The Aesthetic Guide is part of the Informa Markets Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

Calf definition: Calf implants offer enhanced æsthetics for select patient groups

Article-Calf definition: Calf implants offer enhanced æsthetics for select patient groups

Key iconKey Points

  • Calf implants are used create a fuller appearance and correct deformities
  • Strategies for augmenting the upper calf without making it disproportionate with the lower calf and ankle are discussed

Range of standard size silicone calf implants. (All photos credit: John Rusca, M.D.)
The calves may not be the first anatomical area that comes to mind when patients consider cosmetic surgery, but there are indeed some who seek — and find — aesthetic benefit from calf augmentation, either with a fuller appearance or to correct deformities. Candidates for calf augmentation range from polio patients and people with congenital birth defects such as talipes equinovarus, to body builders or those who simply have thin or undefined calves and would like them to have a more shapely appearance.

TECHNIQUE UP CLOSE The silicone calf implants traditionally are designed to fit in a plane dissected between the gastrocnemius fascia and muscle to offer bulk to the upper and middle calf, and the implantation is relatively simple, says John Rusca, M.D., an Atlanta-based plastic surgeon.

"The implant is placed through an incision in the back side of the knee," Dr. Rusca tells Cosmetic Surgery Times. "You go down through the skin through the subcutaneous tissue, and down through the investing fascia of each head of the gastrocnemius muscle."

49-year-old male patient with thin calves due to congenital deformity of leg/foot (top) before and (bottom) five weeks after bilateral calf implants.
"You then make a nick inside the superficial gastrocnemius muscle and there's a space between the fascia and the actual muscle belly with no blood vessels. The implant goes into that space."

One of the most common complications that can occur with the surgery is displacement of the implant, notes Adrien Aiache, M.D., a Los Angles plastic surgeon and designer of one of the most popular types of calf implants. "Surgeons can get into trouble if the implant is in the wrong plane," Dr. Aiache cautions. "That can be corrected — not easily, but it can be done." Compartment syndrome, an intensely painful condition, can also occur if the implant is placed too tightly; however, such cases are not at all common, Dr. Aiache adds.

TAPER CHALLENGE The more common problem with calf implants is aesthetic in nature: If the patient's lower calves and ankles are thin, having calf augmentation may result in a disproportionate appearance that ends up making the lower calf look even more thin. Some implants are designed somewhat longer to try to provide a smoother transition to the lower calf, and an innovative "calf-tibial implant" designed in 2006 was described as offering patient satisfaction and improved aesthetics of the lower calf. But Dr. Aiache warns that, in his opinion, this implant involves crossing into risky anatomical territory. "I wouldn't touch that implant with a 10-foot pole," he says. "There are three big arteries down there and veins in that part of the leg, so it's really more dangerous."

Instead, Dr. Aiache sometimes uses autologous fat to smooth the transition from upper to lower calf. Dr. Rusca relates that he personally prefers Dr. Aiache's implants and shapes them to suit the patient. And while he agrees that augmentation of an already-thin calf area can emphasize a thin lower leg, he nevertheless chooses to use the regular calf implant placed right in the muscle compartment claiming that proper implant size selection is key.

"I think that as long as you're careful not to build the calf out to be too large — which could create a really disproportionate calf to the ankle — it still looks better with just calf augmentation to a modest degree than without it," Dr. Rusca says. He adds that he has only had modest success in enhancing the taper of the lower calf with fat. "I've seen some surgeons try to augment the lower third of the leg from the ankle up, but I haven't seen any that have been very successful," he says. "In my experience, the fat just doesn't stay for long. You can augment with fat and it will be there for several months, but eventually it will dissolve away."

Dr. Rusca blames the relative paucity of vascularity in this area of the leg for the poor autologous fat viability he's experienced in his patients. "Fat grafts really need good blood supply to survive."

COMFORT & LONGEVITY Despite being placed in an area of active daily movement, Dr. Rusca observes that his patients report no sensation related to the devices. "I've never had a patient say they could feel a calf implant," Dr. Rusca says. "It's like a breast implant... After about three weeks, it's incorporated in the body image and patients don't feel it anymore."

Dr. Aiache says he performed his first calf implantation back in the 1980s and hasn't noted problems with their longevity. And although body builders (who were early adopters of the procedure) still come in for the implants, Dr. Aiache says many who had received implants were disappointed to learn that the calf implants disqualified them from competition. "Many came back and wanted them removed," he says.

Dr. Rusca reports that his calf implant patients are evenly comprised of both men and women, with only about half of the male patients being body builders. Among the women, Dr. Rusca described half as being ordinary women from all walks of life, and the other half being younger women who are pursuing modeling careers.

THE FEW, THE AUGMENTED While calf implant patients' motivations run the spectrum, their total is small relative to the number of patients undergoing other cosmetic surgery procedures. Of 23 cosmetic surgical procedures listed in the American Society of Plastic Surgery's National Clearinghouse Report on Plastic Surgery Statistics, calf implants ranked last, with just 328 procedures performed in 2007. That's compared to 347,524 breast augmentation procedures in the same year.

However, both Drs. Aiache and Rusca say that, in their experience, the number of calf implant patients is holding steady, but not increasing — mostly because it remains a less well-known aesthetic option.

"I would say if you went out and asked, about 95 percent of people wouldn't even know that calf implants exist," Dr. Rusca says.


Gutstein RA. Augmentation of the lower leg: a new combined calf-tibial implant. Plast Reconstr Surg. 2006;117:817-826; discussion 827.

For more information
John Rusca, M.D.
[email protected]

Adrien Aiache, M.D.
[email protected]

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.