Efforts to reduce calves for many years involved liposuction; however, results were often disappointing due to the lack of fat and abundance of muscle in the calf. The alternative solution of partial resection surgery of the gastrocnemius muscles was first developed in South Korea, where Dr. Park practices, and where there is high demand from Asian women, who often have short, muscular calves.
That surgery, however, is invasive — typically requiring general anesthesia and an overnight hospital stay — and it leaves a scar.Enter radiofrequency thermal ablation, which can also offer significant reduction, but in a noninvasive manner, requiring no hospital stay and leaving no scar, says Dr. Park, chief of the Samsung Aesthetic Clinic, Kangnam, and associate professor at Samsung Medical Center, Seoul, South Korea.
The method specifically uses low levels of radiofrequency energy to create small, finely controlled necrotic lesions. Following the general pattern of wound healing, the necrosis leads to scar formation and retraction of tissue, resulting in an overall reduction of volume, Dr. Park says.
Over time, the scar tissue is partially resorbed by the body, causing further volume reduction.
Applying the method
In his practice, Dr. Park uses a local anesthetic solution, along with a custom designed guide needle and insulated RF needle inserted into the muscle core. The crude total of RF energy used per calf is about 10Kj to 15Kj, depending on volume, with a concentration on the medial head of the gastrocnemius.
Postoperative management should include Jobst compression for about a month to prevent fluid collection, and vigorous exercise should also be restricted for a month following the operation. Pre- and post-op evaluations should include photos, ultrasonogram and measurement of circumference change.
Dr. Park reported on RF volume reduction among 250 patients, 249 of whom were female, evaluated between July 2004 and April 2006. Follow-up on patients extended up to 17 months. The study showed an average of 1 cm to 5 cm reduction in circumference after three months and up to 6 cm reduction at six months. Contour change was usually seen four to six weeks following an operation.
The overall average reduction was 2.5 cm at six months and was maintained as far as 17 months out until now. The patients showed no functional disability.
Among complications that can occur with RF gastrocnemius reduction are sensory nerve damage, possible gate disturbance or compartment syndrome, incomplete reduction, irregularity, edema, seroma, hematoma or infection. However, Dr. Park says there were no irreversible sequelae.
"It's very gratifying to help improve the appearance of these women's calves without causing functional disability," Dr. Park says. "I regard this as an exceptionally valuable technique in plastic and aesthetic surgery."