Having been used quite often in recent years, cosmetic surgery procedures applied on the calf with silicone implant placement are yet types of surgical interventions that is not well known among surgeons. In this article, I will briefly convey my experience..

Silicone calf implants are mainly silicone prostheses that appear to have the similar anatomical shape with that of the calf muscle (gastrocnemius) located to the posterior of the lower leg right beneath the knee. These silicone implants (prostheses) are used to augment the calf muscle (gastrocnemius) located to the posterior of the lower extremity, beneath the knee.Although we refer to a muscle group consisting of 2 parts, it is usually the atrophy of the medial gastrocnemius (inner muscle of the calf) that causes the atrophy (weakness) and knock knees (genu valgum). For this reason, these silicone implants (prostheses) are usually placed intramuscular into the medial gastrocnemius to restore the knock knees or to augment the muscle located to the posterior of the lower extremity, below the knee. The aim of this intervention is to bring the weak (atrophic) muscle to the size it should be. This operation is performed for 4 groups of eligible patients:

1) Ladies with knock knees (genu valgum) who have a large gap between their feet

2) Ladies with very thin legs (spindleshanks deformity)

3) Patients with thin legs due to having been subjected to prior polio in childhood (male-female)

4) Athletes who are actively engaged in bodybuilding, however have neglected to develop their calf muscles (these muscles are resistant to sports, it is difficult to develop them)

In order to achieve the most natural result with regard to all these patients, implants should be placed right inside the calf muscle (gastrocnemius). We may associate this situation to the traditional matryoshka dolls of Russians. Placing an implant with a similar shape with that of the muscle, right in the middle of the muscle, you will be able to augment the calf with an extremely aesthetic view. It is not possible to notice whether an implant is placed just by looking at it from the outside (just as it is impossible to recognize other matryoshka babies inside the outermost one). I prefer to call this procedure "augmentation" rather than "thickening", as it is not actually a "leg thickening".

Why? Calf implants only augment muscle mass, as they are inserted intramuscular. The area occupied by this muscle in the leg, is the upper 2/3 of the area between the knee and the ankle. The part of the calf muscle (gastrocnemius) that goes down to the ankle has a ligament structure; the implant does not extend here. In other words, these implants do not extend to the ankle; they are limited to the upper muscular region. Thus, by placing the implant right in the muscle, we plump the muscular, fleshy part of the leg (between the knee and ankle); the ankle remains the same. For women, this is already a desirable result.

The female body has a curvy structure; that is some areas are plump and others are thinners (classic glass Coca Cola bottles are designed inspired by the female body). In order to achieve a feminine and attractive appearance of the leg, it is desirable to have a plump look at the muscular part of the calf and thinner ankles. By placing silicone implants directly inside the muscle, patients may be provided this feminine appearance and it will be impossible to notice the implants from the outside.

The situation is the same for men, too; with a single difference. Considering men; it is desirable to have a calf muscle (gastrocnemius) not with a gentle curve, but rather with a noticeable muscular appearance. For this reason, asymmetric implants that are thicker on one side should be used in male patients. Thus, both the calf muscle (gastrocnemius) is plumped and a muscular appearance is obtained. For female patients, on the other hand, it works better to use symmetrical implants with more gentle curves.

Intramuscular insertion of these implants used to be a serious problem, because none of the manufacturers of these implants provided a suitable surgical instrument for intramuscular. Thereupon, I personally designed a surgical instrument suitable for intramuscular insertion of these implants and received an international patent in November 2014 (patent no: TR2014 12611 Y). I scientifically presented this instrument (İdil calf dissector) to my colleagues in 2016 at the Aesthetics Surgery Symposium. This instrument is produced and sold at its cost, exclusively in our country and I do not earn any returns over its sales as I have not developed it with a commercial concern.

I developed this specific surgical instrument, which eliminates the challenges concerning cosmetic surgery procedures applied on the calf performed with silicone implant placement, exclusive for Turkish plastic surgeons and ensured it to be sold at its cost. İdil calf dissector reduces the operation time to 1 hour, ensures that the operation is completed without any bleeding and ensures the implant to be placed exactly in the desired place. I think this surgical instrument is a milestone for these procedures. You can find detailed information about İdil calf dissector on my website: www.bacakestetigi.com / www.calfaugmentation.net

Cosmetic surgery procedures on the calf, with silicone implant placement, are applied on the posterior region of the knee. Calf muscle (gastrocnemius) is reached through a skin incision of 3-4 centimeters, to the posterior of the knee. Using one end of the İdil calf dissector, the pocket into which the implant will be inserted is dissected. The implant is inserted inside, using the other end of the dissector. These stages are finalized without any bleeding, as no incision has been performed into tissues. Implant is placed between the muscular fibers. That's why there's no bleeding. The procedure on one leg is finalized by suturing the muscle, subcutaneous tissues and finally the skin. The operation on both legs is completed within a period of up to 1 hour from the beginning till the end.

The suture to the posterior of the knee usually heals very well; the remaining scar is not very obvious. The patient is hospitalized for 1 night and discharged the next morning. The patient should then rest at home for 3 days following the intervention. At the first post-operation follow-up (3. day), the dressings on the legs are removed and the patient is allowed to walk. The patient usually regains the routine walking performance at the end of 1 week. There is an important detail with regard to these procedures. The patient should be informed about the whole process from the very beginning as the leg shall gain volume for about 3-6 months after the surgery. The underlying reason for this outcome is the originally inelastic structure of sarcolemma which shall relax over time, allowing the leg to become thicker. Sarcolemma is originally inflexible, but an implant placed into the muscle forces it from the inside. Over time (within 3-6 months), the leg becomes somewhat thicker.

The surgeon is required to know this feature and adjust the volume of the implant to be placed accordingly. An experienced surgeon calculates the expected thickness of the leg in 6 months post-surgery and selects the implant accordingly. Therefore, the post-surgery image/look will not represent the final version of the leg. You may see the final version only after 6 months. My suggestion to patients who want to portray the finalized look in their own eyes is as follows:
Using a tape measure, please measure the post-surgery circumference of the thickest region of your leg (between the knee and ankle) after your bandages are removed.
Please re-measure the same region after 3 months and after 6 months, respectively. You will notice that the leg becomes gradually thicker over the months.

Oytun İdil (MD)
oytunmd@gmail.com
www.bacakestetigi.com
www.calfaugmentation.net
+90 533 5690649

Op. Dr. Oytun İdil

(Plastic, aesthetic and reconstructive surgery specialist)

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