Calf and Leg Aesthetics

Calf and Leg Aesthetics

Calf Aesthetics, Leg Aesthetics. The leg is the region that anatomically covers the part from knee level to ankle level. The back surface of this is called calf.

The leg is the region that anatomically covers the part from knee level to ankle level. The back surface of this is called calf. The leg basically consists of two long bones and various muscles, vessels and nerves around them. The main feature of the muscles is that they provide movement of the ankle and toes.

The leg is the part between the knee and the ankle and the back half is called the calf.

Two factors basically determine the aesthetic appearance of the leg; these are bones and muscles.

Although the bones anatomically give the leg a slightly concave appearance, excessive concavity can lead to problems called O-legs or bracket legs. In some selected patients with O-leg deformity, some correction can be achieved with permanent silicone implants or temporary fat injections. On the contrary, the deformity known as If it is protruding excessively, it may require bone corrective surgery by orthopedic specialists.

There are also cases where the muscles in the calf area are deficiently developed, either congenitally or acquired. In this case, the legs normally look thin.

Some of our patients complain that when they put their feet together in front of the mirror, there is a large gap between their legs. As I mentioned before, this problem may occur when the person is completely normal, or it may occur due to polio, sciatic nerve cuts due to trauma, or direct muscle injuries. If the muscle is subjected to direct trauma, either a complete thinning in that area or a regional collapse of the skin descending to the ground is observed.

Another problem of the leg area is the regional plump structure. In such cases, our patients apply either because their legs are too thick, because their ankles are too thick, or both.

Depending on the type of problem in our patients, treatment methods are divided into temporary or permanent solutions.

1- Temporary solutions

The most basic weapon in the hands of a plastic surgeon for a slim leg or calf is fat tissue. It is possible to plump the leg and calf area with fat-based patches. In this plumping surgery, the most basic weapon of the plastic surgeon is fat tissue . It is possible to plump the leg and calf area with fat-based patches. This plumping, that is, fat injection process, is as much as the patient's leg skin allows. Fat injection is performed under the skin and is basically a procedure that corrects the body surface, but in appropriate amounts, it provides volume increase and a fuller appearance in the area. Fat injection is also used in the treatment of regional depressions in the legs.

After fat injection, most of the injected tissue will melt within months. The remaining tissue actually consists largely of connective tissue into which the injected fat tissue is transformed. Repetitive fat injections can increase the permanence of injections by increasing the volume of this connective tissue. It has also been shown that fat injections combined with platelet-rich plasma (PRP) and fat-derived mesenchymal stem cells have longer durability.

If your leg problem is a thick ankle or thick leg , fat removal or liposuction, which is the opposite of the procedure described above, can be performed. Fat removal procedures at the mid-calf level may not generally provide sufficient slimming. This situation must be determined by a physician's examination. Because it would not be a logical procedure to reduce the skin thickness in the leg due to excess muscle tissue.

Botulinum toxin-A (BoNT-A) injection is a treatment option that can be classified as a temporary solution for calf and leg thickness due to thick muscle tissue. A partial volume reduction can be achieved in applications performed with proper dosage adjustment. However, these injections should be done in experienced hands, as they cause regional weakening of muscle functions. Especially in patients with excess fat tissue, this problem can be overcome by injecting into the gastrocnemius muscle, which is only the superficial muscle of the calf, under ultrasound guidance. When these injections are done properly, they do not usually cause a significant loss of function since there is another muscle called soleus deep within the gastrocnemius muscle.

2. Permanent Solutions

Permanent solutions in calf and leg plastic surgery vary depending on the problem. Again, whether the leg or calf is thin or thick or deformities such as O or X leg determine the approach to the problem.

There can be two main problems with a thick calf. First, muscle volume is high. BoNT-A injections provide temporary slimming in these patients. However, to make this more permanent, surgeries in which the nerve leading to the muscle is cut and burned or a half of the muscle is removed have also been described. Although paralyzing the muscle by cutting the nerve seems more feasible, the results of operations based on muscle removal may not be very satisfactory due to the re-swelling of the underlying soleus muscle due to all the work it takes. The surgery may also negatively affect foot functions.

Limited liposuction procedures can also be performed for a thick ankle . However, since the ankle is generally a region where the vessels and nerves going to the foot pass, this surgery is a risky surgery.

The main way to achieve a permanent approach to a thin calf is treatment with silicone implants . Oval-shaped silicone implants consist of an outer medical silicone shell and an inner non-deformable silicone gel. Approaches to treatment with silicone implants vary depending on whether the problem is in one leg, as in polio, or in two legs, as in congenital structural problems.

Contrary to popular belief, treatment may sometimes be more problematic in patients with problems in one leg. This is because the measurements of the other leg are tried to be balanced with fixed volume implants. The main source of the problem here is that the range of implant volumes that can be used is not very wide. In patients where the implant size cannot be determined exactly, balancing is attempted with fat injection.

There are also implants used in leg aesthetics that are made entirely of hard silicone and do not contain gel. While their main advantage is that they can be shaped with a scalpel, problems such as not being felt by hand and coming out of the skin in the long term have been reported more frequently. The costs of these implants are quite high in our country.

In leg aesthetics, silicone gel implants are inserted into the area under the outer membrane layer of the calf muscle by entering through a 3-5 cm incision line behind the knee.

