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Archive for the ‘calf implants’ Category

Case Study – Upper Inner Calf Implants

Saturday, January 28th, 2017

 

Background: The shape of the lower leg is most commonly defined by the contours along its inner half. The knee, calf muscle and ankle provide a curvilinear shape that has a well known pleasing set of convexities and concavities.This undulating shape is highly influenced by the size of the medial gastrocnemius muscle well as the thickness of the subcutaneous fat layer over it.

Typically there is a concavity in the line of the lower leg between the inner knee and the most prominent bulge of the calf muscle. Without this concavity the lower leg looks thicker and ill-defined. If it is not distinct such a concavity can be created by medial calf muscle augmentation, liposuction between the knee and muscle or a combination of both.

In rare cases this inner leg concavity can actually be too deep. This makes the inner calf muscle look like it is too big even though it is of normal size.

Case Study: This 55 year-old female was embarrassed about the shape of her lower legs and refused to even wear shorts. She felt that her inner leg concavity was too deep and made her legs look too muscular.

Inner Upper Calf Implant Technique Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, modified calf implants were placed through an incision on the back of the knee into this inner leg concavity. A small size calf implant was cut down to a smaller size to fit this area. Through a 3.5cm incision located along a popliteal skin crease, a superficial subfascial pocket was created above the bulge of the inner calf muscle to soften the depth of the concavity.

Upper Inner Calf Implants result front view Dr Barry Eppley IndianapolisUpper Inner Calf Implants result back view Dr Barry Eppley IndianapolisHer six week after surgery check showed a pleasing improvement in the inner half shape of her leg just below the knee. Her results show that calf implants can be used in creative ways to create more than just a larger calf muscle prominence.

Highlights:

1) Calf implants are typically used to augment the body of the inner or outer heads of the gastrocnemius muscles.

2) A deep concavity of the inner leg contour between the knee and the inner calf muscle can be augmented by a modified calf implant.

3) Such a modified calf implant needs to be placed in a subcutaneous pocket above the head of the muscle.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Calf Implants for Male Lower Leg Reshaping

Monday, March 7th, 2016

 

Background: Increasing the size of the calf (gastrocnemius) muscles is very difficult. The tight and dense muscle fibers of this lower leg muscle take extreme muscle-building exercises to enlarge the overall muscle size. And unless one is willing to continue these exercises for the rest of one’s life, the size of the calf muscles will not persist.

Calf Implant Augmentation Indianapolis Dr Barry EppleyThe most immediate and permanent method of calf augmentation is the placement of calf implants. Inserted through small incisions on the back of the knee, they are placed in the subfascial location on top of the muscle. Because there are two separate bellies of the muscle, implants can be placed on either the inner or outer calf muscles or both.

Patients for calf augmentation generally hope to achieve one of two effects. Some patients simply want to have a more shapely lower leg by making the inner belly of the calf muscle bigger. This creates an outward bulge that changes a straight line leg profile. Less commonly are patients that want to have a much more muscular appearing calf and need both inner and outer calf implants to create a more profound effect.

Case Study: This 36 year-old male wanted to make his lower leg look more proportionate to his upper leg. He had very skinny lower legs with a straight line profile from the knee to the ankle.

Calf Implant Incisions Dr Barry Eppley IndianapolisCalf Implant Insertion Technique Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, 3.5 cm skin incisions were made on the inner half of the popliteal fossa behind the knees. The fascia was incised and subfascial pockets developed. Medium size calf implants (Implantech) were inserted over the medial belly of the muscle and as anterior s possible. The incisions were closed with resorbable sutures.

Male Calf Implants result front view Dr Barry Eppley IndianapolisMale Calf Implants result front view raised Dr Barry Eppley IndianapolisMale Calf Implants result back view Dr Barry Eppley Indianapolis Male Calf Implants result back view up Dr Barry Eppley IndianapolisHis postoperative results showed an improved lower leg profile in the inner half. There is now a more pronounced bulge below the knee that makes the leg look more muscular and proportionate. The muscle is more evident which is seen when standing his toes.

Calf implants provide permanent muscle enlargement. The size of the calf implant chosen is subjective and the maximum size implant that will fit into the subfascial pocket should always be chosen as it very difficult, if not impossible, to make a calf look too big.

Highlights:

1) Calf implants provide increased gastrocnemius muscle size to improve the shape of the lower leg.

2) The most common location for calf implants is on the medial or inner half of the gastrocnemius muscle.

