What is it?

Muscle Implants are used for enlarging or improving the shape of the arms or legs. The usual indication for this procedure is a man or a woman who has small and underdeveloped muscles in the arms or legs and wants to enhance the shape of the extremity. In men, muscle implants have also been used for enhancing the shape of the chest by augmenting the pectoral muscle.

What alternatives are there for Muscle Implants?

  In certain cases it is possible to place fat in order to shape and sculpt a part of the extremity. Autogenous tissues (your own body's fat and skin) are generally used in cases where firmness in the muscle is not required. However if you want to have this area firm, then the only choice would be to place a muscle implant.

What does it accomplish?

The purpose of the operation is to enhance the aesthetic appearance of the extremity or chest and to improve the proportions of the area as compared to the rest of the body.   Often this improves the self-esteem and psychological well being. This surgery is not a replacement for exercising and bodybuilding. You should continue to work on your own muscle shape as much as you can. However in certain cases, the individual cannot increase the size of that muscle no matter how much he or she tries. In such cases, muscle implants give the person a way to improve the shape of the extremity.

What happens during the first consultation?

In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you.   You will receive information booklets and pricing on the procedures.

How is it done?

The operation is usually done under general anesthesia.   This method of anesthesia is in the best interest of the patient in terms of the comfort and the ease with which the procedure is performed. The implant is placed either under or over the muscle.   I place extremity implants over the muscle. In pectoral implants it may be better to place the implant at least partially under the muscle.

Procedure: Muscle Implants continued

What can I expect after surgery?

You should expect a moderate degree of swelling and discoloration for the first week or two after surgery. The expected postoperative recovery would be approximately one week during which time you should limit your activities and rest as much as possible.   The first two or three days are likely to be the most uncomfortable for you with a moderate degree of pain which is easily relieved with oral pain medications.   After three to four days you should be able to attend to minor activities around the house and go on short walks.   By the fifth or sixth day you should be able to return to work.   Majority of patients return to work within a week. Although some patients feel good enough to exercise in the second week most do not resume their normal exercise routine until the third or fourth week.

What size implants should I choose?  

You should choose a size that is suitable to your body and you think is right for you. Many patients come to my office and say that they want more definition in the shape of the arm or chest. However, you must know that larger size does not necessarily result in better definition. Definition in shape is as much determined by the thinness of the layer fat under the skin. However, we can place the largest implant that would make the shape of the arm or leg more muscular without it looking 'fake'.

What risks are involved with this operation?  

This operation is one of the safest operations we perform. However like any surgery there are risk factors associated with operation.   I will tell you what I generally discuss with my patients in their second consultation prior to surgery. You should understand that all these complications that I will mention are extremely rare and are not a deterrent to surgery for most people.

A complete list of possible side effects and complications will be provided to you when you schedule your surgery. You should talk to your surgeon for more information on each of these possible risks.

•  Bleeding . This is very uncommon with muscle implant surgery because we are generally not cutting tissues but using a blunt tipped cannula to place the implant. However we have had some reports of bleeding in the literature about this complication. There are those who are at higher risk of bleeding. The use of some medications such as aspirin or coudamin (a blood thinner) could put you at higher risk of bleeding. If you are contemplating surgery you should refrain from using Aspirin containing products from two weeks before surgery until two weeks after surgery. Some people with history of uncontrolled hypertension can be at higher risk of bleeding after the surgery. There are some individuals who have some problem with their coagulation system that they were not aware of and consequently have had bleeding after surgery. If you have bleeding after surgery it may entail returning to the operating room to stop it.

•  Infection . It is very uncommon to get an infection with this procedure. We usually give all our patients antibiotics both before and after surgery. If infection however, occurs we will treat it very aggressively with sronger antibiotics.

•  Skin discoloration .   This can occur in any surgery. It is due to blood metabolites and is usually temporary and self-limiting. Sometimes these blood pigments stay in the subcutaneous tissues permanently. These are very rare and generally occur in patients with darker skin complexion.   If this occurs we may need to treat your skin with certain bleaching agents which could help ameliorate the problem

•  Discomfort and pain . This is easily controlled with oral pain medications.   With the use of the modern anesthesia techniques and the use of the local anesthetics in the tissues both the pain and the discomfort should be minimized.  

•  Temporary numbness associated with the surgery.   This numbness usually persists for several weeks and it depends on the extent of surgery performed.   Most of this numbness returns to normal after seven to ten days.   However, it is not unusual to see persistent numbness even after four to six weeks have passed.  

•  Minor lumps and irregularities .   These irregularities are related to accumulations of fluid in certain areas of the subcutaneous fatty layer of the skin as a result of either infiltration of the fluid or as a result of the trauma associated with surgery.   Irregularities even out after the first two or three weeks after the surgery.  

•  Minor asymmetry between the two sides of the body can be seen after the implant has been inserted.   This too is related to accumulations of fluid or trauma related to the operation.   These asymmetries usually resolve within two to three weeks. Activities.

•  Permanent scars.   Scars are present whenever there is any incision. Almost all operations will involve some scarring. The extent of the scar will depend on the nature of the problem and the extent of surgery. The nature and extent of the scar depends on the location of the incision as well as the genetic ability of the patient to heal scars. I rarely see cases in which the scar has become a major problem. However, if they do become prominent and visible I can usually improve them with scar revision procedures. It is more prudent to wait approximately one year before attempting scar revision.

•  Excessive skin. In certain individuals the skin has lost its ability to contract after having been stretched. The patient may be left with an excessive roll of skin in the area of surgery that does not go away. In such cases it is necessary to remove this excessive roll of skin directly. This will result in having a permanent scar in the area of excision.

