The shape and contour of the calf is dominated by the size of the muscles. Larger calves can mostly not be reduced, only by reducing a fat deposit by lipo-suction.An underdevelopment of the bones and muscles of the calf can be a result of congenital malformations or diseases like polio or palsies.

The extreme awareness of the body nowadays, seen as the popping up of fitness-studios, makes people more concerned about the shape and volume of their muscles. In spite of hard training the desired shape might not be achieved and all these factors might give a desire of surgical muscle-augmentation.

Principle:

One of the dominant muscles of the calf, the gastrocnemius muscle, has two heads inserting on the medial and lateral side of the tibia at the hollow of the knee. The muscle bellies run together downwards and join at the Achilles tendon. The investing fascia can easily be lifted from the muscle to form a pocket where one or two implants can be placed. Major blood vessels and nerves run protected under the muscle and are unlikely to be harmed. The implants are mostly made of solid but soft silicone. The implants should have the same length as the muscle bellies so that they are totally protected by the muscle. Normally one implant is used under each head, to give a natural look.

Due to unprotected vessels and nerves, no other parts of the calves can be augmented by implants.

Procedure:

A 4 - 5 cm long incision is made in the lower poplitetal crease and deepened down to the fascia which is opened. The pocket is easily developed and one implant for each muscle belly is inserted. The pocket and the skin is closed. The scar will almost be invisible in the hollow of the knee. A circular bandage is applied and this should be worn for approximately one week.

Bed rest at the clinic for 24 hours. It is advisable to wear shoes with 4 - 5 cm heels to relax the muscles. (Cowboy boots for instance for men).

Operating time:

1 - 2 hours.

Anesthesia:

The operation can be done in conscious sedation with tumscentinfiltration or general anesthesia.

You can expect:

• During the first 24 hours there will be quite heavy tensile pain, which gradually will disappear during the first week
• Bed rest or horizontal positioning with elevated legs as much as possible during the first week.
• It is allowed to go up for bathroom and meals.
• After the first week increased mobilization according to needs and possibilities.
• Restrain from physical activities for 6 weeks.
• Time off 2 - 3 weeks depending on activities.
• Heavy oedemas for the first couple of weeks. A compression stocking should be used.

Complications
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections. An implant has to be removed temporarily and can be reinserted after a few months in case of infection.

Capsular contracture: Every foreign body causes a formation of surrounding connective tissue, a capsule. If this capsule contracts, the implant can be deformed.

Dislocation: The implant can be dislocated or change position. This is often due to direct injury to the muscle.

Scarring: All scars are red for a couple of months and they fade away during the fist year. Direct sun or solarium against the scars should be avoided to prevent them for permanently become red or pigmented. The scars are normally very discrete.

Smoking: Smoking does compromise blood circulation and healing. Smoking should be abandoned prior to a planned operation