Background: In reduction of the large calf the two standard techniques are liposuction and calf muscle reduction. Both are very effective when the calf hypertrophy is caused by large calf muscle (muscle reduction) or there is a normal muscle size with a thick subcutaneous fat layer over it. (liposuction) The success of both of these large calf treatments are based on having reasonably taut skin over them and around the lower leg.
But when you combine a thick fat layer with loose and irregular skin, which is best appreciated when the calf jiggles when walking, liposuction produces a less than satisfactory result. Such dysmorphic skin has a limited ability to shrink down after fat removal alone. This calf problem is not unlike that of the upper arms where such soft tissue sag is more obvious because of its inferior dependent position with the arm raised. (bat wings)
Unlike the arms and upper legs (thighs), however, there is no described method of skin and fat removal in the lower legs. Not that it can not be done but it is more a matter of having the right patient who is willing to trade off a visible longitudinal scar on the leg. But like an arm lift it can be hidden by full extremity coverage (pants) and but not by partial extremity coverage. (shorts)
Case Study: This female had been through numerous prior reductive body contouring procedures for a large amount of weight loss. (arm lifts, circumferential body lift, knee lifts) As a resul she was very familiar with the scar tradeoffs. Her current concern was her large calfs which felt heavy and jiggled when she walked. She was an avid golfer and was bothered by the weight and feel of her lower legs.
The difference in the calf shape could be seen after the left calf was excised and closed first. Drains were not used and a restorable two layer suture closure was done.
When seen one week after the surgery the degree of improvement in her calf size could be seen with the elimination of any jiggling. The long term outcome of the scar remains to be seen but it was never any concern for her initially.
Case Highlights:
1) Large calfs that do not respond well to liposuction or are not good candidates for liposuction can be treated by a vertical calf reduction through a posterior approach.
2) A large vertical elliptical excision of skin and fat on the back of the calfs can create a significantly improved calf shape that feels tighter with a significant scar tradeoff.
3) The only neurovascular structure of significance to avoid in vertical calf reductions is the sural nerve seen in the lower half of the calf at the muscle fascial level.
Dr. Barry Eppley
Indianapolis, Indiana