Case Studies

Calf Implants for Females

Calf implants for women are used to enhance the feminine curves of the lower leg without producing the muscular bulk that most men want.  While some women prefer some muscularity in the leg, most would prefer to accentuate the natural female form.  Combining liposculpture of the inner knees or lateral thighs with calf implants will help create those much sought after those long sexy legs.

It is most important to evaluate the entire body of any patient looking to have body contouring with implants.  Most patients, men especially, will usually ask for the largest implant made.  That is rarely the case in women.  However, using implants that are too large in women will produce a heavy lower leg with exaggerated curves that are unsightly. All calf implants are made of a silicone material.  The implants are solid, but soft. 

Before Surgery

For cosmetic enlargement, 2 implants are usually used in each calf (a total of 4 implants per patient) and are placed under the investing fascia of the medial and lateral heads of the gastrocnemius muscle, which is the large muscle that forms the visible bulk of the calf.  (The 2 implants are necessary to mimic the natural contours of the gastrocnemius muscle.  Using a single implant to enlarge both medial and lateral areas will result in an artificial look.  Single implants are used frequently in reconstructive procedures, which generally require only one side or the other to be augmented.)

Usually the implant length is determined by the length of the patient's own muscle. Sometimes this can cause a problem when the patient's muscle is short in proportion to the length of the lower leg.  In most cases the implant size can be adjusted by lengthening to extend slightly outside of the muscle pocket.  This is exactly the case in those patients that have calf implants to correct deficiencies from Polio or other congenital or degenerative conditions that involve the lower leg musculature.  Because of nerves, tendons, and blood vessels, it is usually not possible to augment the lower 1/2 to 1/3 of the leg.

Once the overall purpose is decided upon, implant design and construction is most important.  The technique to place the implant is relatively simple.  It is the preoperative evaluation and the decisions made before surgery that will determine the ultimate result.  These decisions include the shape of the implant, thickness and the material that will be used to construct the implants.  Once the implant is constructed, only minimal revisions at surgery can be done.  The plastic surgeon needs to have a good eye for body contour, a good ear to hear what the patient wants, and the ability to convey to the implant manufacturer what is to be constructed.  If the implants are too short, the surgeon can't lengthen them at the time of the operation.  If the implants are too thick, removing some of the silicone material is possible, but the implant will have lost its smooth surface due to the trimming.  Implants that are designed to emphasize muscularity in men will not result in the smooth silky curves needed for a woman.  Planning and experience is key as it is in most aesthetic surgery.  Implant manufacturers that work with a plastic surgeon who does more than an occasional calf implant will keep a range of implant designs that that surgeon uses.  Implants are then available within a short time.  In those patients that require a size or design that is unique, a moulage (mold) of the leg will generally need to be done before the implant can be constructed.  In some cases the implant will be sculpted in wax, adjusted to the individual patient's calf and then send it out to be duplicated.  All of these procedures will increase the length of time needed before surgery can be scheduled.  It will also generally increase the cost.

The Surgery

The technique is the same in men or women.  A 1 ½" incision is made in the lower posterior popliteal crease (the lines behind the knee) and deepened to extend through the fascia that covers these 2 areas of the muscle.  Once this investing fascia is opened, the pockets that will receive the implants are easily developed.  Calf implants are placed within the muscle compartments (2 of them in each leg) but on top of the actual muscle fibers.  Because of certain important nerves and blood vessels that are below the muscle, the implants are not usually placed under the muscle (which is the reverse of pec and sometimes breast implants).  The operation will usually last about 1.5 - 2 hours.  It can be done under local, regional, or general anesthesia.  Once the implants are in place, the incisions are closed.

Post Surgery and Recovery

The patient will be more comfortable if a long acting (usually about 10-12 hours) local anesthetic is left in each implant compartment.  Light compression stockings are placed and these will be worn for about 2 weeks.  There are generally no bandages.  When the patient is ready to leave the recovery room, they wear a shoe with a 1.5 to 2 inch heel (clogs, no spike heals ladies!).  Elevation of the heel will cause the calf muscles to relax and the discomfort will be less.  Patients are advised to go home to bed for 24 hours.  After that they can get up for eating or the bathroom but they still need to be off their feet for about a week with the legs elevated.  This may stretch into 2-3 weeks if there is unusual swelling or bruising.  Post-surgery activities are restricted severely for about 6 weeks, especially gym activity.

Discomfort following the surgery can be quite variable.  Women seem to have less pain than men, but that is across the board in all surgical procedures.  Pain is to be expected, especially for the first 48 hours.  The long acting local anesthetic helps with the immediate post-surgical pain.  Keeping the legs elevated will reduce the swelling and therefore reduce pain.  An antibiotic, something specifically for pain, something to reduce inflammation, possibly something for muscle spasms, and occasionally something for sleep will be prescribed by the doctor.  Take medications exactly as prescribed and with no other drugs.  In these days of exotic medications, interaction and cross-reaction of medications is not too uncommon.

Follow-up visits with the doctor vary but patients are usually seen 2 days postop, then weekly for 3 weeks, then at 6 weeks, 3 months, 6 months, 1 year and annually thereafter.  Patients that are from out-of-town have their schedule adjusted to their needs.

Risks & Complications

Complications may occur particularly in patients who do not follow instructions well and insist on returning to work or to the gym too early.  This may result in hematoma (bleeding), seroma, excess swelling and/or other problems.  The outside scar will heal in about 10 days but the area surrounding the implants will take about 6 weeks to heal.  Therefore the patient needs to be careful with his activities.  Delayed complications such as infection or implant displacement are relatively rare.  Once the implants are healed in place, it is unlikely that they will shift unless the patient receives a severe blow to the area (one that would normally do injury to a muscle or break a bone).

The Cost

When budgeting for calf implant surgery, remember there is the fee for the surgeon, the fee for the implant manufacturer, the cost of the surgery facility and the fee for the anesthesiologist.  There are miscellaneous other costs such as lab tests, medications, preop physical, postop clogs, etc.  If you are one that needs a custom implant, especially if you need to have a moulage done first, this will impact the total cost also.  Once you are seen in consult and all factors evaluated, a final cost will be quoted for you.  If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.

 

 

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