Calf Augmentation Research Articles

Calf Augmentation and Volumetric Restoration: A Systematic Review and Meta-analysis

PURPOSE: According to the American Society of Plastic Surgery (ASPS) National Clearinghouse of Procedural Statistics, 655 documented calf augmentation cases were reported during 2018 in the United States, representing a 27.43% increase from 2015. Due to the recent attention that has been brought to the aesthetics of the leg, outcomes in the literature are underreported and require further investigation. We summarized the available evidence on the surgical techniques to augment the volume and dimension of the calf based on clinical outcomes and satisfaction rates METHODS: An electronic search was conducted across PubMed MEDLINE, Web of Science, Scopus, and Ovid MEDLINER(R) in accordance with the PRISMA statement. Data collection included the patients’ characteristics, surgical techniques, and postoperative outcomes. Satisfaction among patients was determined when satisfaction was stated above a numeric threshold in a score or when a patient was explicitly reported to be ‘satisfied’. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model. RESULTS: Forty-eight studies were included in the systematic review. We included 2455 patients. 508 were males (20.7%) while 1176 were females (47.9%). The average age and follow-up were 33.15 years and 33.58 months, respectively. Unilateral calf augmentation was reported in 446 patients (18.16%), while 1565 patients (63.74%) received a bilateral calf augmentation. The indications for calf augmentation were aesthetic concerns in 1196 patients (48.7%) and reconstructive in 558 patients (22.7%). The most common technique for calf augmentation was subfascial implant placement (70.2%) followed by fat transfer (17.6%), submuscular implant placement (10.1%), fasciotomy only (1.71%), reconstruction with free flaps (0.12%), dermal-fat graft (0.04%), subcutaneous implant placement (0.08%) and non-specific implant (0.04%). Overall, the pooled satisfaction rate following calf augmentation was 95.4% (95%CI 93.7%- 97%). The pooled satisfaction rate for implant placement and fat transfer was 96.7% (95%CI 94.4%-97.9%) and 87.2% (95%CI 78.5%-96%), respectively. The most common complications following subfascial implant placement were seroma formation (3.83%), hyperpigmentation or hypertrophic scar formation (2.9%), and pain or discomfort (2.14%). The most common complications after lipotransfer were asymmetry or contour irregularities (4.16%) and pain or discomfort (2.54%). The pooled incidence of implant removal was 1.3% (95%CI 0.7%-2%). The pooled estimate for additional fat grafting procedures following initial fat transfer was 54.1% (95%CI 38.3%-70%). From the patients who underwent reconstruction with a free flap, one patient required the revision of the anastomosis (33.33%) and one had significant blood loss (33.33%). CONCLUSION: Overall, calf augmentation is a safe procedure. Subfascial placement of the implant was the most common technique as it is less invasive and reproducible. However, the rate of minor and major complications may be higher in comparison to other procedures. Fat grafting can be used to improve the outcomes following implant placement. When fat grafting is implemented as a single surgical modality the volumetric expansion is modest versus implant placement, and further fat grafting is required in almost half of cases to achieve satisfactory outcomes.

A New Technique for Remodelling and Increasing the Diameter of the Legs through Lipotransfer and Vertical Subcutaneous Fasciotomy of the Posterior Tibial Aponeurosis.

To describe a new technique for performing thigh and calf augmentation and remodelling through thigh lipotransfer, subcutaneous vertical fasciotomy and leg lipotransfer. Patients with thin legs due to hypotrophy or hypoplasia of the medial portion of the thighs and legs as well as a patient with a prominent tibialis anterior giving the appearance of male legs were selected. A total of 214 surgeries were performed in 107 patients with minimal complications, and most patients reported a high rate of satisfaction. Lipotransfer with fasciotomy improves the standard results of liposculpture in body contour management, which allows balanced relationships among the waist, hips, thighs and legs to be achieved in many patients who are not candidates for the placement of silicone prostheses because their legs and thighs are thin and hypotrophic. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Commentary on: Safe Composite Calf Augmentation: A Staged Procedure.

Commentary on: Safe Composite Calf Augmentation: A Staged Procedure.

