| BODY CONTOURING | PEER-REVIEW


placed under the muscle. The second case was a 32-year-old male patient who sought muscular enhancement. A 215 cc oval implant was placed under the muscle bilaterally. The third case was a 44-year-old patient with a muscular injury on the left arm owing to excessive weight lifting (the lateral portion was broken and atrophied thereafter). A 215 cc oval implant was placed under the injured muscle to achieve symmetry. The fourth case was a 27-year-old male seeking muscular enhancement. In that case a 110 cc oval implant was placed.


Biceps This muscle has two heads with the long one attaching proximally to the supraglenoid tubercle and the short one inserting at the coracoid process. Both heads attach through a tendon distally at the radius. Innervation comes from the musculocutaneous nerve that runs between the brachialis and the biceps tendon. The pocket can be either made


from proximal or distal incisions. A tear is performed in the muscle fibres and the pocket is made bluntly between the biceps and the brachialis. The nerve can be seen at the medial half of the muscle, leaving the coracobrachialis at the junction between the upper and middle third of the muscle. The blunt dissection should be continued upwards while taking care not to stretch the nerve. The best implant to place here is the oval buttock


implant with a volume of 110 cc or 240 cc depending on the width of the arm (Figure 12). If the biceps width is less than 8 cm the author uses Montellano implants. The tip of the implants are placed cranial to the muscle and medial to the nerve.


Figure 9 Oval implant, 240 cc, for unilateral triceps augmentation after injury


Figure 10 32-year-old male patient with injury (rupture) of his left triceps muscle.


Preoperative view: normal (A) versus injured arm (B).


Postoperative view at 8 months:


normal (C) versus


injured arm (D)


prime-journal.com | July/August 2014  Implants are made of


cohesive silicone gel, have the advantages of rapid availability and softness, and can accommodate muscular contraction and relaxation.


The author has performed five cases to date.


The first case was a 22-year-old male patient, in whom a subfascial, 90 cc Glicenstein implant was used to enhance the contour. The result was less than satisfactory owing to migration of the implant when flexing the elbow. In the remaining patients (26-, 33-, 49- and 28-year- olds), the author used oval implants (110, 240, 110 and 110 cc respectively) under the muscle.


The postoperative course was uneventful in all cases.


Discussion Other than the breast, most surgeons worldwide have only experience with buttock, pectoral and calf implants. Patients requesting enhancement at other locations are rare, so it is very difficult to acquire a long series of patients for these regions during the normal course of a surgeon’s life. However, with anatomical knowledge and currently available implants, it is now possible to reconstruct or enhance the contour in certain areas. Hodgkinson7


described some


patients with nerve or muscular injuries that caused contour problems, which he solved using solid silicone implants. The main advantage of these implants is that the surgeon can restore the contour because a moulage from the healthy side is used. However, they are more expensive and take longer for the manufacturer to make. To the author’s knowledge, there are no reports in the available literature about using cohesive implants for muscular limb enhancement. In his


experience, commercially available implants can be used safely in these patients. Implants are made of cohesive silicone gel, have the advantages of rapid availability and softness, and can accommodate muscular contraction and relaxation. The only


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