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Calf reduction (Partial gastrocnemius muscle resection)


  1. Introduction : Why parital gastrocnemius muscle resection
  2. Various Methods of calf reduction
  3. Comparison chart of various calf reduction methods
  4. The Procedure
  5. The Recovery
  6. Risks & Complications
  7. FAQ about calf reduction
  8. Consultation for calf reduction
  9. View examples of calf reduction

Introduction : Why parital Gastrocnemius muscle resection ?

Beautiful calves are desirable to both men and women all over the world. Unfortunately many Asian women have short and muscular calves. Thus, the muscle reduction surgery was first developed in Korea.
For many years, the efforts to reduce calves had focused on fat. But result of liposuction was disappointing in most cases because the calf was mainly composed of muscles with little fat.
By reducing the muscle bulk of Gastrocnemius muscles, the calves can be made thinner and longer.
Among various methods which can reduce the muscle bulk in calf, partial resection of Gastrocnemius muscle is the most effective and safest procedure.

Comparison of various methods to reduce calf
There are many methods which can reduce the calf muscle.
  1. Botox injection to Gastrocnemius Muscle
    Botox injection to Gastrocnemius muscle is very simple and was popular about 10 years ago.
    But its ineffectiveness and need for frequent injection have made this method useless and it is rarely used nowadays.
    It can temporarily reduce the prominence of Gastrocnemius a little bit and the patients need repeated injection every 4 to 6 months.
  2. Nerve Block by Transection, Toxin injection, Radiofrequency Ablation
    By blocking the motor nerves to Gastrocnemius muscle, it can induce the atrophy of Gastrocnemius muscle.
    Eventhough this method is simple and leaves minimal scar(Toxin injection or Radiofrequency Ablation), these nerve blocking have some disadvantages and produce unsatisfactory result:
    Because nerve transection can reduce only medial Gastrocnemius muscle, the lateral Gastrocnemius can be hypertrophied and the legs can be looked bowed.
    Because the calf circumference decrease little to none (below 2 cm), the satisfaction rate for patients is low.
    The result is unpredictable. That means even the doctor can't predict how much muscle will be atrophied.
    Because of the nerve anomaly (over 15%), the risk of injury to other nerves and important vessels are high.
    The recurrence and asymmetry are frequent and can't be treated effectively.
  3. Radiofrequency Muscle Ablation
    Ablating the muscle can induce fibrosis and contracture in muscle.
    Eventhough this fibrosis and contracture make the muscle bulk reduced in volume, it also make many stony hard scar in muscle and secondary correction is extremely difficult.
    The postoperative recovery is long and reduction in calf circumference is not enough.
  4. Partial gastrocnemius muscle resection
    This is the safest, most predictable and effective procedure that can make a remarkable change both in shape and circumference of calf.
    By resecting the part of medial and lateral Gastrocnemius muscle, we can control where and how much muscle could be removed and predict the result more accurately.
    Because there are no important vessel or nerves inside of muscle fascia, there is no risk of nerve or vessel injury.
    Eventhough the postoperative recovery period is long, it worth it !


Comparison chart of various calf reduction methods
  Botox Nerve blocking Radiofrequency Muscle Ablation Partial Resection of Gastrocnemius
Procedure Simple injection of Botox to Gastrocnemius muscle Motor nerve to Gastrocnemius block by injection of toxin (alcohol or pheonol) or radiofrequency ablation Burn muscle fiber by radiofrequency muscle ablation Removal of muscle fiber directly according to the patient's calf shape
Candidate Thin calf with Gastrocnemius muscle bulge Thin calf with Gastrocnemius muscle bulge All the patients who want calf reduction All the patients who want calf reduction
Cost 500-1,000 USD 2,000 - 5,000 USD 5,000 - 10,000 USD 5,000 -10,000 USD
Scar None Spot Spot 2 cm in popliteal fossa
Recovery No need 1 week difficulty in walking 2 weeks difficulty in walking 2 weeks difficulty in walking
Effect Reduced muscle prominence for 4-6 months
No decrease in calf circumference
Reduced muscle prominence and decrease in calf circumference 0-2 cm Reduced muscle prominence and decrease in calf circumference 0-4 cm Total reshaping of calf muscle and decrease in calf circumference 2-8 cm
Possible Complications   Motor nerve to Soleus injury and gait disturbance
Tibial artery or vein injury
Incomplete result and asymmetry
Frequent recurrence
Hematoma
Irregularity and asymmetry
Unsatisfacotry result
Muscle fibrosis & scarring
Frequent recurrence
Hematoma
Irregularity and asymmetry
Advantages Simple
Non-invasive
Short recovery period
Simple and cheap operation
Spot scar
Spot scar Predictable result
Prominent decrease in calf circumference
No risk of nerve or vessel injury
Reshaping of muscle in calf
No recurrence
Disadvantages No decrease in calf circumference
Need for frequent injection
Unpredictable result
Unsatisfactory decrease in calf circumference
Compensatory hypertrophy of lateral Gastrocnemius and Soleus muscle
Frequent recurrence and incomplete result
Unpredictable result
Unsatisfactory decrease in calf circumference
Long recovery period
Difficulty in secondary correction
Possible nerve or vessel injury
Unpredictable result
Long recovery period
2 cm Scar
Necessity of experience and skill of doctor


