[DuHan Plastic Surgery Calf Contouring] - [Methods and Problems of Calf Muscle Reduction]

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The calf bulge is caused by

the gastrocnemius muscle,

and the key point is how effectively it can be reduced without side effects.

There are various methods for calf contouring,

but although each has advantages, most also have many disadvantages.

The principle of calf contouring is

to choose a method with a high treatment effect

and no recurrence. It is important to understand the advantages and disadvantages of the procedure well

before undergoing treatment so that side effects or dissatisfaction do not occur.

As with all plastic surgery, the surgeon's experience is very important.

No matter how good the equipment is,

if the surgeon's skill or experience is lacking,

the result will be unsatisfactory.

Director Shin Duhan

Causes of thick calves - muscle is the main cause

The causes of calves that are thick or clearly show bulging are muscle and fat, but in most cases the main cause is muscle.

Anatomy of bulging calves

The cause of bulging calves is the gastrocnemius muscle, the outermost layer of the calf.

The gastrocnemius is divided into medial and lateral heads, and usually the medial side is more hypertrophied.

Beneath the gastrocnemius is the soleus muscle,

and beneath the soleus are several other muscle layers arranged in multiple layers.

The thickness of the gastrocnemius is usually 2 cm when relaxed

and becomes about 3 to 4 cm thick when contracted, creating bulging calves.

The purpose of nerve block procedures is to reduce the volume of the outermost gastrocnemius muscle, which causes bulging calves.

Movement of the leg involves several other muscle layers, including the soleus, which are involved in the movement of the calf and foot,

and the outer gastrocnemius has no special function, so even without it, leg function is not affected at all.

Procedures for calf muscle reduction and their development

1. Muscle resection surgery - a method of making an incision of about 4 cm in the back of the knee and removing the gastrocnemius with surgical instruments
2. Nerve resection surgery - a method of making an incision of about 4 cm in the back of the knee and resecting the motor nerve going to the medial gastrocnemius
3. Neurolysis - a method of locating the nerve with a nerve finder and injecting phenol solution into the nerve to dissolve it
4. Botox treatment - a method of using Botox to block neurotransmitters at the nerve endings and cause the muscle to atrophy
5. Mid-frequency muscle ablation - a method of burning and necrotizing the gastrocnemius, which causes bulging calves, using a mid-frequency ablation device
6. Selective nerve block - a method of locating the motor nerve of the gastrocnemius with a nerve finder and electrically coagulating the nerve
7. Ultrasound-guided selective nerve block - a method of precisely identifying the location of the nerve with ultrasound and a nerve finder and then electrically coagulating it

