Supporting the LGBTQIA+ Community: Insights on Cosmetic Clavicle Surgery
Ruli is honored to stand alongside the LGBTQIA+ community throughout the year, offering unwavering support. Our platform is dedicated to being a neutral resource for everyone, irrespective of age, ethnicity, sexual orientation, or gender identity.
In celebration of Pride, we are showcasing stories of resilience, authenticity, and transformation from LGBTQIA+ influencers, activists, and community members. Additionally, we are highlighting pioneers in the fields of gender confirmation surgery and hormone replacement therapy.
Over the past five years, a range of gender confirmation surgery options have become increasingly accessible to patients aiming to harmonize their physical appearance with their true gender. Beyond traditional procedures like breast augmentations and mastectomies, as well as vaginoplasties and phalloplasties, advancements such as facial feminization and voice modification have been introduced by a growing number of providers. These innovations have made it easier for transgender patients to feel comfortable in their bodies, alleviating the persistent distress known as gender dysphoria, which arises from the discrepancy between one's self-perception and the gender assigned at birth. Despite the expanded options, not all physical characteristics typically associated with a specific gender are easily modifiable.
One such characteristic is shoulder width. Imagine the most masculine physique you can think of; it likely features a broad chest and shoulders, akin to a Jason Momoa type. For transfeminine patients seeking a more feminine silhouette, this has long posed a significant challenge. "My shoulders are at the top of my dysphoria list," shared a Reddit user in a thread within the r/MtF community. Currently, only a handful of providers worldwide are known to offer the specialized procedure addressing this concern: clavicle cosmetic surgery, also referred to as shoulder surgery.
Most patients opting for this surgery are trans feminine (or occasionally cisgender women) aiming to narrow their shoulder appearance through clavicle shortening. Conversely, some patients, often cisgender men, seek a broader shoulder appearance and are interested in the opposite procedure (clavicle lengthening). Both procedures can yield remarkable results: up to approximately 20% of the clavicle can be removed to slim the shoulders without compromising form and function, while around 20 millimeters can be added to a clavicle, resulting in overall shoulder gains of about 1.5 inches.
If you are deeply troubled by the width or narrowness of your shoulders, these surgical interventions could significantly boost your self-esteem. Here, we delve into the specifics of cosmetic clavicle surgery, its mechanics, and alternative "starter" options for those not yet ready for a more invasive procedure.
What is Clavicle Shortening Surgery?
First, let's clarify what the clavicle is and its location. Also known as the collarbone, these S-shaped bones are located at the front of the chest, connecting the sternum (or breastplate, the bone between your upper ribs, between your pectoral muscles) to the scapulas, or shoulder blades. The clavicle primarily functions as a support structure for your shoulders, protecting vital nerves and organs while facilitating the transfer of weight from your arms to the rest of your body.
Collarbone fractures are relatively common, accounting for 10% of all fractures. When a patient requires treatment for such an injury, they typically consult an orthopedist surgeon, a specialist in diagnosing and treating musculoskeletal conditions. It may come as a surprise that the surgeons performing cosmetic clavicle procedures are plastic surgeons, but this should not be unexpected. "Every aesthetic procedure has its roots in reconstructive surgery," explains Dr. Barry Eppley, a board-certified plastic surgeon in Carmel, Indiana. He has been offering cosmetic clavicle surgery for about six years and is one of only two known American plastic surgeons performing this procedure. "The transition from reconstructive to aesthetic surgery hinges on the ability to modify the operation to achieve the desired aesthetic outcome," he notes, emphasizing the importance of a minimally noticeable incision.
Cosmetic clavicle surgery is a type of osteotomy, involving the lengthening or shortening of a bone. During the procedure, a small incision is made along the collarbone, and the surgeon removes the periosteum, a thin membrane covering the bone, before using a bone saw to cut the clavicle.