Silicone gel implants used in leg aesthetics come in standard sizes, and sometimes some missing parts may need to be corrected with fat injection at the end of the application.

In addition to placing implants under the muscle membrane in leg filling, another popular application today is placement under the calf muscle. In this second type of surgery, which is quite painful, after the implant is placed in the pocket created under the calf muscle, the muscle is expected to get used to its new tension in an already narrow pocket. Implant placement surgeries performed under the muscle membrane are less painful. If the skin thickness is not sufficient, the likelihood of the implant being felt increases. Additionally, there are surgeons who claim that subcutaneous implants slide more upward, downward, or outward. We have not observed this in any patient in our clinical practice.

In calf implants, as in breast implants, if the leg is well protected, within a few months the implant will be surrounded by a connective tissue armor called "capsule" and it will not be easy to move.

Silicone implants used in leg augmentation surgery are oval-shaped and can be symmetrical at the lower and upper ends or in anatomical shapes, being fuller at the upper end.

Silicone gel implants used for leg thickening

For this reason, the need for implants is determined, varying from patient to patient. After the implant is placed, it is surrounded by a connective tissue capsule over time and fixed in the pocket it is located in. After this point, implant slippage is not a common phenomenon unless the area is subjected to serious trauma. On the other hand, due to the possibility of the traumatized implant being perforated, it would be appropriate to detect it at least with a magnetic resonance (MR) examination.

In applications for leg aesthetics, it can be thought that the perforations in silicone implants may be due to frequent crossing of the legs and tearing of the implant shell in the process. It is claimed that especially the knee below can trigger this perforation by regularly causing blunt trauma to the implant.

Pain may occur during implant placement, whether subcutaneous or submuscular, on the first night after surgery. That's why hospitalization is important.

After calf and leg plastic surgery, we recommend patients to wear compression stockings or elastic corsets for about a month to prevent leg swelling. At the end of the surgery, drains, which are used to remove blood that may accumulate inside, are generally not used unless the surgeon deems it absolutely necessary. In the first week after the surgery, it is recommended to sleep with the legs elevated from the body with pillows.

The scars left in calf and leg plastic surgeries vary depending on the technique chosen.

Many of our patients are left with a scar in the form of a faded line on the back of their legs for approximately 6-10 months. However, at the end of this period, it generally becomes unclear. Rarely, it is possible for these scars to swell. Regarding these, some protective gel applications will be recommended to you. Sports such as tennis, basketball, football, and activities such as lifting heavy loads that will cause excessive muscle activity in the leg are not recommended for approximately 3 months. Walking with simple rest can begin after the second week. In the postoperative period, muscle cramps, asymmetrical swelling in the legs, and foot edema may occasionally occur, although rarely. Inform your surgeon about these.

In addition, the main problems that patients may experience in calf implant surgeries are similar to those in other silicone implant applications and are mainly wound infection, blood accumulation in the wound line (hematoma), slipping of the implant, even if it is unlikely, asymmetry between the legs, and inadequate correction of the existing deformity. If infection occurs in the wound line, the patient may require readmission to the hospital and removal of the implant.

In calf and leg aesthetics, placing silicone implants without touching the implant may be advantageous in terms of possible infection and capsular contractures.

Volume increase surgeries with calf implants are very bloodless surgeries. Although the surgery takes varying times between surgeons, it takes approximately 30 minutes for a single leg, Assoc. Dr. Nebil YEŞİLOĞLU has reduced the surgery time to 5 minutes for one leg with the pelican dissector he developed, which allows pocket creation and implant placement in a single step without human contact. These periods are valid for surgeries performed under the muscle membrane. For implants placed under the muscle, the duration is slightly longer.

FREQUENTLY ASKED

Are implants permanent?

As with all medical devices placed in the body, calf implants are not permanent. Although manufacturers recommend a usage period of 15 years, I recommend that my patients replace implants that have completed 10 years.

Are the implants the consistency of calf muscle?

Unlike breast implants, calf implants are not produced in highly variable consistencies. The consistency of silicone gel implants is at a level that can be felt when applied under the muscle membrane if the skin thickness is insufficient. Therefore, skin thickness should be examined when choosing the pocket to be placed in patients.

I am diabetic. Is this an obstacle for a calf implant?

Although wound healing disorders can generally be observed in patients with uncontrolled diabetes for more than 10 years, the patient's skin quality and self-care determine whether such surgery will be performed or not. You can make the best decision on this issue together with your doctor.

Similarly, since smoking is a factor that can impair wound healing, I recommend my patients who will have a calf implant to quit smoking at least a week in advance.

I found out that I am pregnant. Should I have my implants removed?

There is no clear scientific report that silicone implants cause medical problems during pregnancy or lactation. In particular, calf implants have no effect on the pregnancy or breastfeeding process.

Can calf and leg plastic surgeries be performed by anesthetizing the waist?

In patients who will undergo fat injection by removing regional fat or combining it with implant surgery, the surgery can be performed by anesthetizing the waist (spinal anesthesia) or anesthetizing (general anesthesia) depending on the patient's request. Anesthesia from the waist and insertion of a pain catheter can ensure that the first night is pain-free. On the other hand, since the surgery time is already short, the risk of problems that may be encountered during general anesthesia is low. In both types of anesthesia, patients assume the risks of the relevant method. These risks are general risks that apply to all surgeries, and the anesthesiologist will give you the most appropriate information on these issues.