3) Calf implants improve only the upper half of the lower leg.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Female Calf Implants

Sunday, February 14th, 2016

 

Background: The calf or gastrocnemius muscles are a compact and powerful set of lower leg muscles that run from the knee to just above the ankle. It is a bipennate musclke with two known heads. The outer or lateral head starts at the lateral condyle of the femur while the inner head starts from the medial condyle of the femur. The two heads of the muscle join up about midway between the knee and ankle to form a common tendon with the soleus msucle. This common tendon then extends down inferiorly  to fix to the heel and is known as the Achilles tendon.

gastrocnemius muscle anatomyWhen placing calf implants the anatomy of the aforementioned muscles and tendon is critical. Calf implants are always placed in the subfascial location to sit on top of the muscle. But the subfascial dissection can not extend below the most inferior portion of the muscle where it joins the tendon of the soleus muscle. In the upper half of the lower leg the soleus muscle lies under the gastrocnemius muscles. But as the soleus muscle emerges more superficial at the bottom edge of the gastrocnemius muscles, the overlying fascia becomes very adherent and hard to dissect under.

Most women who seek calf augmentation have a different agenda than that of some men. Women are usually concerned about having a very skinny lower leg that has no definition. (so called ‘chicken legs’) They are looking for some sort of an inner calf ‘bump’ that breaks up an otherwise straight line from the knee to the ankle.

Case Study: This 35 year-old Asian female has long been bothered by the shape of her legs. They were very skinny and has very small calf muscles with a small circumferential calf measurement.

Calf Implant Sizing Dr Barry Eppley IndianapolisIntraoperative Calf Implant Sizing Dr Barry Eppley IndianapolisUnder general anesthesia in the prone position, a 3.5 cm incision was made in the inner half of the popliteal skin crease. The gastrocnemius fascia was identified, incised and subfascial dissection down with a long broad flat instrument The dissection was done down to the bottom of the calf muscle which was marked beforehand by having her stand on her toes. The standard medium sized calf implants were too long for the length of her gastrocnemius muscles. The calf implants were trimmed to a proper length and then inserted in the subfascial pocket. The fascia was closed over by a fat flap and the skin closed with resorbable sutures in two layers.

Female Inner Calf Implants result front view Dr Barry Eppley IndianapolisFemale Inner Calf Implants result back view Dr Barry Eppley IndianapolisCalf implants in women are designed to create some muscle enhancement in the inner lower leg so it is not just a straight line. In this patient medium calf implants were used whose length needed to be shortened. In hindsight perhaps large calf implants with a wider width would have produced a more significant result. Larger calf implants are longer but shortening the standard length of medium calf implants was needed anyway.

Highlights:

1) Calf implants can be used to augment either in the inner or outer gastrocnemius muscles

2) Most women want to improve the shape of the skinny lower legs through medial or inner calf implants.

3) Inner calf implants are placed in a subfascial plane on top of the muscle through a popliteal crease skin incision.

Dr. Barry Eppley

Indianapolis, Indiana

Calf Implants Surgical Technique

Tuesday, January 26th, 2016

 

Calf augmentation can be done by two surgical methods. The most historic and reliable is the use of synthetic calf implants. A more recent but far more unpredictable technique is that of fat injections. Each calf augmentation method has its advantages and disadvantages but, like breast augmentation, fat injections are a good volume addition technique in only a very few carefully selected patients.

While calf implants are well known, the surgical method to place them is done by very few plastic surgeons. With good surgical technique, calf augmentation can be done with a good aesthetic outcome and very successful long-term results.

Calf Implant Incisions Dr Barry Eppley IndianapolisThe placement of calf implants is done from incisions behind the knees. A separate incision is need for either medial or lateral implants placed over the gastrocnemius muscles. Each incision does not need to be longer than about 3.5 cms. It should be placed directed in the visible skin crease in the popliteal fossa which is seen  even in young patients.

Calf Implant fascial incision Dr Barry Eppley IndianapolisOnce the skin incision is made, dissection is carried down through the subcutaneous fat to the the dense fascia layer over the muscle. One may encounter cutaneous sensory nerve branches at the end of the incisions and they should be preserved and pushed aside. Once the fascia is encountered it is incised at the same horizontal length as the skin incision.

