Question: Will this surgery have any effect on my gait?

Answer: Yes, but only in the first few days. Because the implants are inserted intramuscularly. Intramuscularly inserted implants cause the muscle to stretched, that's why you feel pain when you’re walking. Particularly in the first 3 days, the patient's walking looks like crawling; the patient walks with short steps. On the page about recovery, you can see how patients walk on different days after surgery. Patients usually regain their normal gait at the end of 1 week. The patients with polio sequelae already have distorted gait; there is a loss of muscular function in the affected leg. Patients, usually, walk by dragging the foot of the affected leg. As the patient gives his weight to the unaffected leg, unaffected leg is usually more muscular. It takes longer for these patients to regain their preoperative gait. These implants do not correct the gait of patients with prior polio. They only provide cosmetic restoration by augmenting the thinner leg. Thus the difference concerning the fullness, which leads to asymmetry between the two legs, is eliminated. At the end of the recovery period, the gait appraxia shall be resumed. That's what I say resumed.

Question: When do I regain normal gait after surgery? How many days off should I take from work?

Answer: It takes nearly 7 days for patients to regain their normal gait. You should rest at home in particular for the first 3 days. You will be able to walk as long as you like, after your bandages are removed on the third day follow-up. Nevertheless, it takes 1 week for majority of the patients to resume their normal lives. Please refer to the recovery page to see the videos of the patients walking.

Question: Is there a way other than a silicone implant surgery to correct crooked legs; for example, a non-surgical method?

Answer: There are some surgeons who claim that they can correct this problem with fat injection, but I think fat injection does not work at all in this area; it will completely disperse. There are also surgeons who use permanent fillers. I neither recommend such fillers; injected filler may dislocate between the muscle fibers due to the load and pressure imposed on the leg and move subcutaneously. However, silicone calf implants have a certain shape due to their sheath which prevent the silicone gel ingredient to disperse or change place. On the contrary, it will give the leg a certain shape. On the other hand, the injected fat or fillers will not shape the leg, as they do not have a sheath; on the contrary, they can disperse and change their places within the tissue. You can get a real and long lasting result only with silicone calf implants.

Question: Are the silicones you use safe?

Answer: Please keep in mind in advance that the number of companies producing such implants is limited. All of these companies are also corporate and reliable companies. The reason for making a decision between companies is only related to which company produces the implant you need. Some companies produce only 2 size implants (large and small), while others offer us 10-12 size implants. I don't think there is a significant difference with regard to the quality of the products of these companies. The main concern is to find the implant in the volume you need. Also, for your convenience let me remind you that all calf implants available in Turkey have CE certification. These products cannot obtain permission from the Ministry of Health for sale in our country without CE certification. For detailed information about CE certification, please click on the following link (the article in the link is only available in Turkish): What does CE certification mean?

Question: We have heard that the silicones used for breast augmentation need to be replaced after a while. Is this the same for the silicones that you use for calf restoration?

Answer: Let us agree on one thing; Breast tissue, whether you place an implant or not, will probably require surgery in the coming years. Breast’s tissue is structured like a fabric and is affected by various hormonal events. Problems like loosening and sagging of breast tissues due to factors such as getting pregnant, gaining and losing weight, aging, sagging of breast tissue due to gravity over the years may always be corrected by surgery. In other words, a woman who has not had breast augmentation surgery will probably undergo breast surgery in the coming years. This is out of the question for the legs. Hormonal factors, pregnancy, aging do not cause any changes in the calves. Calf implants do not wear out over the years, either. Therefore implants may remain where they were placed all through your life.

Question: Is there a risk of blowout or leakage in these silicones?

Answer: Calf implants do not rupture unless they are cut and punctured. Even if they are cut and punctured, the dense medical silicone ingredient does not leak or disperse. They are very safe in this respect.

Question: I intend to undergo this surgery without notifying my family (spouse). Is that possible?

Answer: No it is not. Your gait will be affected for a few days after surgery. Your gait will be affected for a few days, so you will not be able to hide this situation from your family.

Question: How long does the operation take?

Answer: It will take no more than 1 hour (including both legs), in case an experienced surgeon performs this operation with the right surgical instruments.

