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Background: Augmentation of the legs is traditionally done by calf implants. They are the only FDA-approved standard leg implants that have existed…and will likely ever be. But that does not mean that other leg muscles can not be augmented but they have to be done on an individual custom designed basis.

The lessons learned from calf implants is that a long longitudinal muscle belly can be augmented with a subfascial pocket. subfascial. The implant must be longer than it is wide. A superior incisional approach is used with the need for long dissection tools.

When applied to the upper legs the most prominent of the four anterior quad muscles are the rectus femoris and vastus lateralis. The bigger (wider) of the two is the rectus femoris which often has a split appearance. The vastus laterals is just as long but not as wide as the rectus femoris. Both can be concurrently augmented with one implant using a single incision. 

Case Study: This older male had calf implants placed which healed uneventfully. But augmenting the lower legs then made his upper legs look disproportionately too small. Computer imaging showed the effect that thigh augmentation would have on making his upper legs look more in balance with the lower legs.

Custom thigh implants were designed in dimensions to cover the anterolateral surface area of the rectus femoris and vastus laterals muscle areas. This covered a 26cm long and 12 cm wide footprint area. 

The implants were designed with maximal 1.5cm thickness. In surgery multiple perfusion holes were placed through the implants using a 5mm dermal punch.

Under general anesthesia a curved upper leg incision was made of 5 cms in length. A subfascial pocket was developed with long instruments into which the implants were placed. A small inferior incision was needed to get the thin lower edge of the implant to completely unfurl and lay properly. Drains were not used. Subcuticular closures were done on the skin incisions. Ace wraps were placed for circumferential dressings.

All thigh implants have to be made custom since no such standard upper leg implants exist. They are the longest cosmetic body implants that can be placed although not the largest by volume. They can be made either as a smooth implant with no visible separation between the two muscle bellies or a groove can be made lower to see two separate muscle bellies. Thigh implants can also be augmented with vastus medialis medial thigh implants as well if desired.  

Case Highlights:

1) Calf implants are very effective at enlarging the lower leg below the knee but can make the upper legs (thighs) disproportionate in some patients.

2) Thigh implants are designed to augment the two largest quad muscles, the rectus femoris and the vastus lateralis.

3) Subfascial placement of thigh implants are done through a small upper leg incision.

Dr. Barry Eppley

Indianapolis, Indiana

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