Calf Implant Insertion Technique Dr Barry Eppley IndianapolisCalf Implant insertion Technique 2 Dr Barry Eppley IndianapolisA subfascial pocket is developed with special instruments that can create the dimensions needed without tearing the overlying fascial lining. It is important the the pocket not be developed too long so that the fascia is not violated at the bottom of the pocket where it gets adherent to the soleus region. Also the pocket should not be developed across the midline union of the gastrocnemius muscles to prevent implant drift. The calf implants are inserted by squeezing them through the skin and fascial incisions. The special double layer design of the calf implants (Implantech body contouring implants) allows them to be compressed and pushed through small incisions without tearing of his soft gel shape.

Calf Implant Incision Closure 2 Dr Barry Eppley IndianapolisOnce positioned into the pocket, the implant should like well below the fascial incision line. In closing the incision, the underlying fascia should not be attempted to be closed. (which often is impossible anyway) Closing the gastrocnemius fascia makes the calf area very tight and increases after surgery pain. A flap of fat should be used to cover the fascial opening. The skin is then closed in two layers with dissolvable sutures. The incision is covered by tapes and the calfs ace wrapped.

While calf implants are more invasive and involve a longer recovery than fat injections, well placed subfascial implants provide a permanent method of calf augmentation. The subfascial placement of the implants will require several weeks of recovery until one can resume full physical activities.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Intraoperative Shaping of Calf Implants

Sunday, December 27th, 2015

 

The use of calf implants to achieve improved fullness of the lower legs is the most reliable body contouring procedure of the lower legs. Calf augmentation is done for men that want to improve the overall size of their calf muscles. Women are often trying to put their calfs in better aesthetic balance to their thighs. The most common reconstructive use of calf implants is in the congenital club foot deformity to improve calf symmetry (unilateral) or have some semblence of calf muscle mass. (bilateral)

indianapolis calf implants dr barry eppleyCalf implants are made of a pliable and shapeable solid silicone material that feels a lot like muscle tissue. The implants come in three standard sizes which is defined by their length and volume of augmentation. (Implantech calf implants – 15 cms/75cc, 20cms/135cc and 24cm/185cc) The selection of calf implant size is affected by both of these considerations but one of the most important is the length of the patient’s gastrocnemius muscle.

lower leg musclesSince calf implants are placed in a subfascial location, they can not extend below the most inferior level of the gastrocnemius fascia where it meets with the soleus fascia/muscle and achilles tendon. The fascia overlying the junction of these two muscles and tendon is very tight and is easily disrupted. Trying to subfascially dissect and place calf implants that are too long will result in disruption of their fascial covering and a lower end of the implant that is in the subcutaneous location. This will result in a calf deformity and pain.

Intraoperative Calf Implant Sizing Dr Barry Eppley IndianapolisCalf Implant Size Adjustments Dr Barry Eppley IndianapolisWhen the size of the calf implant chosen is too long for the patient’s gastrocnemius muscle length, the implant can be intraoperatively trimmed. The silicone material can be easily and quickly reduced and shaped by scissors. Calf implants can be shorted and the lower end retapered. With the implant in the subfascial location, any small irregularities on the implant’s outer surface will not be seen.

I have yet to see a circumstance where the width of a calf implant needed to be reduced. But it is not rare to have to reduce the standard lengths of the medium and large calf implants to optimize the amount of calf augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Calf Implants for Inner Lower Leg Reshaping

Monday, November 17th, 2014

 

Background: One of the majn features of the lower leg is that of the calfs. The size of the calfs is due to its muscles which contribute to the shape of the leg below the knee. If they are well developed, the leg is seen as very muscular and athletic. If they are underdeveloped and very thin one can be perceived as having skinny or ‘chicken’ legs.

Gastrocnemius Muscle Augmentation by Calf Implants Dr Barry Eppley IndianapolisThe calf region is composed of the gastrocnemius muscles. It gets its name from being called the ‘stomach of the leg’ as it causes a bulge in the back part of the lower leg. It has two separate muscle bellies being a bipennate muscle known as the inner and outer heads of the gastrocnemius muscle. If one includes the deeper soleus muscle, they are a large combined superficial muscle that runs down from the knee and attaches to the heel bone through the achilles tendon.

While calf muscles can be developed through exercise alone, it can be difficult due to the tight and small muscle fibers which comprise it. Even if one can develop significant gastrocnemius muscle enlargement by fiber hypertrophy, it is not sustainable without continued weight training. In addition, some people with little calf muscle mass do not want to undergo an exercise program to try and enlarge them.