For narrower shoulders, a portion of the bone is excised, leaving two halves. These ends are connected and reinforced with supportive metal plates. Once protective tissue is reattached and the incision is closed, the procedure is repeated on the other side. While some surgeons use a single plate on each side and suggest their removal a year after the operation, Dr. Eppley opts for double plates on each side, which also expedites mobility.
When widening shoulders, Dr. Eppley performs a sagittal split. He cuts the collarbone at an oblique angle, slides the two halves apart, and secures them with metal plates.
What is the Recovery Process Like After Cosmetic Shoulder Surgery?
The recovery process is relatively swift, particularly for clavicle shortening surgery. "The clavicle heals quickly when conducting a reductive osteotomy […] it has a large marrow space, so it has numerous cells to aid in healing," says Dr. Eppley. The main challenge during recovery is the temporary loss of mobility.
Dr. Eppley divides his patients' recovery into three two-week phases. For the first two weeks, which he describes as the most challenging part of recovery, patients must keep their elbows close to their bodies. While you can bend your arms at the elbows, you should avoid moving them otherwise, so having a trusted person to assist you during this initial healing stage is advisable. "After two weeks, we want you to extend your arms about 30 or 45 degrees [away from your body]," he says. This is around the time you can style your hair, and you'll gradually adjust to using your arms within a limited range as you heal.
For the final two weeks, you can progress to moving your arms 90 degrees away from your body and begin resuming normal activities. More vigorous physical movements should be postponed until approximately 12 weeks post-operation. "Men who are lengthening [their clavicles] need to be more cautious," warns Dr. Eppley, as the surgical technique does not facilitate as smooth a healing process as the shortening procedure.
What Alternatives Are There to Shoulder Lengthening or Shoulder Shortening Surgery?
If you're looking to narrow your shoulders without surgery, your options are limited. Liposuction in this area won't achieve the desired outcome; the only treatment that can help create a slender appearance is Botox. "I have patients transitioning to a more feminine body, and Botox injections are highly effective in shrinking thick necks and shoulders," says Dr. Jessie Cheung, a board-certified dermatologist with practices in New York City and Chicago. "Depending on the initial thickness of their shoulders, there can be a significant difference – yes, inches! – after a series of injections." To slenderize the neck and shoulders using Botox, Dr. Cheung injects the trapezius muscle, a large, kite-shaped muscle that runs from the base of the skull down your spine and extends from shoulder to shoulder (to feel it in action, shrug your shoulders – your traps did that).
The effects can be noticed after one month, with results peaking approximately three months after treatment and lasting beyond the six-month mark in some cases. "I aim to avoid causing any noticeable shoulder weakness, so I will administer an injection every three to four months until the desired slimming effect is achieved," she says. "I'm a strong advocate of [trapezius] Botox injections – not only for cosmetic purposes but also for patients suffering from shoulder pain, upper back pain, or bruxism."
Dr. Brian Dorner, a board-certified plastic surgeon in Dublin, Ohio, who works with transgender patients, does not offer this option and sees a drawback to the treatment: "The quantity of Botox required would be relatively large, and it would need to be repeated every few months to maintain the effect," he points out. If patients approached him seeking narrower shoulders, he says, he would refer them to someone who performs clavicle shortening surgery.
For those desiring broader shoulders, "there are three options," says Dr. Eppley. Besides clavicle lengthening, there are injections. Dr. Eppley specifically mentions autologous fat injections to the deltoid muscle, or the rounded area of the shoulder (think of the area covered by a cap sleeve). "Fat injections can persist in the muscle," he notes but also indicates that fat injections can be unpredictable in terms of longevity – and the patient needs available fat for harvesting. Dr. Cheung recommends dermal fillers instead. "Fillers are an excellent choice for those not ready to commit to surgery or seeking less downtime," she says. She prefers biostimulatory fillers – such as Bellafill, Radiesse, Sculptra, or Renuva – as the results can last up to five years. "I inject every six to eight weeks until the desired volume is achieved," she says. "Significant results can be achieved over time, and patient satisfaction is quite high while enhancing their body confidence."
