Calf Love

By: Dr Gennaro Selvaggi
Created on 25th March 2010

Plastic surgeon Dr Gennaro Selvaggi reports on a new surgical procedure developed in Asia that is growing in popularity here... calf reduction

In my cosmetic surgery practice, young girls often come to consultation hoping that a liposuction procedure can reduce the size of their calves. Unfortunately, this is one of the areas of the body that does not respond to exercise. In fact, exercise often exacerbates the problem.

Sometimes calf volume is due to fat, but at other times the excessive bulking is due to the presence of exaggeratedly wide and thick muscles, which become even more visible when muscles are contracted, such as walking in heels.

Asian women especially present with hypertrophied muscles which, in combination with a shorter height on average, can become a matter of concern for many women.

Simple liposuction can effectively reduce the amount of fat, but this will have no effect at all on the underlying muscle tissue.

Traditionally, surgeons have been reluctant to target these muscles, but recent discoveries made during reconstructive surgery have demonstrated that loosening part of the calf muscle does not jeopardize patients' physical activity when tissues have healed. Surgeons now remove calf muscle for cosmetic purposes.

The first cases of muscle removal for cosmetic reasons were performed in Germany (more than 12 years ago) and all over Asia. However, muscle removal can cause bleeding during the operation and irregularities such as an icescoop deformity.

Botox injections are a less invasive option. The toxin is injected into the gastrocnemius muscle and, about one week later, the circumference of the calf will start to shrink, because the peripheral motor nerves to the muscle are blocked by the injections. However, the downside of this procedure is that it requires repeated treatments with an unpredictable result.

My favourite and possibly the ultimate procedure to reduce hypertrophic muscle calves, is selective neurectomy or the disconnection of three different nerve branches, going to the medial gastrocnemius muscle, and to the medial and lateral parts of the soleus muscle. For any surgeon capable of performing microsurgery and nerve anastomosis, cutting a selected nerve is not difficult.

Recently, I visited Dr Tsai in Taiwan and he taught me this technique. The residual scar is inconspicuous, being located on the back of the knee, and no longer than 2 cm. Surgery is performed under general anaesthetic, it takes less than an hour and patients can walk home on the same day.

Patients will not be able to lift their heels for a few months, but they will be able to start running at three months, and they can go back to normal exercise six months after the surgery.

Between three and six months, in fact, nerve and muscle compensation will occur; this means the muscles function normally, but are still smaller in size. Dr Tsai's accurate biomechanical examinations of the long-term results show that no functional impairment is present, when the patient is healed. Finally, physical exercises help to keep the result achieved by surgery.