Confident contours come with calf augmentation

The phrase "male plastic surgery" may bring about thoughts of liposuction to address the infamous "dad bod" or the increasingly popular hair restoration procedures that are reversing the impact of male pattern baldness. Yet, it seems men are heading to the plastic surgeon's office with another area of the body in mind – their calves.

Calf augmentation uses an implant to increase the size of a patient's calves. Think of it like breast augmentation but for your lower legs. Using calf implants can give men a sculpted look they desire that they've been unable to achieve no matter how many leg days they do at the gym.

So, how exactly does this procedure work? Are there patients who would benefit from pursuing calf augmentation? What are the results that can be expected from the use of calf implants? We spoke with ASPS Member Surgeons Ryan Stanton, MD, and Paul Vitenas, Jr., MD, to get these answers and more.

What is the popularity of calf augmentation?

You're probably never going to see calf augmentation in the top 10 plastic surgery procedures when ASPS releases its annual stats report. Yet, for patients who are dissatisfied with the appearance of their lower legs, this procedure can be life-changing.

"We probably do 20 cases or so a year, which, to be transparent, most plastic surgeons haven't done five cases in their total career," said Dr. Vitenas.

There are a wide variety of individuals who often seek out this procedure, though men are predominantly the main patients.

"Number one is young males 25 to 35-ish years old," said Dr. Stanton. "Men often choose calf augmentation to beef up calf muscle mass and definition. As you can imagine, this procedure is prevalent among our frustrated but extremely hardworking bodybuilder patients that, no matter how many calf raises they do, they simply cannot grow their calf muscles – period. Second is females of all ages, but mostly over 35 years old. Women typically choose calf implants to enhance proportions, balance and symmetry with their thighs. Third is patients with genetic or developmental defects or malformations, most commonly club foot, but also mild spina bifida or genu varum – also known as "bowlegged". Finally, patients with disease, such as polio, or trauma, direct or indirect, such as nerve injury and secondary gastrocnemius muscle atrophy."

What it truly comes down to for patients is either the symmetry or size of the calves.

"It breaks down into two basic categories of people that come in for it," said Dr. Vitenas. "One is for patients who have had club foot or polio and just have a smaller leg on one side than the other. They're typically trying to achieve some sort of symmetry. So, you can put a calf implant on the smaller leg and help them with that. The other is patients whose calves are just genetically small, and their lower legs don't match proportionately with their upper legs. They will come in and request calf implants on both sides."

What to expect from calf augmentation

As mentioned before, calf augmentation is typically performed by inserting specialized implants into the calves. Fat transfer is sometimes an option, though implants are overwhelmingly the most common and popular option.

"Calf augmentation with soft semi-solid anatomically (teardrop) shaped silicone rubber implants is a very specialized procedure performed by a rare and few board-certified plastic surgeons," said Dr. Stanton. "It is an outpatient procedure performed not infrequently at an outpatient ambulatory surgery center. Surgery takes about one to two hours, recovery another hour, then the patient can proceed home thereafter with a responsible adult."

The procedure itself is very straightforward, often performed under general anesthesia, with implants inserted through a small incision.

"In my experience, deep subfascial placed calf implants are the most aesthetic, reliable, predictable, relatively safe and permanent option – far superior to fat transfer," said Dr. Stanton. "The approach is made by creating a small incision within a skin crease in the back of the knee.  Most patients benefit from implants placed both medially and laterally. That being said, most patients present desiring only medial calf augmentation, thus a tincture of 'patient education' goes a long way in not only improving outcomes but patients' expectations."

Implants are selected prior to the procedure and are available in a variety of shapes and sizes. The patient and surgeon work together to determine the best fit for the placement and desired outcome. However, there is limited space in the calves, so surgeons will be mindful of patients who want to go too big.

"Picking the right size implant is important because you're basically putting that implant in a closed space," said Dr. Vitenas. "The fascial compartment of the leg, which holds the muscles, the bones, the nerves and blood vessels, is a very close space because the fascial tissue that holds all of that is not very elastic. You have some extra space in there, but there's not a lot. So, choosing the right size implant is particularly important. If you put too big an implant in, you increase the pressure within the closed space, and when you increase the pressure, you can decrease the blood supply to the nerve running through the leg. If you decrease the blood supply to the nerve, the nerve begins to fail."

Recovery following a calf augmentation is relatively simple, with limited movement and allowing time for rest. In some cases, patients may opt to use a rolling walker for a few days to get around, although it is not necessary.

"The recovery process itself is very easy," said Dr. Vitenas. "We ask that they limit walking for the first two days and keep their legs elevated when not walking. After two to three days, they pretty much go back to their normal activity. Obviously, we don't want them running or weightlifting for six weeks but they don't honestly have a lot of discomfort. There's some tightness in the calf area, but there's not much in the way of discomfort."

One benefit of calf augmentation is that the visible results are immediate. Patients will see an instant improvement in the appearance of their calves, although some swelling and bruising are to be expected following this procedure. After the swelling and bruising subsides, patients will be able to fully appreciate the appearance of their lower legs and the true impact that a successful calf augmentation can have on their self-esteem.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.