scapular, and clavicular resection due to right humeral fibrosarcoma. In 2000, Saray et al. [2] reported that they performed shoulder contour augmentation using a calf silicone implant to correct Sprengel’s deformity. Hodgkinson [3] in 2006 used silicone implants to correct a forearm contour deformity caused by trauma. He performed shoulder augmentations for patients with deltoid muscle atrophy caused by nerve injury and iatrogenic injury. Using a previous incision line, he inserted the implant between the shoulder joint and the deltoid muscle. In 2007, Chebli et al. [4] used an augmentation patch (porcine submucosa) concomitantly to assist in deltoid muscle repair due to iatrogenic deltoid injury. However we performed the shoulder-broadening surgery using the axillary approach for patients without prior bodily deformities seeking cosmetic alterations. Males in Korea do not commonly opt for plastic surgery using alloplastic implants. In the United States, however,
Aesth Plast Surg (2014) 38:41–48
47
Fig. 12 Left: Preoperative view. Right: View 4 months after surgery
Fig. 13 Left: Preoperative view. Right: View 2 weeks after surgery
since Novack’s first report on this procedure in 1991, many successful calf and pectoral aesthetic surgeries have been performed [5]. Recently, more patients have been requesting procedures for cosmetic surgery on the buttock and even on the forearm [6]. One of the most popular areas for men is their calf muscles. Correction of congenital deformities or deformities caused by trauma were the main reason for this type of procedure initially. Reports on surgeries for cosmetic purposes are steadily emerging currently [7–12]. Many articles are reporting on the various methods used and the types of implants inserted. Because no reports on shoulder augmentation for patients without deformity using silicone implants have
appeared in the literature, we expanded the field of shoulder augmentations to such procedures performed to enhance narrow shoulders for cosmetic reasons. Before our research, clinicians had few comparable procedures to reference. A few things in this procedure received our special care. First, we were careful to avoid dissecting too deeply to avoid damaging the cephalic vein. During dissections, it was necessary to dissect along the subcutaneous plane only up to the anterior border of the pocket. This avoided damage to the cephalic vein. By inserting the implant just above the muscle layer, the visibility of the implant after surgery was reduced. We dissected the supramuscular plane using a supplementary endoscope together with a specially designed dissector.
123
48
To prevent displacement of the implant, we were extremely careful to identify the pocket design area. When dissecting, we took great pains to outline the area of surgical implantation to prevent postsurgery displacement. Also, we used an endoscope to ensure that the pocket was of an appropriate size for the implant. Because any excessive movement or outside force can cause displacement of implants after surgery, patients are encouraged to minimize arm movements above the shoulder for a minimum of 2 weeks. For patients with either thin skin or subcutaneous tissue, thicker implants were visible after surgery. This problem was easily avoided by conducting a presurgery pinch test to determine the thickness of the subcutaneous tissue. After this, an appropriate size for the implant could be determined. Patients must understand this matter and be properly informed about it. If a patient with thin skin and subcutaneous tissue wants thicker implants, a supplementary fat graft is needed 3 months after the initial shoulder augmentation.
Conclusions Using shoulder augmentation surgery, we were able to broaden the shoulders of men with narrow shoulders. Consequently, as their shoulders broadened, their face appeared to be proportionately smaller, and their body appeared to be more balanced as befitting a male image. Therefore, shoulder augmentation for purely aesthetic
123
Aesth Plast Surg (2014) 38:41–48
improvement may be a new field in body-contouring surgery.