The Procedure
This procedure normally takes about 1 and half hour under general anesthesia.
First, a nurse will insert an IV for a saline drip to keep you hydrated and have a vascular doorway and will scrub your legs with sterilizartion solution in standing position..
Then, the anesthesiologist will insert an anesthetic solution into your IV line.
Immediately after injecting the anesthetic solution, you will not feel anything and fall into sleep.
2 cm long incision will be made along the natural fold behind knee.
Through this incision, muscle fibers are delievered directly under direct vision.
Before closing the incision, a suction drain can be inserted to prevent collection of blood (hematoma).
Finally, the legs will be wrapped with elastic bandages.
The patients will be admitted in hospital for 1 day.
Usually patients can't feel pain in rest and feel tightness when trying to walk.
When you are ready to leave you will be instructed to wear high heel shoes with flat bottom and are instructed about stretching of calf muscles.

The Recovery
The two most important things in recovery phase are minimizing swelling and stretching of the calf muscles.
To minimize swelling, you should wear compression stockings for 3 months and elevate your legs for 1 month.
Keeping the legs elevated will reduce the swelling and pain and produce better results.
The stretching exercise should be done every 30 minutes for about 5 minutes.
If you don't do the stretching exercises regularly, you may feel more tightening in walking which will be aggravated.
The stretching exercise should be done for about 3-6 months.
The scar will be faded after 3 months.
Antibiotics, antinflammatory agents, muscle relaxants and pain killers will be prescribed.
Take the medications exactly as prescribed with no other drugs.
Follow-up visits to the clinic vary, but usually occur 2, 5, 8 and 14 days post-operation.

The exact down time for this procedure is difficult to predict, but usually you can see the result after 1 or 2 months..
I usually recommend the foreign patients who will undergo this surgery staying in Korea for more than 2 weeks.
Normally, you may return to exercise after 6 weeks.


A 26 year old (154cm height and 45kg weight) female who has muscular and bowed calf underwent calf reduction.
After surgery, her legs look thinner, longer and straighter without muscle bulge in tiptoe (or wearing highheels) and the scar became innoticeable. Her calf circumference decreased to 30.5 cm and was maintained even at 2 year followup.

Risks & Complications
The possible complications are minor asymmetry, irregularity, hematoma, contracture and sensory nerve injury.
Because there are no important vessel or nerves inside of muscle fascia, there is no risk of nerve or vessel injury. no gait disturbance. .

FAQ
  1. Am I a candidate for calf reduction ?
    If you are in good health(no serious illness) and have realistic expectations, you may be a good candidate for calf reduction.
    Not only the patients who have thick calves but also the patients who have normal calves can be candidates for this surgery.
  2. How many surgery have you performed and was there any serious side effects ?
    I've performed this partial resection of Gastrocnemius muscle over 400 cases for 9 years without any serious complications.
    I have the highest specialty in this surgery in the world and the most experienced surgeon.
  3. Is it possible to undergo this calf reduction and liposuction together ?
    Because there are little fat in calf, the result of liposuction is usually disappointing.
    But I frequently perform liposuction in ankle and medial knee to make legs look straighter and longer.
  4. Is it painful ?
    Most patients say the pain with calf reduction is similar to muscle clamp in calf.
    Patients feel this pain only when they try to walk.
    The prescribed oral pain medication can alleviate the pain.
  5. How's the scar ?
    Calf reduction incisions are made along the natural crease behind knee, where the leg bends.
    The scars will be flattened and faded with time although they may be reddened and raised for months.
    You should apply skin tapes across the wound for 2 to 3 months and can apply scar gel after that.
  6. When can I return to work?
    You should wait a week to ten days to return to work.
    You shouldn't walk excessively after calf reduction for a week.
    As long as you are not doing any hard labor, most patients return to work after 10 days - some 5 days.
  7. When canl I see the results?
    You can see the result after 1 or 2 months but the final result after 6 to 12 months.
  8. Does the result persist forever ?
    The result is essentially permanent and does not diminish over time.
    The resected muscle fibers cannot be regenerated.
  9. How much my calf can be improved ?
    How much can the circumference of calf be decreased vary according to the individual patients.
    1 to 2 inches (3-6 cm) of reduction is usual.
    The goal of this surgery is to make the circumference of calf as ideal (20% of height) and to reshape calf muscle to longer and straighter looking calf.
  10. How long should I stay in Korea for this surgery ?
    In minimum, we need about 10 days for recovery.
  11. But I recommend the foreign patients staying in Korea for more than 2 weeks for proper care and preventing complications.
  12. Can you recommend the doctors in America or Europe who can do this surgery ?
    No, there is no doctor who can do this type of surgery in USA , Canada and Europe. You should come to Korea to undergo this surgery.
  13. How much is the cost of this surgery ?
    The cost of this surgery depends on the range and amount of muscle resection.
    The usual cost of this surgery is 5,300-6,300 USD.
 
 


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