Case Study: This 40 year-old male wanted to improve the shape of his skinny lower legs. He felt he had ‘chicken legs’ and stated he was often referred to as such. He was not an exercise enthusiast and wanted calf implants. The question was whether to augment both heads of the calf muscles or just the inner head. He elected to have a single implant per leg to improve the inner leg bulge.

Calf Implant Surgical technique Dr Barry Eppley IndianapolisUnder general anesthesia in the prone position, a 3cm skin incision was made along the inner half of the popliteal skin crease. The fascia was identified and an incision made through it below the skin incision in a stair-step fashion. A long and blunt dissecting instrument was used to make a subfascial pocket over the medial gastrocnemius muscles.  Medium sized solid silicone calf implants was inserted into the subfascial pockets. The fascia and skin were closed in separate layers. An ace wrap was applied as the dressing.

Calf Implants result front view Dr Barry Eppley IndianapolisCalf Implants result back view Dr Barry Eppley IndianapolisHis recovery took a full three weeks before he could return to all activities including any form of exercise. (walking any distance and running) His legs showed greater muscle definition in the inner halfs which was particularly seen when the calf muscle was flexed (raising up on the toes)

Calf Implant results toes raised Dr Barry Eppley IndianapolisCalf implants are a very effective form of lower leg reshaping/augmentation. The inner calf bulge can be augmented by a single pair of implants while the entire calf can be circumferentially augmented by four total implants for both heads of the gastrocnemius muscles.

Case Highlights:

1) Soft silicone elastomer calf implants can create a permanent cosmetic enhancement of the gactrocnemius muscle.

2) The proper placement for a calf implant is under the fascia but on top of the muscle.

3) When placed bilaterally over the medial heads of the gastrocnemius muscles, a more shapely inner lower leg shape is obtained.

Dr. Barry Eppley

Indianapolis, Indiana

Calf Implants – Effectiveness and Complication Rates

Sunday, September 1st, 2013

 

Body implants, primarily for muscle augmentation, can be done for a variety of anatomic sites including the chest, shoulders, arms, buttock and calfs. While some of these implanted areas are new, the calfs represent one of the original types of body implants. Calf implants have been around now for several decades using a variety of silicone implant shapes.

The calfs acquire their shape by several factors including the size of the gastrocnemius and soleus muscles, the length and orientation of the crural bones, and the amount of fat between the skin and the underlying muscles. Some people have naturally thin or underdeveloped calf muscles that remain small no matter how much exercise they do. Calf implants can be used aesthetically to make the inner or outer heads of the gastrocnemius muscles appear larger by placing an implant on top of the muscle but below its investing fascia.

Calf implant surgery is fairly straightforward. The superficial anatomy of the calfs is not confounded by neurovascular structures nor being deeply embedded beneath a lot of tissues. The incision(s) are behind the knees, the entrance through the fascia of the gastrocnemius muscles is fairly easy to find, the subfascial plane is developed with long instruments, the chosen implant is slid into place and the incision is closed in multiple layers. Within an hour the calfs of both legs can be augmented.

With the relatively long history of calf augmentation, even though it is not commonly done, the success of the procedure and the incidence of complications should be well known. Two recently published articles chronicled significant calf augmentation experiences.

In the April 2012 issue of Aesthetic Plastic Surgery, an article entitled ‘ Bilateral Calf Augmentation for Aesthetic Purposes’ was published. Calf implants were placed in 53 patients (40 women and 13 men, 106 implants) over a three year period and followed for an at least one year. Smooth silicone elastomer implants were used. The implant sizes were 125cc in 37 bilateral cases, 70cc implants in 10 cases and 175cc in 6 cases. No infections or hematomas occurred. Three seromas developed. (3%) Four cases of hypertrophic scars (4%) were seen. One patient (1%) wanted the implants were removed. No case of compartment syndrome or deep vein thrombosis was seen.  Implant displacement or rotation did not occur. From an aesthetic standpoint, 73% of the patients were completely satisfied and 19% were mainly satisfied. Only 8% of the patients felt that the appearance was not what they wanted.

In the June 2013 issue of the American Journal of Cosmetic Surgery, a published paper entitled ‘Calf Augmentation: A Single Institution Review of Over 200 Cases’ appeared. Over a five year period, a total of 202 calf augmentations were performed using semirigid silicone elastomer implants. They reported a satisfaction rate of 92% (186/202) Dissatisfactions were related to the amount of augmentation achieved or by hypertrophy of the knee scars.

