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Archive for the ‘calf implants’ Category

Long-Term Results in Calf Implants

Sunday, November 19th, 2017

 

Calf augmentation is most commonly done with implants. There are a variety of reasons patients pursue augmenting the gastrocnemius muscle from congenitally thin legs, muscle atrophy due to disease or trauma and the desire for larger calfs that exercise and effort alone can not easily achieve.

While injection fat grafting is another option for larger appearing calfs, its volume retention is not assured unlike that of calf implants. Placing an implant underneath the investing crural fascia of the muscle has been done for decades and offers a better aesthetic result with less complications than a subcutaneous implant location would.

But despite the success of calf augmentation with proper surgical technique, it is not commonly performed by most plastic surgeons. This is undoubtably because it is infrequently requested and, as a result, it is very hard for a surgeon to develop much experience with this type of body implant surgery.

In the October 2017 issue of the Aesthetic Surgery Journal, an article entitled ‘Calf Augmentation and Restoration: Long-Term Results and the Review of the Reported Complications’. The authors reviewed their 25 year experience with calf implant augmentation in 50 patients. (60 calfs) Indications were aesthetic in 23 patients, six were bodybuilders, and 21 underwent lower leg reconstruction because of deformity caused by illness. Their results based on surgeon evaluation had good to excellent results obtained in 30 out of 37 implanted patients. (81%) Patients rated their results as acceptable to good in 35 out of 37 patients. One very serious complication occurred in a bodybuilder who developed compartment syndrome in one leg leading to the necrosis of muscles. The authors report other complications as minor and manageable.

This series of calf implants shows that it can be a successful and low complication body contouring procedure. From a medical complication standpoint, infection is always a risk with an implant but that appears to be fairly low in a pocket that is partially lined may muscle. The devastating complication of compartment syndrome has rarely been reported but it is easy to see how it is possible…the use of four implants (two in each leg, medial and lateral muscle bellies) on top of already large calf muscles. This can potentially impair arterial inflow and one must always be on guard for its prevention.

Dr. Barry Eppley

Indianapolis, Indiana

Subfascial Calf Augmentation

Thursday, March 16th, 2017

 

Calf augmentation is one of the most infrequently performed of all body contouring procedures. Part of the reason for its low rate of performance is patient demand. The other reason is that most plastic surgeons are uncomfortable performing the procedure having never seen it done or been trained to do it.

The widespread use of fat grafting has increased the number of calf augmentation being performed. This is a much simpler method that requires no surgical method and avoids the use of an implant. But is far from reliable in creating assured volume and in many calf augmentation patients is not an option due to lack of adequate fat donor sites or tight calf tissues.

In the March 2017 issue of the journal Plastic and Reconstructive Surgery an article was published entitled ‘Safety and Efficacy of Subfascial Calf Augmentation’. In this paper the authors review their 12 year experience with 134 cases of either primary or revisional calf implant surgery. In all primary cases they performed a subfascial implant placement technique. In revisional cases injectable fat grafting and/or implant repositioning was done. The authors conclude that the placement of calf implants is a safe and easy procedure to perform, has a rapid recovery period and a low complication rate. (< 1%)

Of the three possible calf implant tissue locations (subcutaneous, subfascial and intramuscular, the subfascial is the best. While originally described in its introduction back in the late 1970s  as an intramuscular technique, the risk of nerve injury and the induced muscle trauma favors a more superficial location. While a subcutaneous pocket dissection is very easy it is prone to visible encapsulation and implant show. The subfascial location offers good implant coverage, a lower risk on capsular contracture and  a more natural appearance.

While subfascial calf implant placement is preferred, there are several important technical maneuvers to have an uncomplicated outcome. The incisional access must be in a popliteal skin crease and be fairly small in length. Once past the incision the actual fascia covering the calf muscles is lower than one would initially think. The fascia immediately beneath the incision is that of the hamstring tendons. On the inner knee these are the semimembranous and semitendinous tendons. On the outer knee it is the biceps femoris tendons. One must go past these tendons and look lower for  calf muscle fascia.

calf implant muscle anatomyThe subfascial dissection should be carried out with a flat broad instrument that is long enough to reach calf muscle-soleus junction which is located at the midway point between the knee and the ankle. Here the fascia becomes adherent and the implant can not extend below this level. If the fascia is inadvertently perforated here and the implant is placed in a combined subfascial/subcutaneous location it will cause persistent postoperative discomfort.

Calf Implant Incision Dr Barry Eppley IndianapolisCalf implant insertion technique Dr Barry Eppley IndianapolisThe remaining key is the calf implant itself. Besides having the right shape and length, it needs to be made of an ultrasoft solid silicone material that has an outer shell layer on it. (Implantech) This allows the implant to be inserted through a small incision without tearing of the implant. Soft silicone calf implants without this coating are prone to tearing or fracture during insertion potentially leading to long-term tissue reactions.

Dr. Barry Eppley

Indianapolis, Indian

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.


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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