Safe Composite Calf Augmentation: A Staged Procedure.

Calf augmentation can be achieved by fat grafting, calf implants, or a combination of both methods (composite augmentation). For safety reasons, it is important to be aware of important calf anatomic features, specific physiologic considerations, and some health conditions that can hinder the outcome of these procedures. The aim of this study was to present our experience with performing composite calf augmentation, and to describe indications, surgical techniques and safety issues. We retrospectively analyzed 63 patients who had undergone composite calf augmentation for cosmetic and reconstructive surgery in our practice. We reviewed group demographics, complications, and results, and identified all the pitfalls encountered in our cases. Additionally, dissection of the calf regions in fresh cadavers was performed to obtain more accurate anatomy. We also measured intracompartmental pressures before and after calf augmentation with implants in 6 cases to determine pressure changes. All cases received subfascial implant insertion and fat grafting as a delayed procedure. If there is a need for multiple implants, we recommend a staged procedure. Our study showed high muscle sensitivity to pressure increase after augmentation. Hence, from the standpoint of safety, we advocate subcutaneous fat grafting only. No patients developed compartment syndrome. Composite calf augmentation surgery is safe and easy to reproduce, with a short recovery period and a low complication rate when done as a staged procedure and respecting specific anatomic and physiologic calf features.

Surgical Calf Augmentation Techniques: Personal Experience, Literature Review and Analysis of Complications.

More attention is paid to calf appearance, both in males and females, and several surgical techniques are available. Different studies have been published over time for calf augmentation, but, to the best of our knowledge, no comprehensive literature review and complications analysis have been published. The aim of the study is to analyse the overall complication rate of calf augmentation surgical procedures and complication rates associated with the investigated techniques, namely subfascial implant placement, submuscular implant placement and fat grafting or lipofilling. Demographic analysis, including age and gender, is also performed. A literature review on the PubMed database was performed for clinical studies regarding calf augmentation surgical procedures. The authors selected and analysed 26 articles among the actual literature on this field and reported personal experience in calf augmentation surgery. Twenty-six studies, published from 1993 to 2018, were included in the study for a total amount of 1498 patients, with a total of 2629 calves treated. Three different surgical techniques have been reviewed, excluding medical procedures: subfascial implant augmentation (n = 1929), submuscular implant augmentation (n = 435) and fat grafting (n = 265). The overall complication rate was 4.4883%. Calf augmentation with subfascial implants presented a total complication rate of 5.702%. The submuscular implant placement complication rate was 0.92%. Fat grafting presented a global complication rate of 1.509%. Calf augmentation, with all reviewed surgical techniques, has a low rate of complications compared to other body contouring procedures, but a high rate of satisfaction among patients. Fat grafting has the lowest rate of complications, but multiple sessions are required. Specific complications of implants, such as capsular contracture, malposition or rupture, are less common compared to the use of implants for other cosmetic purposes. Procedures should always be performed by experienced plastic surgeons. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ПЛАСТИКА ГОЛЕНЕЙ ИМПЛАНТАТАМИ: ПОВТОРНЫЕ ОПЕРАЦИИ

Calf augmentation is a quite popular surgery in Russia. However, there is insufficient data on complications after the implants’ installation, its analysis is missing, and methods for correction and prevention of complications are not developed. The author has the experience of 53 re-surgeries after calf plasty with implants. The incorrect selection of implants was the cause of correction in 36 patients, the surgeon’s errors in their installation — in 7, the implant displacement — in 4, and its contouring — in 6 women. The analysis of each group of complications was performed. The author considers the installation of implants under the medial head of the gastrocnemius muscle as the method of choice for secondary surgery, which prevents implant displacement and isolates it from the previously formed cavity. The result of the correction directly depends on the proper selection of implants. The author recommends using his own method of implant selection, considering the length of the gastrocnemius muscle and the harmony of the leg contour. Sufficient knowledge of the anatomy of the lower leg is necessary to eliminate technical errors. Implant visualization after calf augmentation for aesthetic reasons was observed in 26 out of 561 cases, and in 3 of those cases an implant replacement surgery was required. To a large extent, contouring of the implant is observed due to its design. The advantage of custom-made implants of improved shape is shown.

