This surgical procedure is performed in our outpatient facility under general anesthesia. Regional spinal anesthesia or local anesthesia with intravenous sedation may also be used. Calf augmentation usually takes from one-and-a-half to two hours. Preoperatively, in front of a full-length mirror, sizers are placed on the claves to determine appropriate location and outline the precise “pockets” for the implants. Planning and placement are crucial. Implants placed too posterior will not show adequate enhancement when viewed from front and behind. The incision in the natural crease behind the knee is outlined. With positions and outlines completed and agreed upon, the patient speaks with the anesthetist/anesthesiologist and is brought to the operating room. After asleep, the patient is turned on to his or her stomach and the legs prepped. Local nerve blocks, combined with medication that shrinks blood vessels and capillaries to reduce bleeding, are instilled. A one-and-a-half to two inch incision is made in the natural crease behind the knee. The incision is continued through the tough connective tissue fascia that covers the gastrocnemius muscle. A long blunt dissector carefully creates a pocket between the fascia and the underlying muscle.

It is important to make the pocket just large enough to accommodate the implant to avoid post-operative displacement. The implant is then carefully inserted into this space to insure the implant lies correctly without buckling or folds. The same procedure is followed for the additional implant(s). The fascia and skin are closed with dissolving sutures, which are placed under the surface of the skin in the dermis to avoid cross- hatching and allow for the finest healing. With both legs symmetrical and complete, they are wrapped with compression bandages and the patient is returned to a face up position. Once awake, the patient is taken to recovery with the legs elevated.

Recovery after Calf Implants

Following the surgery, patients generally report mild to moderate discomfort, which is easily controlled with medication. Varying degrees of swelling, bruising and firmness subside in the days and weeks ahead. The first 24-48 hours after surgery consist of bed rest with the legs elevated to reduce swelling. Short walks to the bathroom and other short distances are permitted. The patient is seen for an initial follow up appointment one or two days after surgery and again one week later. Showering is permitted after the first post-operative visit.

There are usually no sutures to remove as dissolvable sutures are placed below the skin surface to help avoid hatch marks and optimize healing. Ace wraps are exchanged for heavy above the knee support hose on the first or second visit -to be worn for 6 to 8 weeks. After 48 hours, light walking is encouraged, with more routine walking and activities progressing in the first and second week. Normal walking and non-strenuous activities usually start at three weeks after surgery, but can vary. Strenuous activity such as bicycling, jogging and leg exercises must be avoided for eight weeks to allow more complete healing around the implant, which prevents shifting and displacement. The skin will begin to stretch, relax and lose its shiny appearance in two to four weeks. Complete healing takes time and patience, taking up to one year. It can take this long for scars to soften and fade.

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