• Introduction: Why Get Calf Implants?

• The Implants 

• What To Expect At Your Consult

• Preparing For Your Surgery

• The Procedure

• The Road To Recovery

• Risks & Complications

• Calf Implants Pre-Operative Instructions

• Calf Implants Post-Operative Instructions

• Frequently Asked Questions About Calf Implants
  

Introduction: Why Get Calf Implants?
The desire for defined calves is pretty strong for both women and men.  For quite a few of us, no matter if we work out our calves until we are lying, cramped up on the gym floor -- still can not develop defined calf muscles.  Even male and female bodybuilders may have trouble developing calf muscles that are proportionate to the rest of their body.  That is where calf implants come into play.  And you don't just have to be a bodybuilder to get these implants to make your legs look good.  They are also beneficial for men and women who have suffered an injury or neurological diseases that cause the calf muscles to deteriorate, such as polio or spina bifida.  Another benefit is the correction of the condition known as "bow legs" or "bowed legs."

Dr. John A. Rusca writes, "The last statistics that I reviewed showed that more women than men have calf implants, however, in my own practice the number has been about equal. Women usually have calf implants to achieve better balance in the lower leg when compared to the rest of the body, especially the thighs. But calf implants in women are usually designed to enhance curves in the lower leg as well as to enlarge the overall diameter. On the other hand, implants for men are used to bulk up the appearance of the calf muscles to give the look of having been in the gym for hours working out the calf muscles. The difference in purpose is most important since the design of the implant shape and thickness will determine the ultimate result. 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. Without evaluating the rest of the body, it is easy to over-do the implant size and get a result that looks more like Popeye than Arnold."

"Patient with two implants in each calf shown five weeks after surgery. He has returned to full work and complete workouts at the gym."  Photo credit: James Romano, M.D. of San Francisco, CA - Board Certified Plastic Surgeon
 

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Calf Augmentation With Fat Grafting
Please see our Fat Grafting Section for more information.  Buttock augmentation is also performed with fat grafting.

The Implants
Calf implants are constructed to be soft, yet solid; the implant is made primarily of silicone.  Remember they are still soft, but firm and have the feel of a well exercised and developed calf muscle.  The calf implants are available in different sizes to suit your individual needs.  It isn't a one size fits all type of implant -- different people want different results.  You will be measured and fitted for implant size at your pre-operative visit.  The surgeon can custom design the implants for each individual patient by making a mold of each individual calf muscle and sending it to the manufacturer, or if equipped, process it right in the office.  That way there is less of a chance of discomfort and irritability.

Dr. Rusca writes, "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 manufactures 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 I will sculpt in wax the implant, adjust it 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."

What to Expect at Your Consult
After checking a surgeon's background and credentials, you will make an appointment for a consultation.  You will meet with this surgeon and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take. This is very important.  Visit the Medication & Supplement List for more information.  You will discuss your complaints and concerns and discuss the various techniques and implants, if needed, available to you.  Your surgeon will explain the technique and incision placements and methods that may be most appropriate for you and should discuss the Risks associated with calf implants with you, as well. 

You will also discuss the available anesthesia that will be used for your procedure.  Most calf implants procedures are performed under Light Sleep Sedation although some docs may use General Anesthesia.  If you do go under General, you make sure that the anesthesiologist is certified!  Please read the All About Anesthesia Page for more information.

This surgery is not a one size fits all type of thing.  Knowledge is power -- so research before your consultation.  You will also discuss your pre-operative instructions and speak, at length, about the recovery period instructions and what to expect in the months ahead.  You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, anti-inflammatory drugs and perhaps a box or directions for gaining a box of Arnica montana. 

This is stronger than the stuff you can get at any heath food store.  I swear by this stuff, I used it for all 4 of my surgeries and I know others who have used it and their bruising was practically non-existent and their swelling, minimal.  I also used a topical formulation (however I never had calf implants), called 'Boiron.'  Ask your doctor about these two products.  Would like to know more on the benefits of Arnica montana?  Also read up on Bromelain.

If you would like more information on consultations or a list of questions to ask your surgeon please visit the Consultation Help Page 

Preparing For Your Surgery
You will be given a pre-operative information packet that explains everything you should do and know before your surgery date.  The packet should include all the medications you should not take for up to 2 weeks before your surgery.  These medications will include, but are not limited to, aspirin-containing products . Would you like to view a typical Medication & Supplements List? 

It is quite possible that you will have preliminary blood work performed.  This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count (CBC, complete blood count) which can ultimately indicate  disease or disorders beforehand.  So many things to do... so little time.  Surgery will be here before you know it so visit the Preparing For Surgery page and relax.  This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

The Procedure
A calf augmentation with implants procedure normally takes about 2 hours to perform.  First, you will be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date.  If you had been given an oral sedative or valium prior you usually could care less what they are sticking in you.  They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular doorway should the need arise.  If you haven't been given a sedative, it is more stressful for some patients. Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time.  It's the initial placement of the IV that may sting a bit. After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein.  This is called a catheter, which is taped to your skin so it is not knocked out and is ready to be used as a sort of entryway for anything the surgical team deems suitable for your body.  This is usually done before you get into the actual O.R. -- by a nurse -- and you have a saline bag hooked up to you. The medications will usually be given with a drip system with this saline.  As I said, the saline will keep you hydrated both during and post-operatively.