Analysis and Interpretation of Google Trends Data on Public Interest in Cosmetic Body Procedures.

Several online resources such as Google Trends (GT) enable plastic surgeons to track search volume trends for cosmetic procedures. Understanding these data may allow surgeons to better anticipate patients' interests and meet their needs. The authors sought to evaluate the correlation between GT search volumes and annual surgery volumes. Search terms were generated using the "related queries" feature of GT. Data were obtained for the terms breast augmentation, buttock augmentation, buttock implants, buttock lift, calf augmentation, liposuction, lower body lift, thighplasty, abdominoplasty, and brachioplasty from January 2004 to November 2017. Annual volumes for respective procedures were obtained from statistics reports of the American Society of Plastic Surgeons (ASPS) from 2006 to 2017 and American Society of Aesthetic Plastic Surgery (ASAPS) from 2004 to 2017. Correlations were evaluated applying univariate linear regression of GT data to both ASPS and ASAPS data. Geographical and temporal variations in search volume were detected during the study. Search volume trends that correlated significantly with both ASPS and ASAPS surgery volume trends were: "butt implants surgery" (ASPS: R2 = 0.366, P = 0.049; ASAPS: R2 = 0.380, P = 0.019); "liposuction" (ASPS: R2 = 0.690, P = 0.002; ASAPS: R2 = 0.578, P = 0.002); and "liposuction surgery" (ASPS: R2 = 0.672, P = 0.002; ASAPS: R2 = 0.476, P = 0.006). Several search terms demonstrated no significant relationships, negative correlations, or were significant with only one database. This study characterizes GT as a convenient and informative data set for plastic surgeons to analyze patient interest in cosmetic body-sculpting procedures. GT represents a useful instrument for tailoring marketing strategies and addressing the needs of our patient population.

Aesthetic Improvement of Undeveloped Calves After Treatment of Congenital Clubfoot Deformity.

Even when clubfoot deformity is treated in a timely manner, the consequences observed in adulthood include hypoplasia of the calf muscles, gait impairment, decreases in foot size, and it can also affect the tibial length. These consequences may have negative impacts on the patient's subjective appraisal of long-term outcomes, and can influence the patient's self-esteem in both male and female patients. We present our experience in the treatment of undeveloped calves after surgical treatment of congenital clubfoot. In total, 72 patients underwent corrective surgery in order to improve undeveloped calves resulting from a congenital clubfoot deformity. We used calf silicone implants in combination with fat grafting in multistaged procedures, in order to decrease complication rates and improve aesthetic outcome. Amongst our patients there were 54 (75%) females and 18 (25%) males. All of the patients, except one, had unilateral calf hypoplasia. The procedures were divided into several groups: (1) medial calf augmentation with silicone implants; (2) medial calf augmentation with silicone implants and fat grafting; and (3) medial and lateral calf augmentation with silicone implants and fat grafting. We had one case of a hyperpigmented scar and one case of partial scar dehiscence. There were no cases of compartment syndrome. The average follow-up period was 9.8 months. Calf enhancement surgery in patients with congenital clubfoot deformity is very gratifying. When combining calf implants with fat grafting in multistaged procedures, we can achieve excellent results with low complication rates.

CHANGE OF PRESSURE INSIDE THE SUPERFICIAL POSTERIOR MUSCULAR-FASCIAL COMPARTMENT OF THE LEG AFTER CALF AUGMENTATION WITH GEL-FILLED SILICONE IMPLANTS

Purpose: The purpose of the study was to examine the degree of tissue compression and evaluate the safety of installation of a volume gel-filled implant inside the superficial posterior muscular-fascial compartment of the legs. Materials and methods: The author conducted a direct measurement of the pressure inside the superficial posterior muscular-fascial compartment of the legs in five patients (10 calves) before the surgery and immediately after installation of gel-filled silicone implants inside the superficial posterior compartment of the legs with an average volume of 85-140 ml. Results and conclusions: The pressure measured by the proposed method inside the superficial posterior muscular-fascial compartment of the legs before the surgery was on average 2,1 ± 0,4 mm Hg, after implants installation - 8,9 ± 0,9 mm Hg. The result obtained is significantly lower than the critical intra-compartmental pressure, which indicates the safety of calf augmentation by insertion of implant inside the superficial posterior muscular-fascial compartment.

