Calf implants

Cosmetic Calf Augmentation and Restoration
Igor Niechajev, M.D., D.Sc.
Stockhlom, Sweden

Background: Calf augmentation is indicated for cosmetic reasons or to reconstruct a shrunken lower leg that is the result of injury, illness, or congenital disability. Calf implants are made of solid semisoft silicone, which can be customized by carving, or of a thick shell of solid silicone containingcohesive silicone. Methods: During the years 1991 through 2004, 18 patients (13 women and five men) underwent 20 calf augmentations at the Lidingö Clinic in Stockholm. Indication for operation was aesthetic in 10 patients. Four patients were body-builders. Another four underwent unilateral crural restoration because of the deformity caused by an illness. Both cigar-shaped and anatomically formedsilicone implants filled with cohesive gel were used. Several technical improvements were introduced; among them, a new instrument for insertion of the implants. The long-acting anesthetic ropivacaine was used to flush the dissected cavity and for intermittent regional analgesia during the first postoperative day. One or two implants were placed in the space between the investing crural fascia andgastrocnemius muscle, depending on the aesthetic demand. In five patients, an augmentation procedure was combined with circumferential liposuction of the lower legs. Results: All patients obtained good aesthetic improvement and were satisfied with the outcome. No serious complications were encountered in this series. Liposuction contributed to better cosmesis and symmetry in some aesthetic patientsand was particularly important in the reconstructive cases. Ropivacaine

flush almost eliminated the postoperative pain and discomfort. Several clinical examples of calf augmentation attributable for aesthetic and/or medical reasons are presented. Conclusion: Calf augmentation or reconstruction with silicone implants is a safe, efficient, and satisfying aesthetic procedure. (Plast. Reconstr.Surg. 116: 295, 2005.)

In the Western world, modern lifestyles emphasize health and fitness. Our current outdoor living habits and liberal clothing fashions expose more of the body than was the norm only a few decades ago. Not surprisingly, legs have become increasingly more important as one of the assets of personal beauty and one of the secondary gender characteristics in both women and men.Not only young women might be unhappy because of slim calves but male and female athletes as well. All patients seeking calf augmentation want to correct a relative disproportion between the thigh and the calf. However, their wishes and needs are different. Body-builders desire an upper calf volume increase to simulate a welldefined and bulky gastrocnemius muscle,1 whereas the thin-legged personwants creation of the long, gentle curve on the medial and sometimes also on the lateral side of the leg. Calf augmentation may also be beneficial for reconstructing a shrunken lower leg that is the result of an injury, illness, or congenital disability. Poliomyelitis is the single most common cause for underdevelopment of the calf. Calf implants are made either of solid semisoft sili-

From theLidingö Clinic. Received for publication February 3, 2004; revised November 24, 2004. Presented at the Annual Meeting of the Swedish Society of Plastic Surgery, in Gothenburg, Sweden, November 30, 2002. Readers may also refer to the online version of the article at the Journal’s Web site (www.plasreconsurg.org) for additional materials. DOI: 10.1097/01.PRS.0000170050.86464.8E

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296PLASTIC AND RECONSTRUCTIVE SURGERY,

July 2005

cone,2,3 which can be customized by carving, or of a thick shell of solid silicone containing liquid or cohesive silicone.4 –7 The concept of enhancing lower leg contour by silicone implants inserted under the investing crural fascia was introduced in the 1970s by Carlsen and independently published by Carlsen2 and Glicenstein4 in 1979. Correction...