Calf augmentation and restoration.
BACKGROUND: Calf augmentation is indicated for cosmetic reasons or to reconstruct a shrunken lower leg that is the result of injury, illness, or congenital disability. Calf implants are made of solid semisoft silicone, which can be customized by carving, or of a thick shell of solid silicone containing cohesive silicone. METHODS: During the years 1991 through 2004, 18 patients (13 women and five men) underwent 20 calf augmentations at the Lidingö Clinic in Stockholm. Indication for operation was aesthetic in 10 patients. Four patients were body-builders. Another four underwent unilateral crural restoration because of the deformity caused by an illness. Both cigar-shaped and anatomically formed silicone implants filled with cohesive gel were used. Several technical improvements were introduced; among them, a new instrument for insertion of the implants. The long-acting anesthetic ropivacaine was used to flush the dissected cavity and for intermittent regional analgesia during the first postoperative day. One or two implants were placed in the space between the investing crural fascia and gastrocnemius muscle, depending on the aesthetic demand. In five patients, an augmentation procedure was combined with circumferential liposuction of the lower legs. RESULTS: All patients obtained good aesthetic improvement and were satisfied with the outcome. No serious complications were encountered in this series. Liposuction contributed to better cosmesis and symmetry in some aesthetic patients and was particularly important in the reconstructive cases. Ropivacaine flush almost eliminated the postoperative pain and discomfort. Several clinical examples of calf augmentation attributable for aesthetic and/or medical reasons are presented. CONCLUSION: Calf augmentation or reconstruction with silicone implants is a safe, efficient, and satisfying aesthetic procedure.