Question: Is there no possibility to perform the operation under local anesthesia? I'm afraid of being anaesthetized.

Answer: This operation cannot be performed under local anesthesia, because the implant is placed intramuscularly. It is not possible to anesthetize the calf completely. I also do not recommend the patient to be anesthetized from the waist down with epidural anesthesia because the patient will be lied in prone position throughout the operation. It will be difficult for a conscious patient to lie in this position for a long time. For this reason, general anesthesia is the most appropriate form of anesthesia for this surgery

Question: Is there any bleeding in this surgery? Will I need blood transfusion?

Answer: Bleeding almost never occurs in this operation. It is absolutely not necessary to have blood ready for transfusion. Bleeding is only encountered when making an incision on the skin. The gauze bandages, which appear in the photo below, were used during the surgery of a patient who had silicone calf implants placed on both legs. All the bleeding encountered in the operation is as much as you can see in the photo. The operation is one of the most atraumatic operations. Implants are placed between the muscular fibers. Muscle tissue is not excised at all, so there is no bleeding.

Question: How do you decide on which implant to insert? Can I have the implant I want?

Answer: In fact, it is more likely up to the surgeons to decide on the most suitable implant for each patient. If your surgeon is experienced, s/he will know which implant to insert for the restoration of very thin legs. Your surgeon will decide on the right implant to correct the asymmetry in patients with prior poliomyelitis. Your surgeon will consider many parameters such as the thinness of the legs, the elasticity of the skin, the number of implants to be used (1, 2, 3 or even 4??) when making this decision (that's why it's not that easy to choose the right implant, it requires expertise). In addition, too large implants should not be used bearing in mind that the legs will gain some more volume in the first 1 year after the implant is inserted.

Question: Is it possible to switch back after this operation? Let's say I'm not satisfied with the result, can I have the implants removed? Does any deformation remain?

Answer: If you wish, you can have the implants removed. This situation does not lead to any deformation. This operation may completely be reversed. I've had patients who had their implants removed, even though their surgery was successful. For example, a patient who had undergone leg restoration surgery with a silicone implant at another clinic applied to me to have the implants removed. In fact, the result of the prior operation was quite successful. When I asked the patient why she wanted to have her implants removed, the answer was surprising: I had undergone this surgery to get my husband's attention and look good to him. Later, we divorced and this surgery reminds me of my husband. I want to get rid of these implants now..” Although the result was satisfactory, we removed the implants of that female patient. She didn't even want to take back the implants that we removed. There were no deformities in her legs after the operation. Based on my similar experience, I can clearly emphasize that: 'This surgery is completely reversible; the procedure will not leave any deformation behind even if the implants are removed later.’

Question: Because of prior polio, my one leg is thinner than the other. Do we have any chance to fully equalize the two legs with silicone calf implants?

Answer: With these operations, our goal is never to achieve an exact equalization and symmetry between the two legs. The product range with regard to implants produced by companies is rather limited. Our goal here is to use the most suitable of the implants that we have at hand and to reduce the asymmetry between the legs to a degree that will not attract attention when viewed from outside. The asymmetry between two legs will be corrected/reduced to a degree so that it does not attract attention; however, there may still be a few inches of difference between the two legs when you measure it with a tape measure. In this case, we consider the result to be successful. If the patient is lucky, the implant inserted can fully equalize the circumference of both legs, but this cannot always be guaranteed. Also, no one on the street will stop by and measure the circumference of your legs with a tape measure and make comparisons. It will be enough to reduce the visible asymmetry between the two legs to a level that it is not noticeable.

Question: I have read on a foreign forum saying that some patients had difficult in bending their knees and sitting down after the surgery. Is that true?

Answer: This can only happen if the implant has not been placed correctly; maybe if it is inserted above the place where it was supposed to be. In case the upper part of the implant remains posterior to the knee, it will make it difficult to bend the knee. We can prevent this situation as such: The implant should be placed exactly intramuscularly; that is, none of the tips should be visible through the incision line after the procedure. The incisions made in the fascia and subcutaneous tissues when inserting the implant should be easily sutured.