Problems with procedures for calf muscle reduction

Muscle resection surgery - scars and contour irregularities in the calf This method involves making a 4 to 6 cm incision in the back of the knee and removing the gastrocnemius itself with surgical instruments. It leaves a large scar in the back of the knee, and because the muscle is resected irregularly, the shape is not good. Severe swelling and pain make it difficult to resume daily life immediately. In other words, it does not allow a quick return to social life after the procedure and may cause large scars and contour irregularities in the calf, so it is hardly suitable for cosmetic purposes. It is rarely used today.
Nerve resection surgery - scars and bow legs This method makes a 4 to 6 cm incision in the back of the knee, finds the medial motor nerve going to the gastrocnemius, and resects it. It leaves a large scar in the back of the knee. Because only the medial nerve is resected, the lateral muscle may develop relatively more, which can result in bow legs. Because it leaves scars and can cause bow legs, great caution is required.
Neurolysis - insufficient treatment effect and frequent recurrence This method uses a nerve finder to locate the nerve and then injects a drug (phenol) around the nerve to dissolve it. Because the nerve search itself is not done properly, the procedure is not accurate, and after phenol is injected, the expectation is that the nerve will dissolve. However, the effect is often below expectations or nearly absent. As the phenol spreads, it may damage important nerves or blood vessels. In other words, caution is required because insufficient treatment effect, recurrence, and side effects due to drug spread can occur.
Botox treatment - insufficient results and recurrence This method temporarily paralyzes and atrophies the calf gastrocnemius with Botox. However, the treatment effect is weak, the cost is high, and it is a temporary method that recurs after several months, so it is not a recommended method for calf reduction surgery. Botox is mainly effective when used on the masseter muscles that cause a square jaw, but using it on calf muscles, which are dozens of times larger, is too much of a stretch and is rarely used.
Mid-frequency muscle ablation - insufficient results, severe swelling, and pain This method burns the gastrocnemius with a mid-frequency ablation device to necrotize it. Because the muscle itself is damaged, the procedure is burdensome, and side effects such as damage to tissues other than muscle may occur. As the muscle becomes necrotic, scar tissue is produced, which can cause various problems such as insufficient results, recurrence, contour irregularity, and sensory disturbance. In other words, the effect is poor, and contour irregularity and recurrence are common.
Selective nerve block - insufficient results and recurrence The principle is to block the gastrocnemius nerve branching from the tibial nerve so that the gastrocnemius loses motor function. Since blocked muscles cannot contract or relax, their motor activity is lost and the muscles gradually atrophy over time. However, it is very difficult to probe around with a nerve finder to locate an invisible nerve, and if the nerve is not found properly or if the nerve that is found is incompletely blocked, the biggest problem is reduced treatment effect and frequent recurrence.

DuHan Plastic Surgery calf muscle reduction procedure

Non-incisional ultrasound-guided selective nerve block - requires expensive equipment, accumulated experience, and technique

This method uses both the nerve finder, which is the basic equipment for nerve block, and ultrasound imaging

to locate the nerve accurately and block it.

A drawback is that finding nerves that cannot be seen is tricky and time-consuming.

Also, if the nerve deviates from its normal path, finding it becomes very difficult,

and there are frequent cases where the procedure is not performed properly.

If the nerve is not found properly, the treatment effect is reduced,

side effects may occur, and recurrence rates are high.

To search for nerves more quickly and accurately, an ultrasound imaging device with a high-frequency probe is used.

By checking with ultrasound while searching for nerves, it is possible to find them accurately

and effectively block multiple nerve branches within a short time.

This is a non-incisional ultrasound-guided selective nerve block,

which has the advantages of increasing treatment effectiveness and significantly lowering recurrence rates without side effects.

It is the most advanced method for muscle reduction surgery, but it requires expensive equipment

and also a great deal of procedural experience and skill.

Equipment for non-incisional ultrasound-guided selective nerve block

In addition to the basic equipment for nerve block, an ultrasound diagnostic device is used as a visual inspection tool

to find the nerve branches more quickly and accurately.

With the basic equipment alone, there are limitations in finding nerves,

and when there are many nerve branches or nerves traveling along unexpected paths, they are very difficult to locate.

The success of the procedure depends on finding the nerve branches accurately and in a short time.

For this reason, ultrasound equipment helps improve the accuracy of the procedure and shorten the time.

Advantages of non-incisional ultrasound-guided selective nerve block

1. It can find nerve branches quickly and accurately, so the treatment effect is high.
2. It significantly shortens procedure time compared with using only basic equipment.
3. Because the nerve branches are identified accurately, it does not damage tissues in other areas, making it safe.
4. Because the procedure time is shortened, there is less pain after the procedure and recovery is faster.
5. Due to the procedure being performed through accurate nerve searching, the recurrence rate is significantly reduced.