•  Waviness and surface irregularities .   This is not a common problem with this operation. Never the less there is still a chance that you may develop some irregularity and if this does occur we can usually fix this problem in a touch up procedure.   This touch up procedure is done in a second stage approximately three months after the initial liposuctioning.

•  . Persistent edema . This problem is very rare but if it occurs it can be bothersome and may last for many weeks after surgery. Generally this is not a permanent problem.   Only in a few cases in the literature have people had problems with persistent edema.   It is because of problems such as this that we encourage the use of the garments after surgery and should there be continued edema we will encourage the use of this garment until the problem is resolved.  

•  Altered areas of sensation .   In rare occasions it is possible to have an area remain permanently numb or be associated with parasthesia. Usually these problems are seen in cases that a skin resection is being performed at the same time as the liposuctioning.   The liposuctioning can, however, injure nerves in the area and these injured nerves can later develop permanent scarring and problems related to nerve conduction.   Usually, the surrounding nerves are able to cover the area of impaired sensation and after four or five weeks these nerves reenervate the area.   However, if this does not happen the patient is left with an area that has permanent numbness or altered sensation.   This may or may not be a correctable problem.   Often the size of these impaired sensory areas are not much larger than half a dollar or a quarter sized area and most patients are not bothered by it.

•  Surgical Shock and Pulmonary complications . There are certain uncommon risks and complications that can also occur.   These include shock that might require transfusion. This is a very uncommon problem that I have certainly not seen in any of my patients but is occasionally reported in the literature.   The need for autologous blood was discussed and I mentioned to the patient that because of the tumescent technique the need for autologous blood transfusion in these cases has been virtually eliminated.

•    Seromas and hematomas .   These are collections of fluid or blood under the skin. If this occurs it will need to be drained.   This is usually done with the use of a syringe.   To the patient it will entail more frequent office visits after surgery until the problem is solved.   Usually these problems do not cause any permanent damage.  

•  Skin loss . This has been seen in a few cases with major skin undermining.    Usually these occur in people who are smokers or have some underlying problem with circulation.   If you smoke I strongly encourage you to quit smoking two weeks prior to surgery and to refrain from smoking until two weeks after surgery.  

•  Life threatening conditions . It is very uncommon to see severe complications with cosmetic surgery. However should such a condition arise for any reason, you will be immediately admitted to the hospital.

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•  Impingement of a nerve or blood vessel by the implant . Pressure over a sensitive structure such as a nerve may result in serious problems if not corrected. If this should happen it may be necessary to reposition the implant or to temporarily remove it.

•  There are risks associated with anesthesia . With modern equipment and techniques available in modern hospitals risks from surgical anesthesia are minimal.  

•  Chronic pain . A few patients in the literature have been reported to have chronic pain as a result of Muscle Implants.

•  Positional Changes . Certain position changes may cause indentations in the implant that reveal its presence.   This has generally been a problem in people who are very thin and whose skin does not have sufficient thickness to camouflage the implant.

•  Disappointment with the result . Some patients are disappointed with the results of their surgery. This is sometimes related to the fact that they had unrealistic expectations in terms of the outcome of the operation

What about risk of Connective tissue disease and arthritis with muscle implants? The rare and unsubstantiated risk of connective tissue disorders such as arthritis relates to silicone gel implants and you should not worry about this with solid silicone implants.

When are the sutures removed?

Sutures are generally removed 2 weeks after surgery.

How many visits do I have after surgery?

We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then the normal postoperative routine is: 1 week, 1month, 3 months, 6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I cover my bruises with makeup?

You should be able to put makeup on the bruises after the first week.   However we do not recommend your putting makeup on your incisions until they have completely healed because this may result in tattooing of the skin by the pigments of the makeup.

Will insurances cover costs for future problems with my implants?

Most insurance carriers may not cover you for problems related to the muscle implants since it was placed for aesthetic reasons.   You should have no problems however, in obtaining coverage for the conditions affecting the extremities unrelated to the implant surgery.

Am I a good candidate?

The best candidate for this surgery is a person who has small and underdeveloped muscles. Those who have very asymmetrical arms or legs are also good candidates. Generally the younger you are the better a candidate you are for cosmetic surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

Procedure: Muscle Implants continued

What does the surgery cost?

The cost of surgery varies but here are some guidelines that will help you determine roughly what you could expect. Remember that these are only rough estimates . These estimations include the cost of the operating room and the anesthesia. The fee may be subject to change without notice. The best way for you get an accurate cost analysis is to see a doctor.

Breast Aug:    $5,050

How do I pay for surgery?   

You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?

Yes. But these scars usually heal very well and become almost imperceptible after several months. We generally place the incisions in hidden folds of the body so that it is not readily seen.

Does it hurt?

Yes. However, the pain involved in Muscle Implants is very tolerable. We have heard our patients describe it as 'muscle aches and pain' or just 'soreness'.   I like to inject the area of surgery with a long lasting anesthetic solution that significantly reduces the pain in the first few days after surgery. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?

No. I like to do this procedure under general anesthesia. If there are risk factors related to your health for having general anesthesia we can sometimes do this procedure under heavy sedation. If you are having just a small touchup procedure and this can be done in the office then you will be awake. However if you are having a large revisional procedure, or having multiple changes made to your implant you will most likely be done in an outpatient facility under general anesthesia,

Where is the surgery performed ? (i.e. office suite or hospital)

The surgery is done in an Ambulatory Surgery Center. I do not do this operation in the office. The Surgery Center provides a safe environment without the inconveniences of a busy hospital operating room.

Are medical photographs taken?  

Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 1/23/07

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