References 1. Menick FJ, Brody GS (1980) Shoulder contour deformity after the Tikhoff–Linberg procedure: Correction by silicone implant. Plast Reconstr Surg 66:760–762 2. Saray A, Eskandari M, Oztuna V (2000) Augmentation of shoulder contour using a calf implant. Aesthetic Plast Surg 24:386–388 3. Hodgkinson DJ (2006) Contour restoration of the upper limb using solid silicone implant. Aesthetic Plast Surg 30:53–58 4. Chebli CM, Murthi AM, Baltimore (2007) Deltoidplasty: outcomes using orthobiologic augmentation. J Shoulder Elbow Surg 16:425–428 5. Novack BH (1991) Alloplastic implants for men. Clin Plast Surg 18:829–855 6. Flores-Lima G, Eppley BL (2009) Body contouring with solid silicone implants. Aesthetic Plast Surg 33:140–146 7. Gutstein RA (2006) Augmentation of the lower leg: a new combined calf-tibial implant. Plast Reconstr Surg 117:817–826 8. Kalixto MA, Vergara R (2003) Submuscular calf implants. Aesthetic Plast Surg 27:135–138 9. Felicio Y (2000) Calfplasty. Aesthetic Plast Surg 24:141–147 10. Dini M, Innocenti A, Lorenzetti P (2002) Aesthetic calf augmentation with silicone implants. Aesthetic Plast Surg 26:490–492 11. Nunes GO, Garcia DPL (2004) Calf augmentation with supraperiostic solid prosthesis associated with fasciotomies. Aesthetic Plast Surg 28:17–19 12. Pereira LH, Nicaretta B, Sterodimas A (2012) Bilateral calf augmentation for aesthetic purposes. Aesthetic Plast Surg 36:295–302
ORIGINAL ARTICLE
AESTHETIC
Aesthetic Shoulder Augmentation with Silicone Implants Yoon Jae Chung • Hyun Jang
Received: 14 July 2013 / Accepted: 13 October 2013 / Published online: 15 November 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013
Abstract Background Men with narrower shoulders may appear less muscular than other men. Deltoid muscle underdevelopment or atrophy, a condition commonly linked to narrow shoulder issues, may be associated with congenital deformity, trauma, or neoplasm. For some people, regular exercise does not effectively develop the deltoid muscle region. Some people naturally have a smaller build than others. Even with developed deltoid muscles, these people still appear to be small. The authors have performed lateral shoulder augmentation with silicone implants for 4 years. Based on their experience, this procedure stands as a reliable solution for men with narrow shoulders. Methods Lateral shoulder augmentation with silicone implants was developed and used for 81 patients between April 2009 and April 2013. None of the patients had shoulder deformities except for two patients (one patient with Poland’s syndrome and one patient with Sprengel’s deformity). The implants were placed through a horizontal axillary crease incision in a plane dissected between the deltoid fascia and muscle. Results All augmentation or correction procedures have been met with complete patient approval. Five patients had minor complications such as hematoma and implement displacement. However, all these complications were resolved to the satisfaction of the patients.
Y. J. Chung Eve Plastic Surgery Clinic, Seoul, South Korea H. Jang (&) Dopo Branch of Yeongam Public Health Center, Guhak-ri, Dopo-myeon, Yeongam-gun, Jeollanam-do, South Korea e-mail: [email protected]
Conclusion When silicone implants are used to achieve purely aesthetic improvements, successful shoulder augmentation procedures are observed. Level of Evidence IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. Keywords Shoulder augmentation Silicone implant Deltoid implant
In the perpetual pursuit to achieve the idyllic image of a man, among other improvements, some men seek a defining shoulder frame. It is commonly believed that men with comparably broader shoulders are more physically attractive and more masculine overall. For men with comparably narrow shoulders, the head may appear to be large in proportion to the remainder of the body. To compensate for this disparity, the man may wear a jacket or some other outerwear while using shoulder pads. An individual may have narrow shoulders for various reasons including, but are not limited to, congenital deformities, various forms of trauma, neoplasm, or muscle infirmity. To give the appearance of broader shoulders, a man can engage in more rigorous forms of exercise. However, this solution does not always work for everyone. For those that fall into this category, shoulder augmentation may stand as a desirable solution (Fig. 1).
123
42
Aesth Plast Surg (2014) 38:41–48
Fig. 2 Intraoperative endoscopic view. Note the cephalic vein (arrow)
Table 1 Average shoulder width of 81 patients before and after surgery Shoulder width (cm3)
Fig. 1 Deltoid implant. The deltoid pocket is located over the muscle and below the fascia
In this report, we submit that the placement of soft silicone implants on the deltoid muscle is both a safe and effective means of broadening a man’s shoulders.
