No Calf Measures! Calf Augmentation Surgery Explained: Procedure, Recovery & Results

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Strong thighs and toned abs often steal the spotlight but, for many, the elusive calf muscle refuses to play along. As such, when diet and exercise alone aren’t doing enough, a cosmetic calf augmentation procedure may provide the solution. Calf implants are becoming increasingly popular for both men and women, though their goals may differ: men often seek a more muscular, defined appearance, whereas women might prefer a softer, shapelier contour – an enhancement to give them a “well-turned” calf. Paola Chellew speaks with Dr Deon Weyers and Dr Saul Braun to learn more about what really goes into reshaping the lower leg. 

Are calves really the most difficult muscle to train? 

SB: Calves are the single muscle in the body that do not respond significantly to any exercise at all; in other words, they do not hypertrophy, get bigger, or change in shape. This explains why so many bodybuilders struggle to balance their well-developed thigh muscles with underdeveloped calves.  

Does genetics determine calf shape? Or can one change it through exercise? 

DW: Yes, absolutely. The shape of the lower leg, between the knee and ankle, is largely inherited. 

We are a product of our parents, so that plays a definite role, as well as what happens in the developing years. Up until late adolescence and early adulthood, the amount of exercise has a big impact on the ultimate shape and size of the leg. 

However, the calf is a very confined anatomical space. The skin sits closely over the muscle, leaving little room for growth. While training improves strength and definition, there is a natural limit to size gains. 

Who is a good candidate for calf augmentation? 

DW: It varies in both sexes and their individual goals. In my practice, I do more calf augmentation procedures on females, but it is also popular with males. When considering having this procedure, you should look at the desired outcome. For a typical example of a potential candidate: if you are a male who trains hard, with a good physique in general, but sees limited growth in the calves, you might want a more permanent solution to give a more balanced look to the body. 

Potential candidates are also those who don’t necessarily want to train and have a muscular appearance, and therefore won’t alter the shape that has been determined by their genetics and their development. 

If you are an individual with less shapely calves – maybe the leg just extends straight down from the knee to the ankle without a soft curve – then the augmentation procedure might be the answer.  

From a medical point of view, a patient needs to be sound and in good health, with ideally a normal body mass index (slightly overweight would be fine) and realistic expectations.   

SB: Importantly, calf augmentation should never be considered before growth is completed at about 18 years of age. 

What exactly are calf implants? 

SB: Calf implants are silicone-based, high-density cohesive gel in a silicone envelope, which comes in different shapes as well as lengths, widths, and projections.  

What are the different shapes and sizes? 

DW: The most common implant would be cigar-shaped, placed on the inner side of the calf muscle. 

How does the surgeon decide on which implant is best? 

DW: If the patient has had some development or muscular atrophy resulting in loss of muscle mass in the calf muscle – or in the case of a bodybuilder, where they require a more muscular enhancement – then it’s more of a reconstructive case, and the implant can be shaped accordingly. 

SB: After consulting with the patient, the surgeon decides on the exact shape and size of the calf that the patient would like to acquire. The dimensions of the implant have to suit the patient’s anatomy, and one has to take into consideration the patient’s skin, muscle, tightness, and length of the existing calf muscle.  

What does the procedure involve? 

SB: The procedure is done under general anaesthesia as an inpatient. The patient goes home on the same day in the afternoon, following the operation in the morning. The incision is approximately 4 cm in the crease behind the knee, either on the inner or the outer side, depending on which calf head is to be augmented.  

A dissection is made under the fatty tissue for approximately 2 cm, and then the fascia (the tight band of tissue that envelopes the muscle) is opened, and a pocket is dissected in exactly the position where the implant will be placed. This makes for the implant to lie directly on the muscle itself, and it will certainly animate when the calf muscle is contracted and with walking. Several deep sutures and a dissolving skin suture are applied with a crêpe bandage across the knee.  

What happens post-surgery?  

SB: After surgery, the patient is allowed to walk short distances for the first 5 days and may drive after a week. Heavy exercise, including calf contractions, is not to be performed for 6 weeks after the surgery.  

Are there any risks and potential side effects? 

SB: With a skilled surgeon, the risks are minimal. Potential side effects are infection and bleeding, which can occur in any operation and are particularly rare in this operation. Misplacement of the implant to cause asymmetry can also occur.  

What results can patients realistically expect?  

SB: The degree of satisfaction post calf augmentation is as high as 95%. The most important factor is that the patient is educated regarding the limitations of the procedure and as to what a realistic expectation would be.  

Are there alternatives to implants? 

SB: Fat transplant has been used to bulk up the calf. The problem is that this is inanimate – i.e. it does not move, does not look like a natural calf in any way, and, in my opinion, should be avoided. It is sometimes used to perfect particular imperfections in the shape of the calf after calf augmentation.  

It is also useful in augmenting the area around the ankle and above the ankle in people who have small calves with very thin lower legs. The calf implant cannot be placed lower than where the calf muscle ends, and in certain circumstances, the last 15–30 cm of the leg might remain very thin. This can be well tailored with fat grafting.  

DW: Body (dermal) fillers are becoming more and more relevant – although they haven’t quite replaced what a calf implant can do. That said, a filler can sometimes be used to soften the contours of the implant. According to ISAPS (International Society of Aesthetic Plastic Surgeons), hyaluronic body fillers are an acceptable alternative or addition in the scope of calf augmentation, and are becoming more relevant, although they cannot replace what a calf implant would do.

The disadvantage of using a body filler instead of an implant is that you need a lot of product to achieve a certain result, which is not permanent. Used in combination with implants, it could create a softer, more natural contour. Permanent fillers used, such as liquid silicone or where non-qualified physicians are injecting oils or paraffin oil, should not be done, and this has overwhelming complications and problems.

SB: In my opinion, these fillers are an absolute contraindication and bear in mind that they are a temporary solution. 

The bottom line 

Overall, it seems that implants remain the gold standard for long-lasting results; if you want a potentially quicker recovery, lower risks, and a more natural look, fat grafting might be the answer.  

Bearing in mind that each person is unique, a thorough consultation with a registered plastic surgeon (The Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa – APRASSA) is your first port of call.