Calf Augmentation and Restoration: Long-Term Results and the Review of the Reported Complications.

Augmentation or reconstruction of the calves is indicated in patients with thin legs, for bodybuilders, or when there is a defect after an injury or illness. The principle of placing implants under the investing crural fascia was worked out in the 1980s. The senior author (I.N.) introduced many technical modifications and improvements for this operation, among them the new instrument, an inserter for the calf implants. Presented patient material is unique in that the more challenging reconstructive cases almost equal the numbers of the aesthetic cases. During the years 1991 through 2016, 50 patients underwent 60 calf contour corrections. Indications were aesthetic in 23 patients, six were bodybuilders, and 21 underwent lower leg reconstruction because of deformity caused by illness. According to evaluation by the surgeon, excellent-to-good results were obtained in 30 out of 37 followed patients. Patients rated their results as very good (18), good (10), acceptable (7) and bad (2). One 28-year-old professional bodybuilder sustained acute anterior compartment syndrome in one leg. Implants were removed 16h after surgery, but he developed ischaemia in the anterior compartment leading to the necrosis of muscles. After several surgical operations, including microsurgical transfer of the innervated central caput of the quadriceps femoris muscle, he could resume his bodybuilding activities. Other complications were minor and manageable. Calf augmentation, performed properly, has evolved to be a safe, efficient and aesthetically pleasing operation. The possibility of acute compartment syndrome should be kept in mind. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Calf Augmentation and Reshaping with Autologous Fat Grafting.

Despite multiple advantages of fat grafting for calf augmentation and re-shaping over traditional silicone calf implants, few reports have been published. To report our technique and results with autologous fat grafting for calf augmentation and reshaping. A retrospective review of the senior author's (JEV) experience with autologous fat grafting for calf augmentation was performed. Medial and lateral calf augmentation was accomplished with injection of prepared autologous lipoaspirate intramuscularly and subcutaneously. Over a 5-year period, 13 patients underwent calf augmentation and reshaping with the described technique. Ten cases were bilateral (77%), and 3 cases (23%) were performed for congenital leg discrepancies. Mean 157 cc of prepared lipoaspirate was transferred per leg, with roughly 60% and 40% transferred into the medial and lateral calf, respectively. Four patients (31%) underwent a second round of autologous fat injection for further calf augmentation because they desired more volume. At mean 19.6 month follow-up, durable augmentation and improvement in calf contour was documented by comparison of standardized preoperative and postoperative photographs. Autologous calf fat grafting is a viable alternative to traditional implant-based calf augmentation for congenital calf discrepancies and the aesthetic pseudo-varus deformity. This technique provides results comparable to those obtainable with traditional methods. LEVEL OF EVIDENCE 4: Therapeutic.

Capsular Contracture after Calf Augmentation with Silicone Implant Insertion.

Capsular Contracture after Calf Augmentation with Silicone Implant Insertion.

Preoperative Color Duplex Echographical Venous Mapping Before Autologous Fat Graft for Calf Augmentation

Autologous fat grafting for calf augmentation is considered an easy and safe technique. Only few cases of potential complications have been described in literature; among them, vein thrombosis was never reported. We report a case of superficial vein thrombosis of the intersaphenic anastomosis after fat graft for calf symmetrization in club-foot syndrome. A color duplex echographical study showed that such intersaphenic anastomoses are present in all patients, but they have an ectatic diameter in 70% of patients with great saphenous vein insufficiency and in 50% of patients without insufficiency. The plastic surgeon should be aware of the presence and topography of such anatomical variations before performing the procedure. Moreover, a preoperative color duplex echographical venous mapping may help the surgeon in avoiding the trauma on vein variants and subsequent complications.