Before surgery
42.7
After surgery
48.2
Materials and Methods Patients From April 2009 to April 2013, we placed soft silicone implants into 81 male patients. The patients ranged in age from 20 to 53 years (mean 26 years). Two patients had shoulder deformities (one patient had Poland’s syndrome and one patient had Sprengel’s deformity). The remaining patients had no shoulder traumas or deformities. Surgical Techniques All the operations were conducted with the patient under local anesthesia (using sedation) in the supine position. A 6-cm parallel incision line was drawn following the natural axillary crease. The surgeon drew an outline of the place where the implant was to be positioned. It should be noted that the size of a patient’s implant was determined after the surgeon had ascertained the size of the patients’ deltoid muscle with the arms in an half abduct position. The implants were to be 3 to 5 mm thicker than the measurement of the pinch test. This selection recognizes the presence of both subcutaneous tissue and surrounding skin. Next, the incision line was connected to the pocket outline. Starting from the incision, a subcutaneous dissection
123
Fig. 3 Increased shoulder width using the silicone implants
Table 2 Satisfaction assessment of 81 patients Very satisfied
15
Somewhat satisfied
53
Neither satisfied nor dissatisfied
13
Somewhat dissatisfied
0
Very satisfied
0
Aesth Plast Surg (2014) 38:41–48
43
Fig. 4 Left: Preoperative view. Right: View 18 months after surgery
Fig. 5 Sprengel’s deformity case. Left: Preoperative view. Right: View 2 weeks after surgery
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Fig. 6 Top left: Preoperative view. Top right. View 8 days after surgery. Bottom left: Preoperative view of patient clothed. Bottom right: View of patient clothed 2 weeks after surgery
Fig. 7 Left: Preoperative view. Right: View 13 months after surgery. The implant contour is visible for the thin skin/tissue patients
was performed to the anterior border of the pocket. Beyond the anterior border, another dissection was performed just above the deltoid muscle layer with an endoscope (Fig. 2). Once the silicone implant was inserted in the deltoid region,
123
the wound was closed in standard fashion. Prefabricated, carved Allied Biomedical (Ventura, CA) silicone elastomer implants (very soft grade, 8–12 on a firmness scale) were used. The patient’s shoulders were bound tight with tape and
Aesth Plast Surg (2014) 38:41–48
45
Fig. 9 Poland’s syndrome case. Top: Preoperative view. Center: Preoperative design. Bottom: View 10 days after surgery. The thickness and size of the silicone implants differ for each side. The deltoid and pectoral implants are delivered through a single axillary incision Fig. 8 Top: Preoperative view. Center: View 2 months after surgery. Bottom: View 2 months after surgery. Abducted arms show the entirety of the implants’ upper borders
elastic bandages for a period of 4 days after surgery. Moreover, the patients were advised to limit their shoulder activity for a minimum of 2 weeks.
Results The shoulder contours of all the patients changed from narrow and round to broader and more angular. Overall, they appeared to give off a more masculine and healthy look. Because an incision was made in the axillary crease, surgical scars were nearly, if not entirely, invisible. The average distance between the lateral margins of the acromion tip (point A) of both shoulders, measured at
42.7 cm, represents a patient’s original shoulder width (Table 1). The new lateral end point of the shoulder (point B), measured after surgery, represents an increased shoulder width, averaging 48.2 cm. The distance between points A and B represents an increased maximum slope of the deltoid muscle region to point B. In our study, this increase on the average extended the overall shoulder width for all the patients by 5.5 cm (Fig. 3). Most of the patients expressed satisfaction with the results of their surgery. Their satisfaction ratings ranged from ‘‘very satisfied’’ to ‘‘neither satisfied nor dissatisfied’’ (Table 2). The postsurgery follow-up periods ranged from 6 to 48 months (average 20 months). The study had two cases of complications involving hematoma and three cases involving implant displacement. The hematoma complications were resolved by either spontaneous absorption or punctured drainage. The implant displacement complications, occurring within 2 weeks
123
46
Aesth Plast Surg (2014) 38:41–48
Fig. 10 Left: Preoperative view. Right: View 1 month after surgery
Fig. 11 Left: Preoperative view. Right: View 11 days after surgery
after the surgery, were resolved by creating a new pocket or by applying an external suture fixation to the original pocket. At this writing, the patients have experienced no limitations in motion, no remarkable malpositions, and no aesthetic restrictions. The postsurgery follow-up evaluations have shown no obvious capsular contractures. In the event of a visible implant, as is the case for patients with thin skin and subcutaneous tissue, a supplementary fat graft is performed 3 months after the initial surgery. In short, satisfactory augmentation of the shoulder width was achieved through this simple procedure (Figs. 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13).
Discussion Shoulders have a large impact on how others view remaining parts of the body such as the head, arms, and legs. Consequently, improved shoulders can cause the face to appear smaller and give the body an inverted triangle shape, making the waistline appear smaller. If a man has this inverted triangle shape, his clothes appear to fit better, and he thereby gives off a healthy and attractive image. With round-shaped shoulders, men appear to be feminine and soft, whereas with angled shoulders, men appear to be strong and more masculine.
