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The most common lower extremity body contouring implant is that of the calfs. Both the inner and outer head of the gastrocnemius muscles can be augmented through incisions placed behind the knee. But there are other leg implants that can be done above the knee in the anterolateral thighs. Thigh or quad implants are available which provide augmentation to the rectus femoris and the vastus lateralis which are the two largest of the anterior quad muscles.

But other quad muscles can be augmented including the vastus medalis whose prominence is greatest just above the inner knee. It is the most medial of the quad muscles which originates along the length of the femur and inserts into the quadriceps tendon of the knee. By its origin and insertion its role is to help with knee extension. When it comes to augmentation of the muscle it is the most distal part near the knee that is enhanced which has been anatomically identified as the obliques genus section of the muscle. It is almost also part of an overall quad augmentation including the larger rectus femoris-vastus lateralis muscle group.

The vastus medialis quad implant is placed through a 3.5cm skin incision placed in the suprapatellar skin crease where it can heal in the most scarless manner. The muscle fascia is identified and the subfascial pocket created by blunt dissectors. This is a fairly bloodless dissection plane.

The implant to use has to be chosen from what is commercially available from other implant sites. (e.g.,) Calf implants can be custom carved to achieve the implant size and shape needed. The tail or feather edge of the implant extends superiorly while the fullest part of the implant is near the knee/next to the incision. After insertion of the implant the fascia, dermis and skin is closed. No drain is needed.

When combined with larger anterolateral thigh implants the upper leg can achieve a fuller and more muscular appearance. It can be done alone if one has adequate quad musculature above it.

Dr. Barry Eppley

Indianapolis, Indiana

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