Of all the locations for body augmentation, the calfs represent the ‘simplest’ location for the placement of implants based on the anatomy of the area. These two clinical studies demonstrate that the overall satisfaction rate is high and the complication rate fairly low. To put this in perspective, compare calf implant complication rates to that of breast implants and it is actually far less. The recovery is actually more difficult as it affects walking, as breast implants obviously do not, but the risk of potential complications appears to be much lower.

Dissatisfaction with calf implants largely resolves around the amount of augmentation obtained. Any patient’s interpretation of calf size is obviously subjective but there are limits to the size of calf implants that can be safely placed. The range of calf implant volumes is always less than 200cc, usually being between 70cc and 170cc with 125cc being the most common size calf implant placed in my practice. Larger implants, particularly if both muscle heads are implanted in each leg, raises concerns about the potential for a compartment syndrome or deep vein thrombosis (DVT) after implantation due to the compression of the deeper vessels. At the least over sizing implants in the calfs makes for a more uncomfortable and prolonged walking recovery.

Now that fat injections are becoming a standard option in plastic surgery for soft tissue augmentation, how well a synthetic implant performs by comparison is important to know. Implants offer an effective and low risk option for calf augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Instructions for Calf Implants

Saturday, August 17th, 2013

 

Implants for calf augmentation are surgically placed by incisions behind the knee. Very soft solid silicone implants are inserted under the fascia and on top of the gastrocnemius muscle. Either the inner half of the muscle (two implants) or both halfs of the paired gastrocnemius muscle (four implants) can be augmented.

The following are the typical instructions for calf implant augmentation:

1. On discharge from the surgery center, go home directly to bed for the night. Get up only to go to the bathroom and keep the legs elevated as much as possible.

2. Calf implants are associated with a moderate amount of pain in the first few days after surgery.  Narcotic pain medications are almost always needed and you should them as prescribed. In a few days or by a week after surgery, you may switch to Ibuprofen completely or alternate between doses with the narcotic medication.

3.  There will be ace wraps placed around the calfs after surgery. This is in place for comfort only and does not play a role in maintaining the position of the implants. You may take these off the next day and they do not need to be put back on unless they feel better if they are worn.

4.  The incisions behind the knees are covered with glued on tapes. This may be allowed to get wet while showering. They will be removed during your first postoperative visit. The sutures in the incisions are under the skin and do not need to be removed.

5. Swelling and tightness of the calfs is common and peaks by two to three days after surgery. Conversely, bruising is uncommon although possible.

6. You can’t walk around a lot nor walk up stairs at first when you have this type of implant. You MUST limit your walking or risk infection. You should also 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.

7. It may be helpful to wear hoes with 1 – 2” heels after surgery and for several weeks thereafter. This will cause the calf muscles to not be under too much stretch and the discomfort will be less.

8. Do not expose the calf or scars to the sun or tanning bed for at least 2 -3 weeks after the surgery as severe burns can occur from minimal exposure. Scars must be covered when exposed to sun or the tanning bed (so as not to hyperpigment) until all redness is gone which takes 3 to 6 months. You may use tanning creams.

9. The incision behind the knee will heal in about 10 days. However, it will remain red for up to 6 months until its color eventually fades and blends in better with the surrounding skin. A small fine-line scar will remain. The area surrounding the implants, however, will take about 6 weeks to fully heal. Therefore, you need to be careful with activities to avoid potential problems. Most complications occur in men who do not follow instructions well and insist on returning to work or the gym too early. This can result in hematoma (bleeding), excess swelling, or other problems.

10.  If any redness, tenderness, or drainage develops on the chest or from the armpit incisions after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery – Calf Implants

Saturday, August 17th, 2013

 

These explanations are intended to improve your understanding of the calf implant procedure. Please read them carefully and understand that this list includes many, but not all of the different outcomes from surgery. Please feel free to ask Dr. Eppley any further questions regarding your surgery.

ALTERNATIVES 

The alternative to implants for calf augmentation are strenuous exercise/weight training (non-surgical) and fat injections. (surgical)Fat injections are the most commonly used alternative augmentation technique.

GOALS

The goal of calf implants is to increase the size and shape of the gastrocnemius muscle by creating the appearance of increased muscle mass by placing an implant on top of the muscle under the fascia. This could be done for either the inner half of the calf muscle (medial belly of the gastrocnemius muscle), the outer half of the calf muscle (lateral head of the gastrocnemius muscle) or both.

