Many men and women are dissatisfied with the size and shape of their calves. Calf augmentation, or calf implants, is a surgical procedure that uses soft, solid silicone implants to increase the size and enhance the shape of the calves. Reasons for calf augmentation are varfied and include cosmetic enhancement and reconstructive necessity. Men and women body builders often use calf augmentation to enhance the fullness, shape and bulk of the calf muscles when exercise falls short on further development.
Others choose calf implants to improve proportions, definitions and curves of the lower legs for simple muscular enhancement or to correct the appearance of thin and/or bowed legs. Calf implants can also be used to correct asymmetry in calf muscles from trauma or genetic birth deformities such as in polio, spina bifida and clubfoot.
Calf Implant Consultation
During the initial consultation, it is important to review the patient’s medical history, goals and expectations, as well as develop mutual trust and rapport. Numerous before and after photos are reviewed, the procedure and alternatives are discussed, and the calves are measured. Physical examination and discussion in front of a mirror will evaluate the deficiencies in the medial, lateral or (both) gastrocnemius muscles and determine if calf augmentation will require one or two implants for each lower leg. Next, the size and shape of the implants are reviewed and chosen.
Prospective patients are encouraged to speak with previous patients about their surgery and results. Dr. Gershenbaum and his staff are always available for questions. Following the initial consultation, and after appropriate time for reflection an appointment is scheduled for routine preparation and informed consent. Routine blood analysis and medical clearance are required before surgery.
About the Calf Implant Procedure
Calf augmentation is performed by placing soft solid silicone implants in “pockets” created between the gastrocnemius muscles and their tough outer connective tissue fascia. The gastrocnemius calf muscle is comprised of two heads on the back of the lower leg; with one head medial (inside) and one head lateral. Most often, only one implant is needed on the medial side to enhance and proportion the calves. However, for body builders, or those with more pronounced deficiencies, calf implants may be used to enhance both the medial and lateral gastrocnemius muscles. After healing, there is no impairment of normal muscular function because no muscles are cut or detached.
Undergoing Calf Implant Surgery
This surgical procedure is performed in our out patient facility under general anesthesia. Regional spinal anesthesia or local anesthesia with intravenous sedation may also be used. Calf augmentation usually takes from one-and-a-half to two hours. Preoperatively, in front of a full-length mirror, sizers are placed on the claves to determine appropriate location and outline the precise “pockets” for the implants. Planning and placement are crucial. Implants placed too posterior will not show adequate enhancement when viewed from front and behind. The incision in the natural crease behind the knee is outlined. With positions and outlines completed and agreed upon, the patient speaks with the anesthetist/anesthesiologist and is brought to the operating room. After asleep, the patient is turned on to his or her stomach and the legs prepped. Local nerve blocks, combined with medication that shrinks blood vessels and capillaries to reduce bleeding, are instilled. A one-and-a-half to two inch incision is made in the natural crease behind the knee. The incision is continued through the tough connective tissue fascia that covers the gastrocnemius muscle. A long blunt dissector carefully creates a pocket between the fascia and the underlying muscle.
It is important to make the pocket just large enough to accommodate the implant to avoid post-operative displacement. The implant is then carefully inserted into this space to insure the implant lies correctly without buckling or folds. The same procedure is followed for the additional implant(s). The fascia and skin are closed with dissolving sutures, which are placed under the surface of the skin in the dermis to avoid cross- hatching and allow for the finest healing. With both legs symmetrical and complete, they are wrapped with compression bandages and the patient is returned to a face up position. Once awake, the patient is taken to recovery with the legs elevated.
Complications with Calf Implants
As with most cosmetic surgical procedures, complications are unlikely when performed by a skilled and competent surgeon. To reduce the chances of complications, ensure that the surgeon performs calf augmentation regularly, review many before and after photos and speak with one or more previous patients. Following the post-operative instructions are critical to avoid complications, which include, but are not limited to:
Poor healing with obvious wide and/or raised scars,
Motor or sensory nerve damage,
Need for revisional surgery.
Also rare, but possible are blood clots or emboli (blood clots which dislodge and travel in the bloodstream to distant sites) which can be fatal.
Be assured that Aventura Center for Cosmetic Surgery will do everything to make the procedure(s) and experience rewarding. In the unlikely event of a complication, or less-than-desirable result, we will do all we can to work toward a satisfactory result.
Recovery After Calf Implants
Following the surgery, patients generally report mild to moderate discomfort, which is easily controlled with medication. Varying degrees of swelling, bruising and firmness subside in the days and weeks ahead. The first 24-48 hours after surgery consist of bed rest with the legs elevated to reduce swelling. Short walks to the bathroom and other short distances are permitted. The patient is seen for an initial follow up appointment one or two days after surgery and again one week later. Showering is permitted after the first post-operative visit.
There are usually no sutures to remove as dissolvable sutures are placed below the skin surface to help avoid hatch marks and optimize healing. Ace wraps are exchanged for heavy above the knee support hose on the first or second visit -to be worn for 6 to 8 weeks. After 48 hours, light walking is encouraged, with more routine walking and activities progressing in the first and second week. Normal walking and non-strenuous activities usually start at three weeks after surgery, but can vary. Strenuous activity such as bicycling, jogging and leg exercises must be avoided for eight weeks to allow more complete healing around the implant, which prevents shifting and displacement. The skin will begin to stretch, relax and lose its shiny appearance in two to four weeks. Complete healing takes time and patience, taking up to one year. It can take this long for scars to soften and fade. Follow up appointments will be scheduled periodically up to one year post-operatively, and annually thereafter.
Calf augmentation with implants uses an incision placed in the natural crease behind the knee that generally heals in an inconspicuous manner over time. Calf implants come in many different shapes and sizes, and can accommodate most requirements made during consultation. Also, custom-made moulage implants can be crafted for more specific requirements, such as in cases of trauma or birth defects.