Question: Is there a generally accepted statistic about optimal leg sizes? How long should the calf circumference or leg length be in order to be considered normal/optimal? Which sizes are considered thin, thick, short or long?

Answer: The leg circumference is measured from where the leg is the plumpest in the calf area; 34-36 centimeters is generally considered as normal. A leg measured below 32 centimeters in the plumpest place of the calf area is indicated as thin.

Question: In normal conditions, I regularly go to the gym and do sports. How long after the surgery can I go on to do sports?

Answer: Normally, you need to take a 1-month break from doing sports after more severe surgeries such as abdominoplasty (tummy tuck), breast reduction etc. Although calf restoration is a milder operation than abdominoplasty (tummy tuck) or breast reduction, here we insert the implants right intramuscularly. That is why we recommend you to stay away from gym for at least 2 months and thereafter to begin with light movements.

Question: They say that patients may have difficulty in walking immediately after the surgery. Can I use a cane or walking aid during this period?

Answer: Absolutely no! A cane or a walker delays your normal walking. They will cause a delay in your recovery period. I recommend you to walk slowly but as much as possible, after the bandages on your legs are removed at your first follow-up on the post-operative third day. Walking will speed up the recovery period..

Question: Some patients persistently want their legs to be straight from top to bottom. In other words, they want their knee circumference, calf circumference and ankle circumference to be at the same thickness. Is this a correct request?

Answer: I don't understand this situation either. Female leg and body actually have a curvy structure. This is where the beauty and fragility attributed to the female body originates. It is desirable to have the neck, waist, ankles and knee circumference to be thin/frail. On the other hand the breasts and buttocks are expected to be plump and the calf part is desired to be voluminous. But for some reason, I wonder why, some patients want their knee-calf-ankle to be at the same thickness. A straight, pillar-like leg will certainly not look aesthetically pleasing. Look at the pictures below; none of the legs that are appreciated as feminine and sexy are straight from top to bottom, like a pillar.

Answer: Hard to believe, but I think that some women have really misunderstood the concept of "a pillar-like leg". When we say a pillar-like leg, we don't in fact mean a leg at the same thickness from top to bottom; this is rather referred to as stove-pipe shaped legs. We don’t even mean the pillars of ancient temples! No one finds a completely straight, pillar-like leg attractive!. It's amazing, but when I ask some patients "Do you really want your legs to be straight from top to bottom like a stove-pipe?" They say “Yes”. THAT'S NOT WHAT WE MEAN BY PILLAR-LIKE LEGS! Can such a leg be attractive? Have you ever seen a model with her legs completely straight up and down?

Question: People say that the first few days immediately after the surgery were painful. Would you suggest anything to reduce the pain suffered during this period?

Answer: On the post-op first evening, we necessarily hospitalize the patient as we administer strong analgesics with anesthesia effect. The next morning, the patient's pain is relieved enough to be discharged by walking in short steps. Now tablet analgesics will be enough. I recommend wearing wedged heeled and high-heeled slippers when discharging the patient. With these slippers, not only the heels of the feet stand high (so that the calf muscles relax and the pain is relieved) but also the patient easily maintains the balance owing to the wide soles. Patients are allowed to use neuromuscular blockers as well as analgesics at home. In particular taking neuromuscular blockers at night 1 hour before bedtime will relax the calf muscles, so patients will spend the night comfortably. One other method to keep calf muscles loose is to stretch the legs straight on the bed and place a small pillow under the knees. With the knees slightly bent, calf muscles will relax again. Patient will feel relieved.

Op. Dr. Oytun İdil

(Plastic, aesthetic and reconstructive surgery specialist)

• Whatsapp: +90 533 569 0649    +90 553 985 8087
• E-mail: oytunmd@gmail.com
• Op. Dr. Oytun İdil: +90 533 569 0649
           +90 505 296 5569
• Asistant: +90 553 985 8087
• Office line: +90 212 296 3656
           +90 505 137 1393
• Address: Halaskargazi mah. Rumeli cad. No:3 D:1
  Nişantaşı, şişli - Istanbul / Türkiye