Also known as calf augmentation and calf enlargement
Calf augmentation with implants is a procedure to increase the size and improve the shape of the calf. Patients seek calf implants to tone and define the lower leg if it cannot be achieved with exercise alone, or to correct a muscle imbalance resulting from physical or birth defects.
When to Consider Calf Implants
- If you seek to emphasize the bulk of the calf muscle (usually men)
- If you desire a lower leg more anatomically proportionate to your thigh (usually women)
- If you are a bodybuilder and you’ve reached the plateau of calf development with exercise, but you’re not satisfied with the definition of your lower leg
- If you wish to correct lower leg defects resulting from injury; disease, such as polio; or from birth conditions, such as clubfoot or spina bifida
- Your legs are measured during a preoperative office visit to determine the right implant size, and then the implants are ordered for surgery.
- The day of surgery, you are given general anesthesia or sedation anesthesia and placed in the prone position (lying face down) on the operating table.
- The incision is made at the back of the knee, through the skin and fascia (sheet of connective tissue) covering the gastrocnemius muscle.
- Once your surgeon locates the most salient nerve (tibial nerve), the procedure can proceed without much concern for encountering other nerves or arteries, because there aren't many in this area.
- A snug pocket (large enough only for the implant) is made between this fascia and muscle, into which the implant will be inserted.
- The implant is inserted and the leg is examined before the incision is closed with sutures.
Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery.
In advance of your procedure, your surgeon will ask you to:
- Stop smoking before undergoing surgery to promote better healing
- Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications can cause increased bleeding
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
- Possibly have blood and urine tests, and a pregnancy test for women, to prepare for anesthesia
Calf augmentation is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
What can I expect on the day of my calf implant surgery?
Your calf implant surgery may be performed in an accredited hospital, free-standing ambulatory facility, or office-based surgical suite. Most calf implant procedures take at least 1 to 2 hours to complete but may take longer.
- Medications are administered for your comfort during the surgical procedure.
- General anesthesia is commonly used during your calf implant procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
- For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
- Your surgeon will follow the surgical plan discussed with you before surgery.
- After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will have drainage tubes in place. After implant surgery, you will be placed in a surgical dressing that includes a support or compression garment over your legs.
You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate postoperative recovery.
Types of Implant and Implant Material
Calf implants are available in silicone gel and solid silicone. Silicone-gel implants can cause capsular contracture (shrinking and tightening of the scar tissue around the implant causing pain, unnatural firmness, and distortion); however, this rarely occurs in calf implants. Solid silicone implants can leave a palpable edge (one that can be felt) if placed too close to the surface. Silicone-gel calf implants are available in symmetrical sizes, which are suited best for the general population, and anatomical (asymmetrical sizes), which are best used for bodybuilders who desire more dramatic volume than the average-build patient. Your surgeon can custom-carve solid silicone implants before inserting. Depending on your individual need and desire, one or two implants may be inserted in each leg. Body fat is not an option for this procedure, as it's better used for augmenting smaller areas of the body, and because it absorbs into the area in which it's placed.
The implants can be placed either subfascially (just beneath the fascia) or submuscularly (within the muscle). Subfascial placement is used more frequently because the procedure is less invasive, less difficult, and leads to a faster, less painful recovery for the patient. However, subfascial placement can sometimes result in implant rotation and a palpable implant, and the postoperative appearance can be less than desired, because the calf shape is defined more by the implant and less by the muscle tissue. This can occur using either silicone-gel or solid silicone implants. Lastly, subfascial placement requires more attention to implant placement.
Submuscular placement is considered more difficult because your surgeon must dissect deeper into muscle tissue. You can also expect a few additional days of recovery and greater discomfort. However, the implant is more securely and accurately placed within the muscle and results in a better aesthetic outcome, including a more natural shape because the calf muscles cover the implant. Surgical complications such as vascular or nerve damage can be more easily controlled with submuscular placement.
It's important to choose your surgeon based on:
- Education, training, and certification
- Experience with calf implant surgery
- Your comfort level with him or her
Members of the American Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure. Learn how to select a surgeon.
After finding a board-certified plastic surgeon in your area who is experienced in performing calf implants, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a calf implant candidate and clarify what calf implants can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered. (See related procedures).
You should come to the consultation prepared to discuss your complete medical history. This will include information about:
- Previous surgeries
- Past and present medical conditions
- Allergies and current medications
Based on your goals, physical characteristics and the surgeon's training and experience, your surgeon will share recommendations and information with you, including:
- An approach to your surgery, including the type of procedure or combination of procedures
- The outcomes that you can anticipate
- Your financial investment for the procedure
- Associated risks and complications
- Options for anesthesia and surgery location
- What you need to prepare for your surgery
- What you can expect to experience after surgery
- Show before-and-after photos of cases similar to yours and answer any questions
For a general list of questions to ask your surgeon about his/her background, find out about plastic surgery safety and to plan your procedure visit the Planning Toolkit.
We developed these questions to help you:
- Make the most informed and intelligent decisions about your procedure
- Confirm that you have the right surgeon for your procedure
- Make your initial consultation as rewarding as possible
- Understand your options, potential outcomes, and risks
It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.
- Am I a good candidate for a calf implants?
- Are the results I am seeking reasonable and realistic?
- Do you have before-and-after photos I can look at for the procedure I am undergoing?
- Will my scars be visible? Where will my scars be located?
- What kind of anesthesia do you recommend for me?
- What will be the costs associated with my surgery?
- What will you expect of me to get the best results?
- What kind of recovery period can I expect, and when can I resume normal activities?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
- Drains, if they have been placed
- Normal symptoms you will experience
- Potential signs of complication.
See options for short-term recovery locations in Aftercare and Recovery (Planning Toolkit).
Immediately after your calf implant surgery
The incision sites will be slightly bruised and your lower legs will be swollen. Any postoperative pain or discomfort you experience will be managed with medication. These symptoms generally subside after a few days.
When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. Contact your surgeon to find out if your pain, redness, and swelling is normal or a sign of a problem.
Recovery time frame after calf implants
It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about care of your drains if necessary, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first two weeks
- The first day or two after surgery, you should be assisted when getting up to go to the bathroom and your legs should be elevated as often as possible to reduce swelling and discomfort.
- The second day after surgery your dressings can be removed and you are encouraged to walk around the house and begin taking brief daily showers.
- You can expect to walk stiffly for the first week or so, but you are encouraged to gradually walk greater distances.
Week two to eight
- Normal walking starts to return during the second and third week after surgery
- The skin starts to stretch and the bruising and "shiny" appearance of the skin starts to fade
- Activities such as running, biking, weight-lifting should be avoided until one or two months after surgery, depending on your comfort level
- Full return to normal activities usually occurs after four to six weeks
Calf implant results are permanent.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it's important to return to your plastic surgeon's office for follow-up evaluation at prescribed times and whenever you notice any changes in your calf implants. Do not hesitate to contact your surgeon when you have any questions or concerns.
The cost of calf implants varies from doctor to doctor and from one geographic area to another.
See the national average for physician fees per procedure.
These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to breast revision.
Because calf augmentation is elective surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.
Choose your surgeon based on quality, training, and experience—not cost.
See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training, and certifications.
Fortunately, significant complications from calf implants are infrequent. Your specific risks for calf implants will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
Other risks specific to calf implants are outlined below:
- Visible implant due to incorrect pocket dissection or incorrect implant placement
- Nerve and/or muscle damage
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your calf implant surgery.This article was originally published for Smart Beauty Guide and was legally licensed