Were You Told Your Popeye Deformity Can't Be Fixed? It Can.
If you've been living with a Popeye deformity — that telltale bulge in your upper arm where the biceps muscle has dropped and balled up — you may have been told by your surgeon that nothing can be done. That the tendon is gone. That it's "just cosmetic."
Dr. Raffy Mirzayan has heard this story hundreds of times. And he disagrees.
Dr. Mirzayan is the first surgeon in the world to perform and publish a technique for reconstructing, or rebuilding, a chronic, torn, or surgically released long head of the biceps tendon (LHBT) using a tendon allograft — even when the original tendon has completely disappeared. He has performed this procedure with outstanding results, and every single patient has been extremely satisfied with the outcomes.
If you are suffering from biceps cramping, spasms, pain, or weakness — or simply unhappy with how your arm looks — you may be a candidate for this procedure regardless of how long ago your injury or surgery occurred.
To find out if you qualify, call (310) 746-5918 or request a consultation online. Virtual consultations are available. Dr. Mirzayan welcomes patients traveling from Las Vegas, Henderson, Phoenix, and Scottsdale.
What Is a Popeye Deformity?
The long head of the biceps tendon (LHBT) is the tendon that connects the biceps muscle to the shoulder. When this tendon ruptures from injury or is surgically released (tenotomy) — the biceps muscle loses its anchor and slides down the arm, creating a characteristic bulge known as a Popeye deformity (named after the cartoon sailor's exaggerated biceps).
Most surgeons tell patients this is a cosmetic issue. While it is true that many patients adapt, a significant number experience:
- Persistent biceps muscle cramping and spasms
- Pain in the upper arm
- Fatigue with repetitive arm use
- Loss of supination strength (rotation of the forearm)
- Cosmetic dissatisfaction that affects confidence and quality of life
The Problem With Waiting — And Why Most Surgeons Can't Help
When a biceps tendon ruptures or is cut during surgery, the window for straightforward repair closes quickly. As weeks and months pass, the tendon retracts, shortens, and in many cases disappears entirely — for reasons that are not yet fully understood.
By the time most patients seek a second opinion, their surgeon faces an impossible situation: there is no tendon left to suture. Standard repair and tenodesis techniques require sufficient tendon length — and in chronic cases, that tendon is simply gone.
This is exactly the problem Dr. Mirzayan set out to solve.
Dr. Mirzayan's Solution: Biceps Tendon Reconstruction with Gracilis Allograft
Dr. Mirzayan developed and published a novel surgical technique that rebuilds the missing biceps tendon using a gracilis or semitendinosus tendon allograft — donor tendon tissue that replaces what the body can no longer provide.
The allograft is carefully woven through the biceps muscle belly using a technique called Pulver-Taft weaving, which integrates the graft directly into the native muscle for maximum pull-out strength. The reconstructed tendon is then anchored to the humerus (subpectoral tenodesis), restoring the proper length and tension of the biceps muscle.
This technique was published in the peer-reviewed journal Clinics in Shoulder and Elbow (2024) and represents the first published report of long head of biceps tendon reconstruction and tenodesis in the world.
Key advantages of this technique:
- Rebuilds the tendon even when it has completely disappeared
- No donor site — allograft avoids harvesting from your own body
- Pulver-Taft weaving provides strong, durable graft integration
- Eliminates cramping, spasms, and pain in all reported cases
- Restores normal biceps contour and appearance
- Outpatient surgery — go home the same day
Who Is a Candidate?
You may be a candidate for chronic biceps tendon reconstruction if:
- You have had a rupture of the long head of the biceps tendon
- Your surgeon performed a biceps tenotomy (surgical release) during a previous shoulder surgery
- You are experiencing cramping, spasms, pain, or weakness in the biceps
- You are unhappy with the appearance of the Popeye deformity
- You were told "nothing can be done" because the tendon is too short or absent
There is no time limit!
From your original injury or surgery — Dr. Mirzayan has successfully reconstructed tendons in patients years after the original event. Most patients seeking this procedure are between 40 and 70 years of age, though there is no strict age limit.
What to Expect
- Surgery type: Outpatient (same-day discharge)
- Anesthesia: General
- Recovery: Sling for 2 weeks, light activity at 6 weeks, strengthening at 3 months, full recovery at 4–5 months
- Results: All patients treated by Dr. Mirzayan have achieved complete resolution of cramping and spasms, restoration of biceps contour, and high satisfaction scores (SANE score of 100 in published cases)
Frequently Asked Questions
Can a Popeye deformity really be fixed years after the injury?
Yes. Dr. Mirzayan's technique uses a tendon allograft to replace the missing biceps tendon, which means the procedure can be performed even when the original tendon has completely retracted or disappeared. There is no time limit from the original injury.
Is this the same as a standard biceps tenodesis?
No. A standard tenodesis requires sufficient native tendon to anchor. Dr. Mirzayan's technique is specifically designed for cases where the tendon is too short or completely absent — a situation where standard tenodesis is not possible.
My surgeon told me nothing can be done. Is that true?
For most surgeons, yes — because they don't perform this reconstruction. Dr. Mirzayan is the only surgeon to have published this technique. If you have been told nothing can be done, we encourage you to seek a consultation.
Will this fix my cramping and pain, or just the appearance?
Both. In Dr. Mirzayan's experience, every patient has achieved complete resolution of cramping and spasms. Cosmetic restoration of the biceps contour has also been achieved in all cases.
Is this covered by insurance?
Reconstruction for functional symptoms (cramping, pain, weakness) is typically covered. Dr. Mirzayan is an out-of-network surgeon, but many patients have excellent out-of-network benefits with costs equivalent to in-network care. His team will help you understand your coverage before surgery.
Do you see patients from outside Los Angeles?
Yes. Dr. Mirzayan welcomes patients from all over the world including Las Vegas, Henderson, Phoenix, Scottsdale, and beyond. Virtual consultations are available. Call (310) 746-5918 to get started.
