Silhouette cosmetic surgery
The correction of hypoplastic calves (undersized calves) can occur in the context of either restorative surgery (congenital muscular atrophy, after effects of polio) or cosmetic surgery
Three methods are used :
- lipofilling (fat transfer) ;
- insertion of calf implants ;
- hyaluronic acid injections (Macrolane).
This technique involves removing fat by liposuction from areas where there is an excess of fat and then re-injecting it into the area where you want to restore volume, all performed during the same surgery under general anesthesia. The re-injected or grafted fat must first be purified by centrifugation, filtration or decantation during the procedure.
The rate of engraftment varies between 50 and 70%, which means that we must inject more fat than necessary in theory to achieve the desired volume. We must therefore have a "reserve" of sufficient fat and / or perform several sessions of lipomodelage several months apart.
The advantage of this technique is the natural characteristic of the fat injections. The result is permanent after the partial reduction phase is completed. However, the volume of fat grafted will fluctuate with any significant weight change.
Hyaluronic acid injections
A very dense hyaluronic acidof non-animal origin (Macrolane) is deeply injected through several millimeter long incisions. Unlike fat injections, hyaluronic acid injections take place in the doctor’s office. This method is the easiest way to increase the volume of the calves. However, the absorbable nature of the product requires sessions to be done every 10 to 12 months to maintain the results. This represents a significant cost that is higher than the cost of surgery.
This is preferred choice for increasing calf size. This is the only technique available for patients who do not have sufficient fat reserves to have lipomodelage and who also want a lasting result with one operation.
The implant is most often placed in an internal position. More rarely, an external implant is recommended. Two calf implants can be placed on the same calf at the same time when the increase in calf size is more general, usually in the context of a reconstruction (after effects of polio or clubfoot).
The implants used are specially designed for calf augmentations. They are pre-filled with a highly cohesive silicone gel (very strong) and have adurable casing. In the absence of violent trauma (traffic accident...) the risk of rupture is very low. If a rupture occurs, the implant should be changed, but this is not an emergency. Two main types of implants are available (arched type Glicenstein or cone-type Montellano). The shape and volume of the implant are tailored to meet the needs of each patient.
Principle of calf implant surgery
The incision is hidden in a fold of the knee bend and is between 3 and 5 cm in length. The implant is positioned deep against the calf muscles. The procedure is performed under local or general anesthesia and takes about 1 hour. The patient lies on their stomach. No drain is inserted. Hospitalisation is 12 to 24 hours.
Pain, which is relieved by the appropriate analgesics, only lasts for the first few days but discomfort may be felt for several weeks. Walk is allowed immediately after surgery.
Showering is permitted from the day after the procedure.
Complete healing is achieved in 2 to 3 weeks.
Sporting activities may be resumed 3 months after the treatment.
Risk of complications
As with any surgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include :
- stopping smoking 1 month before and after the procedure (reduction of all risks) ;
- stopping the pill two months before and after the procedure (reducing the risk of phlebitis and pulmonary embolism);
- not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma) ;
- Where applicable, achieving the target weight your surgeon has determined before surgery, (reducing risk of phlebitis and pulmonary embolism and the risk of a poor cosmetic outcome).
Fortunately, postoperative effects are generally manageable following a calf augmentation that has been carried out properly, so serious complications are rare.
In spite of the fact that complications are so rare you must be aware of the following problems :
- Haematomas are quite rare but can occur. They can be evacuated.
- Infection : this is extremely rare when the procedure is carried out in sterile environment.
- Seroma : lymph collection under the skin that can be evacuated and that will dry up without sequelae.
- Thrombo-embolic accidents (blood clots in the veins of the legs, pulmonary embolism) are rare and can be prevented by strict prophylactic measures (standing and walking as soon as possible after surgery, wearing compression stockings, or heparin therapy).
In case of a complications, your surgeon will treat them successfully if necessary.
In practice, the vast majority of cases take place without any problem and the patients are satisfied with the result.
Health insurance coverage
As this procedure is considered purely for aesthetic purposes, no coverage is provided by health insurance.
In some rare cases (polio) a partial reimbursement of the cost of the procedure may be considered upon prior agreement.
In case of prior agreement, you will be responsible for the additional surgeon and anesthesiologist fees which will be redeemable in whole or in part by your health insurance.
Author: Dr. Christophe Laveaux
Specialist in aesthetic surgery - Antibes
Reproductions, even partial, of the texts are allowed on the express condition cite the author (Dr. Christophe Laveaux) with a direct link to the article mentioned.