If you're comfortable with the concept of surgery but not ready for a bone saw, you can always opt for the implant route. "Implants are common for broader shoulders," says Dr. Dorner. "They can be either standard deltoid implants or a custom implant, which can be crafted either from a custom molded putty or by CT scan," he says. "These effectively broaden the shoulders and typically last for decades." Dr. Eppley adds that deltoid implants can be inserted above or beneath the muscle – just like breast implants.
Why is Cosmetic Clavicle Surgery So Uncommonly Performed?
Clavicle surgery is, understandably, not a casual procedure. Unlike addressing concerns with Botox injections or implants, the patient seeking this treatment needs to be highly committed, have a support system in place, and be prepared for any potential drawbacks. "I have conducted consultations and surgical work for patients within the LGBTQIA+ community," says Dr. Kevin Debiparshad, a board-certified orthopedic surgeon in Henderson, Nevada, specializing in limb-lengthening procedures. "In general, I find that these patients are motivated and have high satisfaction with the surgical results that help them achieve the image they are pursuing. Overall, these patients seem to experience an improvement in quality of life as successful surgical outcomes are attained."
However, this doesn’t imply that Dr. Debiparshad plans to perform this procedure anytime soon. "I believe the ability to shorten or lengthen the clavicle can be done safely to achieve a cosmetic result," he says, "but there is very limited peer-reviewed data reporting the outcomes." His main concern is the risk of affecting the function of the clavicle. "In general, if I perform a cosmetic procedure on a patient, I do not wish to compromise function to obtain the desired cosmetic outcome." Immediate risks of clavicle surgery can include sensory nerve damage or a collapsed lung, while "long-term risks include hardware irritation and, most importantly, the permanent shift of the shoulder girdle," says Dr. Debiparshad. The muscles where the scapula and clavicle connect to the arm could weaken over time and become easily fatigued, ultimately hindering the shoulder’s effective movement.
As is the case with all aesthetic procedures, it’s crucial to weigh the benefits against the disadvantages and consult a highly skilled provider when considering such an intensive procedure. Dr. Debiparshad also recommends physical therapy and muscle rehabilitation after clavicle surgery to optimize the outcome.
Perhaps the most significant reason that clavicle surgery is so niche is that no one knows to request it. As we mentioned earlier, gender confirmation procedures have become more accessible in recent years, largely due to increased awareness. "In my practice, I rarely, if ever, receive a request for clavicle shortening," says Dr. Dorner. "The fact that there are few patients seeking the procedure makes it more challenging to justify training to incorporate it into my practice." But just as facial feminization surgery is far more popular and widely available today than it was a decade ago, the trend could change for clavicle surgery. "As this growing transgender population becomes more aware of it and the demand increases, I’m certain there will be more than four [providers]," says Dr. Eppley, who performs about one cosmetic clavicle procedure a month. "Awareness generates need, which leads to availability."
Is Shoulder Surgery Worth It?
Anyone who has undergone plastic surgery knows that it can be life-altering, especially in the context of gender affirmation. Though Dr. Dorner doesn’t offer clavicle procedures, he does provide rib reshaping and removal, which is often requested by trans patients. "It can be extremely gratifying as they continue their transition and helps them feel more at ease with their own body image," he says.
Regarding his own cosmetic clavicle surgery patients, Dr. Eppley has discovered that all have been content with their results – he attributes this, to a large extent, to setting expectations. Before surgery, he always conducts computer imaging, creating the minimum possible result. "I tell patients, ‘Never enter an elective aesthetic procedure expecting the best outcome,’" he says. He finds that those who are satisfied with even the slightest change to their image typically proceed with the procedure. "It doesn’t surprise me that in my experience, every single patient believes it was well worth it."