LIMITATIONS

The limitations to calf augmentation is the tightness of the surrounding skin of the calfs and how much the skin can stretch. This ultimately determines the size of implants that can be placed and whether one or two implants are placed per leg.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and possible bruising of the calfs, a temporary firmness/hardness of the calfs, mild to moderate discomfort of the calfs and temporary redness of the behind the knee incision line/scar. It will take four to six weeks before the final shape and appearance of the calfs can be completely appreciated.

RISKS

Complications may include bleeding, infection, dehiscence of the incisional closure (partial or complete separation), prominent or noticeable knee scars, calf implant asymmetry, and too big or too small of a calf size increase result.

ADDITIONAL SURGERY

How the implanted site heals and the occurrence of complications can influence the final shape and appearance of the calfs. Should complications or the desire to enhance the result further by additional surgery be needed, this will generate additional costs.

Case Study: Calf Implants in Bilateral Clubfeet

Saturday, August 3rd, 2013

 

Background: Calf augmentation using either a synthetic implant or fat injections is a well known surgical procedure to increase the prominence of the calf muscle. While many people think of the typical calf augmentation patient as a body builder or an athlete, aesthetic enhancement of normal calf muscles is only one reason to have the procedure. The other reason calf implants are done is for congenital deformities or obvious developmental asymmetries. Such deformities can include club foot, spina bifida and even polio.

Clubfoot is a well recognized lower leg deformity which is reported to be the most common birth defect. Medically known as congenital talipes equinovarus, the involved foot looks like it has been turned inward at the ankle. It occurs half the time in both feet at birth and more frequently in males. The calf (gastrocnemius) muscle is always smaller on the affected foot. Besides the issue of less functional use, studies have shown that the smaller size of the gastrocnemius muscle is due to wasting of the calf muscle from a reduction in the number of muscle fibers rather than their size.

When occurring on one side, clubfeet patients have a much smaller muscle than on the normal leg. When occurring in both feet, the calfs (as well as the entire leg) can be extremely thin. The calf muscle is so atrophic that there is a straight line from the inner knee straight down to the ankle without the usual calf muscle bulge seen in the frontal view. This is a source of embarrassment for many patients and will often prevent them from wearing shorts or otherwise exposing their calfs in public.

Case Study: This 23 year-old male was born with bilateral clubfeet and had been through many years of physical therapy, splints and achilles release surgery. He had thin upper thighs and very thin calfs that tapered inward from below the knee to the ankle. His skin was very tight around his calfs. While he ideally could have aesthetically benefited by both medial and lateral calf implants for both legs, the tightness of his tissues made that consideration too risky for fear of a compartment syndrome after surgery.

Under general anesthesia in the prone position, 3.5 cms long incisions were made in skin creases behind the knees at the inner half. Dissection was carried down to the muscle fascia where, in a stairstep fashion, fascial incisions were made well below the level of the skin incisions. An instrument dissected out a subfascial plane over the medial gastrocnemius muscle where solid soft silicone elastomer calf implants (15cm long x 5 cm wide, 135cc volume) were placed. the fascia and skin were closed in separate layers. He was dressed with tapes for his incisions and ace wraps for his calfs. The procedure was completed in one hour.

He rested his legs for the first few days, keeping his legs elevated. His recovery occurred over the next 3 weeks during which the calf muscles became used to having an implant sitting on top of it and the overlying skin stretched a bit. Returning to normal walking gradually occurred although a bit slower in the club foot patient who already had comfortable walking issues beforehand. His results showed a visible enlargement in his inner calf size that was proportionate to his thighs.

Calf implants in the clubfoot patient provide an immediate improvement in calf size. Fat injections are often not an option if they do not have any significant amount of fat to harvest in thinner patients. It is tempting to use larger sizes of calf implant or even two implants per leg but the tightness of the surrounding skin makes this a more risky approach in the patient with an atrophic overall calf. A larger size or an additional implant can be placed at a later date if desired.

Case Highlights:

1) For the clubfoot patient, calf augmentation with implants can provide a immediate and visible change in atrophic calf size.

2) Calf implants are placed on top of the muscle under the fascia in the inner calf muscle to get the most visible effect.

3) Calf implant augmentation is a very straightforward procedure that is accompanied by a longer recovery than the simplicity of the operation would suggest due to lower extremity dependency and function.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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