Hyaluronic acid in calves defects correction

Aim: Since the advent of fillers, new techniques are continuously developed for different uses. In this study, we evaluated the use of hyaluronic acid for calf augmentation. Methods: A total of 42 patients were enrolled in this study. All of them underwent augmentation procedure in our centers under local anesthesia, the operations were completed within 1 h with a prompt correction of the defects. Results: Thirty-nine patients were satisfied with the treatment (93%), while three had complications, local infection, and lumps, that were resolved quickly (7%). Conclusion: Macrofillers can be injected into the calf to correct any defects. The advantages include short duration of treatment; the procedure performed under local anesthesia and limited side-effects that resolve promptly. This study suggests the use of biocompatible macrofillers for the augmentation of not only calves, but also for augmentation of breast and buttocks.

Calf contouring with endoscopic fascial release, calf implant, and structural fat grafting.

Background:Curved lower legs cause psychological stress for women. In evaluating the shape, if thickness is the main contributing factor of leg aesthetic, then lipoplasty or calf reducing procedures will be the option. If the legs are slender and have no muscle hypertrophy but still have some indentation or bulges on both sides and lack an aesthetic shape what will be the options? The answer to the question is discussed in detail in this article.Methods:Twenty-two patients, operated over a period of 5 years from 2007 to 2012, were included in the study. A novel technique has been introduced. This method requires release of fascia covering muscles of the inner leg bulge via endoscopic approach and simultaneous calf augmentation with calf implant, liposuction, and structural fat grafting to optimize the results.Results:Patients were followed on a regular basis with a mean follow-up of 31 months. The procedure was well tolerated with minimal discomfort during the postoperative period. Increase in diameter of proximal and distal lower legs was measured at least 6 months after surgery. Mean diameter change of proximal lower legs was 2.16 cm and 1.77 cm in distal lower legs.Conclusions:A novel endoscopic approach for lower leg contouring is discussed. Endoscopic fasciotomy technique with calf implant and structural fat grafting for improved lower leg aesthetics is a simple, effective, reliable, and predictable technique for calf contouring.

Calf Augmentation: A Single Institution Review of over 200 Cases

Introduction: Over the past several decades, there has been increased interest in creating a fuller-appearing and more well-defined calf region. The primary method for augmentation is use of a semirigid silicone prosthesis as it produces reliable results and an aesthetically pleasing calf contour. Materials and Methods: A retrospective review of patient charts was performed to identify patients who had undergone calf augmentation from 2007 through 2011. The charts were reviewed for patient satisfaction, size of implant, and observed complications. Results: A total of 202 calf augmentations were performed over the 5 years studied. The overall satisfaction rate was 92.1% (186/202). Patients who were unsatisfied with the procedure were primarily dissatisfied with the amount of augmentation achieved or by hypertrophic scarring. Conclusions: Calf augmentation is a procedure that can nicely enhance the physique in a reliable fashion. The overall satisfaction rate is excellent as long as care is taken to ensure that the right implant is chosen to meet the patient's expectations, that meticulous attention is paid to dissection of the pocket to minimize implant migration, and that a layered closure is used to minimize hypertrophic scarring.

Necrotizing Fasciitis Following Calf Augmentation

We are writing to present a short case that we believe might be of interest to the Aesthetic Surgery Journal readership. Necrotizing fasciitis remains one of the most life-threatening soft tissue infections, and a patient presented to us with this infection following calf augmentation.1 In 2011, a 26-year-old man presented to our hospital 2 days after cosmetic calf augmentation with implants, complaining of a fever and pain when standing or walking. He had no allergies and no significant past medical history. The initial augmentation procedure was performed by a private surgeon in an accredited center; 105-mL, symmetrical-base, smooth-surface silicone implants were placed in the retromuscular plane. No other procedures were performed concurrently. The patient did not provide information about which antibiotic …