123
To date, most medical articles and other academic literature report on shoulder surgeries occasioned by the aforementioned causes and tumor removal. Few reports describe shoulder augmentation for cosmetic enhancement. Since the 1980s, when Menick and Brody [1] published the first of their several reports on shoulder augmentation, shoulder augmentations with silicone implants have been available. A report presented the case of significant right shoulder deformity after the Tikhoff–Linberg procedure, an en bloc proximal humeral, scapular, and clavicular resection due to right humeral fibrosarcoma. In 2000, Saray et al. [2] reported that they performed shoulder contour augmentation using a calf silicone implant to correct Sprengel’s deformity. Hodgkinson [3] in 2006 used silicone implants to correct a forearm contour deformity caused by trauma. He performed shoulder augmentations for patients with deltoid muscle atrophy caused by nerve injury and iatrogenic injury. Using a previous incision line, he inserted the implant between the shoulder joint and the deltoid muscle. In 2007, Chebli et al. [4] used an augmentation patch (porcine submucosa) concomitantly to assist in deltoid muscle repair due to iatrogenic deltoid injury. However we performed the shoulder-broadening surgery using the axillary approach for patients without prior bodily deformities seeking cosmetic alterations. Males in Korea do not commonly opt for plastic surgery using alloplastic implants. In the United States, however,
Aesth Plast Surg (2014) 38:41–48
47
Fig. 12 Left: Preoperative view. Right: View 4 months after surgery
Fig. 13 Left: Preoperative view. Right: View 2 weeks after surgery
since Novack’s first report on this procedure in 1991, many successful calf and pectoral aesthetic surgeries have been performed [5]. Recently, more patients have been requesting procedures for cosmetic surgery on the buttock and even on the forearm [6]. One of the most popular areas for men is their calf muscles. Correction of congenital deformities or deformities caused by trauma were the main reason for this type of procedure initially. Reports on surgeries for cosmetic purposes are steadily emerging currently [7–12]. Many articles are reporting on the various methods used and the types of implants inserted. Because no reports on shoulder augmentation for patients without deformity using silicone implants have
appeared in the literature, we expanded the field of shoulder augmentations to such procedures performed to enhance narrow shoulders for cosmetic reasons. Before our research, clinicians had few comparable procedures to reference. A few things in this procedure received our special care. First, we were careful to avoid dissecting too deeply to avoid damaging the cephalic vein. During dissections, it was necessary to dissect along the subcutaneous plane only up to the anterior border of the pocket. This avoided damage to the cephalic vein. By inserting the implant just above the muscle layer, the visibility of the implant after surgery was reduced. We dissected the supramuscular plane using a supplementary endoscope together with a specially designed dissector.
123
48
To prevent displacement of the implant, we were extremely careful to identify the pocket design area. When dissecting, we took great pains to outline the area of surgical implantation to prevent postsurgery displacement. Also, we used an endoscope to ensure that the pocket was of an appropriate size for the implant. Because any excessive movement or outside force can cause displacement of implants after surgery, patients are encouraged to minimize arm movements above the shoulder for a minimum of 2 weeks. For patients with either thin skin or subcutaneous tissue, thicker implants were visible after surgery. This problem was easily avoided by conducting a presurgery pinch test to determine the thickness of the subcutaneous tissue. After this, an appropriate size for the implant could be determined. Patients must understand this matter and be properly informed about it. If a patient with thin skin and subcutaneous tissue wants thicker implants, a supplementary fat graft is needed 3 months after the initial shoulder augmentation.
Conclusions Using shoulder augmentation surgery, we were able to broaden the shoulders of men with narrow shoulders. Consequently, as their shoulders broadened, their face appeared to be proportionately smaller, and their body appeared to be more balanced as befitting a male image. Therefore, shoulder augmentation for purely aesthetic
123
Aesth Plast Surg (2014) 38:41–48
improvement may be a new field in body-contouring surgery.
References 1. Menick FJ, Brody GS (1980) Shoulder contour deformity after the Tikhoff–Linberg procedure: Correction by silicone implant. Plast Reconstr Surg 66:760–762 2. Saray A, Eskandari M, Oztuna V (2000) Augmentation of shoulder contour using a calf implant. Aesthetic Plast Surg 24:386–388 3. Hodgkinson DJ (2006) Contour restoration of the upper limb using solid silicone implant. Aesthetic Plast Surg 30:53–58 4. Chebli CM, Murthi AM, Baltimore (2007) Deltoidplasty: outcomes using orthobiologic augmentation. J Shoulder Elbow Surg 16:425–428 5. Novack BH (1991) Alloplastic implants for men. Clin Plast Surg 18:829–855 6. Flores-Lima G, Eppley BL (2009) Body contouring with solid silicone implants. Aesthetic Plast Surg 33:140–146 7. Gutstein RA (2006) Augmentation of the lower leg: a new combined calf-tibial implant. Plast Reconstr Surg 117:817–826 8. Kalixto MA, Vergara R (2003) Submuscular calf implants. Aesthetic Plast Surg 27:135–138 9. Felicio Y (2000) Calfplasty. Aesthetic Plast Surg 24:141–147 10. Dini M, Innocenti A, Lorenzetti P (2002) Aesthetic calf augmentation with silicone implants. Aesthetic Plast Surg 26:490–492 11. Nunes GO, Garcia DPL (2004) Calf augmentation with supraperiostic solid prosthesis associated with fasciotomies. Aesthetic Plast Surg 28:17–19 12. Pereira LH, Nicaretta B, Sterodimas A (2012) Bilateral calf augmentation for aesthetic purposes. Aesthetic Plast Surg 36:295–302
