| BODY CONTOURING | PEER-REVIEW
designed by Montellano (Figure 5). This implant has more projection at its upper third, imitating the muscle. However, the author prefers the Glicenstein implant to enhance the lateral aspect of the leg. This implant is fusiform and symmetric, with maximal projection at its middle. The medial aspect of the leg is very shapely, with an upper convexity and a lower concavity. However, as the lateral gastrocnemius has less volume, the leg laterally has a gentle convexity. In men that train heavily or follow special diets, the
implants can be seen subcutaneously when placed in the classical plane, subfascially4, 5
the submuscular approach more requently6
. The author now uses . The wound
is made at the posterior crease of the knee, the skin undermined and an incision is made at the fascia 4 cm lower to the skin incision. With a finger, the author identifies the border of the gastrocnemius and enters the space between this muscle and soleus. The pocket is made between them down to the Achilles tendon and between the midline of the leg and the edges of the bones (tibia and fibula). Care must be taken to avoid dissecting in the midline, where the sural nerve is located.
Figure 6 Calf augmentation, subfascial. Two implants in each leg (Montellano medial of 140 cc and lateral of 85 cc). (A, B) before and (C, D) after
For most patients, commercially-
available implants give a very natural profile and are enough for their expectations.
Figure 7 Calf augmentation, submuscular. Two implants in each leg (Montellano medial of 140 cc and lateral of 85 cc). (A, B) before and (C, D) after
The chosen implant depends strictly on the length of
the pocket, which is positioned between the incision at the fascia and the most caudal limit of the pocket. The patient can start walking with crutches the next
day. Painkillers and sometimes muscular relaxants are needed, especially when two implants are placed. It is very important to watch out for any sign of ischaemia or compartment syndrome. Sometimes the patient may feel paresthesia and sensory disturbances that resolve spontaneously. The author treated 11 male patients between 2009 and 2012, as follows: Group I: patients who complained of a lack of volume at the medial aspect of the leg and did not want a big augmentation. One patient with Glicenstein (symmetric) implant, 90 cc, subfascial
Group II: atrophy owing to neurological problems, sequelae of poliomyelitis or previous foot operations. Four male patients. Three patients needed two implants (medial and lateral). In one patient tissue expanders were used under both muscles and these were replaced by one 500 cc oval implant for
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