Calf Implants: A 25-Year Experience and an Anatomical Review

Body contouring in the calf region is becoming a more frequently requested procedure. There are several techniques for calf enhancement, including implants, liposuction, and free flaps. Alloplastic augmentation can be performed with several implant types and several layers of pocket dissection. We present our 25 years of experience using the subfascial technique for calf implantation along with an anatomical study to illustrate all the important steps and relevant anatomy of this augmentation technique. The subfascial technique was performed in 25 cadavers, in which the important layers were dissected for high-resolution photos of the surgery to learn about the relevant anatomy of the region. Also, we did a retrospective study of our experience with calf implants, studying the aesthetic outcome, the presence of early complications, and the presence of late complications. We performed dissections in 25 cadavers and surgery in 63 patients (126 implants). In our series of patients the final aesthetic index was of 9.8. The early complications were severe postoperative pain (11.11%), infection (0.79%), seroma (21.42%), hematoma (0%), and wound dehiscence (7.14%). The late complications were capsular contracture (Baker grades III and IV) (3.17%), implant rupture (1.58%), implant leaking (0%), implant displacement (3.96%), numbness at the ankle (2.38%), and palpability of the implant (0%). The subfascial technique for calf augmentation has complication rates low enough and surgical outcomes good enough to recommend it as the gold standard for alloplastic calf augmentation.

Bilateral Calf Augmentation for Aesthetic Purposes

The shape of the calf is determined by the development of the soleus and gastrocnemius muscles, the length and orientation of the crural bones, and the distribution of subcutaneous fat. Some people have a naturally thin or underdeveloped calf that remains small despite exercise. Calf augmentation is indicated for cosmetic reasons or for reconstruction of a shrunken lower leg resulting from injury, illness, or congenital disability. A total of 53 consecutive patients (40 women and 13 men) had surgery for calf augmentation between January 2004 and January 2007. The patients ranged in age from 25 to 51years (mean, 29.5years). All the patients included in the study requested calf augmentation for aesthetic purposes. Asymmetric-base silicone elastomer smooth-surface implants were used. Overall satisfaction after silicone calf augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). All the patients had surgery by the same team of surgeons (L.H.P., A.S., B.N.). The evaluation was made at follow-up office consultations after 1year. The total mean follow-up time was 4.4years. In this study, 53 bilateral calf augmentations were performed, for a total of 106 procedures. The 125-ml implant was used in 37 bilateral cases, the 70-ml implant in 10 cases; and the 175-ml implant in 6 cases. In three cases, unilateral seroma formation needed to be drained by a partial skin incision opening. There were no cases of infection or hematoma. Hypertrophic scar was observed in four patients bilaterally. One patient requested removal of the implants, and the procedure was performed on an outpatient basis. There were no cases of compartment syndrome or deep vein thrombosis, and no pulmonary embolisms occurred. There were no cases of rotation or displacement of the implant. At 12months, 73% of the patients rated their appearance after calf augmentation as "very good" to "excellent," and 19% responded that their appearance was "good." Only 8% of the patients thought their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 3.4years. Calf augmentation by silicone-filled implants for cosmetic purposes appears to be effective, safe, and aesthetically pleasing, with minor side effects.

Inclusion of calf implants for the correction of lower limb amyotrophy

Background: Lower limb amyotrophy is a serious deformity that is often disabling and causes esthetic problems such as asymmetries and changes in the shape and contour of the legs. The present study evaluated the use of silicone implants for the correction of lower limb amyotrophy. Methods: Women who underwent surgical correction of lower limb amyotrophy with silicone implants between 2002 and 2009 at the Plastic Surgery Service of Instituto Ivo Pitanguy at the 38 th Nursing Service of Santa Casa da Misericordia, Rio de Janeiro and at their associated services were retrospectively reviewed. Results: Five cases were studied and the results were retrospectively assessed. Follow-up ranged from 3 months to 2 years after surgery until the last postoperative visit. In 4 of 5 patients, the desired result was obtained after a single surgical procedure, and no patient developed capsular contracture, compartment syndrome, circulatory disorders, neurological disorders, or infections. Conclusions: Calf augmentation in patients with lower limb amyotrophy did not correct the associated functional deficit, but resulted in a high level of satisfaction with regard to the esthetic improvement of the limb, thus improving the quality of life of these patients.