Some people get their IV placed in the crook of the elbow, some the hand -- it all depends upon your veins though.  So, if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet.

If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of it with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body.  The effects of the anesthesia are felt soon after injection or opening the stopper -- a few seconds in fact.  It feels like heat going into you veins then creeping up your arm -- then it jumps from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized.

Your surgeon may inject lidocaine and epinephrine into your treatment area and will make an incision about 3 inches long in the the natural fold of the back of the knee.  Your surgeon will then dissect tissue and muscle fascia and make a pocket to fit your implant.  The implant is placed under the muscle fascia and the pocket is sutured.

Dr. Rusca advises, "All calf implants are made of a silicone material. The implants are solid, but soft.  The implants may be clear but the I  use are opaque and white. 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.)  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. Because of certain important nerves and blood vessels that are below the muscle, the implants cannot be placed under the muscle (which is the reverse of male pectoral implants). 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 outside of the muscle pocket. This is exactly the case in those patients that have calf implants to correct deficiencies from Polio or other degenerative conditions that involve the lower leg musculature. Because of nerves, tendons, and blood vessels, it is usually not possible to augment the lower 1/3 to ¼ of the leg.  The operation will usually last about 1-½ hours. It can be done under local, regional, or general anesthesia.  I prefer general anesthesia for a number of reasons but I will do what the patient prefers after I tell them the differences in anesthesia. Once the implants are in place, the incisions are closed. I use no external stitches so there are no stitches to remove. The patient will be more comfortable if a long acting (usually about 10-12 hours) local anesthetic is left in each implant compartment. Compression stockings are placed and these will be worn for about 2-3 weeks. There are generally no bandages. When the patient is ready to leave the recovery room, I suggest that they wear a shoe with a 1 ½ to 2 inch heel (cowboy boots or the like for men). This will cause the calf muscles to relax and the discomfort will be less. Patients are advised to go home to bed for 24 hours." 

The surgical team then performs a sponge and instrument count and your surgeon then closes your initial incisions with, more than likely, a non-dissolvable type suture.  The operating room staff or your surgeon will then wrapped with ace bandages.  Of course there may be differences in surgical technique depending upon the preference of your surgeon.

You are then wakened gently and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released.  This is dependent upon the individual but may take up to two hours.  Your calves may feel tight and quite tender as the anesthesia wears off.  You may even feel emotional or upset -- this will depend upon your body's reaction to anesthesia.  You may also experience rigors or shivering.  This may feel uncontrollable and  is usually from the medications -- more than likely epinephrine that is used as a vasoconstrictor.  The recovery nurse usually has wrapped you in a warm blanket but if not, request one.  It certainly makes things more tolerable.  When you are ready to leave you will be wheeled out in a wheelchair or told to wear some sort of heels to keep from stretching your calf muscles.

As far as post-operative nausea, some patients feel nothing different although if you have had General you may feel a little sick -- hopefully your surgeon gave you something to lessen this.  Your prescribed medication should alleviate this pain and discomfort.  However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.  You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

The Road To Recovery
The down time for this procedure is difficult to determine as each case is individual.  However, on those with an office job with little walking and a lot of sitting, the time off is about 1 to 2 weeks, depending on your individual needs.  For those who are required to do physical labor, the time off is about 3 weeks.  You can't walk around a lot nor walk up stairs at first when you have this type of implant.  You MUST remain stationary or risk infection.  You also should elevate your legs as much as possible for the first week and wear a type of support hose for 3 weeks.  Normally, you may return to exercise and other activities after 6 weeks.  Remember, too much, too soon equals disaster. 

Dr. John Rusca writes, "After 24 hour bed rest.  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. Their post-surgery activities are restricted severely for about 6 weeks. The only complications I have had have been in men who do not follow instructions well and insist on returning to work or to the gym too early. This will result in hematoma (bleeding), 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. 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. In male patients, 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 to the doctor vary with each physician but I usually see patients 2 days post-op, 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
Well, most plastic surgeons are reluctant to perform this surgery as they say it has a high rate of implant shifting and/or infection; especially with multiple implant usage. This however is not true in experienced surgeons, you must find a surgeon who is highly skilled with this procedure.  Actually, the use of two implants per leg is quite common in both women and men. With the right surgeon, this to can be achieved without complications.  

Dr. Rusca writes, "Delayed complications such as infection or implant displacement have not occurred in my practice. 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)."

Inherent risks and complications include hematoma, infection, inflammation, seroma and asymmetry.  Also be advised there are risks of anesthesia.  Please read the Anesthesia section for more information.

References
(1) Pre & Post-operative Instructions and comments courtesy John A. Rusca, MD - Atlanta, GA Board Certified Plastic Surgeon
(2) The Calf Implants - James Romano, M.D. - San Francisco, CA Board Certified Plastic Surgeon

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