Examples of non-incisional ultrasound-guided selective nerve block procedures

Comparison between non-incisional ultrasound-guided selective nerve block and other calf surgery methods

Classification	Incisional muscle resection surgery	Incisional nerve block surgery	Mid/high-frequency muscle reduction surgery	Neurolysis	Non-incisional ultrasound-guided selective nerve block
Scar	3 to 4 cm on the back of the knee	3 to 4 cm on the back of the knee	No scar	No scar	No scar
Procedure time	1 to 2 hours	1 to 2 hours	40 minutes to 1 hour	30 minutes to 1 hour	30 minutes to 1 hour
Effect and prognosis	Uneven legs may result because of irregular muscle removal.	Highly effective. Only the medial side can be treated, so the lateral side becomes compensatorily thicker. It may look bow-legged.	Low effect. Little reduction in thickness.	The effect is inconsistent, and due to drug spread, the drug may act on unintended areas and cause side effects.	Highly effective. Calves become much slimmer. Both medial and lateral sides are treated, sufficiently reducing the muscle.
Discharge and function	Severe swelling, bruising, and pain require 1 to 2 weeks of rest. Walking is very uncomfortable for about a month.	Uncomfortable for about 15 days, and walking is difficult. There is pulling pain for about a month.	Accompanied by severe swelling and pain, walking is uncomfortable for about a month.	It is possible to return to daily life immediately, but there may be pulling pain for about 3 to 4 weeks.	It is possible to return to daily life immediately, but there may be pulling pain for about 3 to 4 weeks.

Post-procedure course after non-incisional ultrasound-guided selective nerve block

If only the medial calf is treated, the procedure takes about 30 minutes. After the procedure, you simply wear the compression band provided by the hospital.
Immediately after the procedure, you can lift your heel and directly confirm that the calf bulge no longer appears.
There may be slight pulling pain after the procedure, but it does not interfere with daily life.
There is almost no swelling or bruising.
Due to gradual muscle atrophy, slight pulling and stiffness in the calf for about a month is a normal part of the recovery process.
A visible reduction in calf thickness can be noticed after about 15 days to a month.
Maximum effect appears after 3 to 6 months, and if there is no recurrence, the procedure effect is permanent.

Post-procedure precautions for non-incisional ultrasound-guided selective nerve block

1. Due to gradual muscle atrophy, slight pulling and stiffness in the calf for about a month is a normal part of the recovery process. There may be some discomfort when walking, but if you naturally stretch the muscle while walking, the pulling sensation will gradually disappear. The period until the pulling sensation disappears can range from as short as 2 weeks to more than a month.
2. It is better not to wear very high heels for about a month. Since the muscle shrinks as it atrophies, there will be a pulling sensation. To address this, wearing shoes with low heels or sneakers and doing light exercise such as walking little by little can help stretch the muscle, improve the procedure effect, and relieve the pulling and stiffness faster. 3. If you start wearing high heels immediately after the procedure, the muscle length may shorten, which can cause a tiptoe side effect where the heel does not touch the ground, so caution is required.
3. If you start wearing high heels immediately after the procedure, the muscle length may shorten, which can cause a tiptoe side effect where the heel does not touch the ground, so caution is required. However, this problem will absolutely not occur if you live in low-heeled shoes or sneakers for about a month.
4. In hospitals with little experience in calf procedures, patients are sometimes told to wear high heels after the procedure. This should never be done. If you wear high heels, the muscle remains contracted, so if that state continues, it is natural for the muscle length to shorten. If the muscle length shortens, the heel will not touch the ground. This advice comes from not understanding the principle of muscle atrophy, so please keep in mind that it can create side effects that should not occur.

Principles of calf muscle reduction surgery

1. It should not recur. It is most important that proper treatment prevents recurrence.
2. The effect must be clear. The result of muscle reduction should be certain and close to 100%.
3. There should be no side effects. There should be no side effects so that other tissues are not damaged.
4. Daily life should be possible immediately. Bruising, swelling, and pain should be minimized so daily life is possible right after the procedure.

Frequently asked questions and answers about calf reduction surgery

Question) Is calf muscle reduction surgery something anyone can do? Calf procedures are absolutely not something anyone can perform. As with all surgeries, the results vary depending on the surgeon's experience and know-how. Simply having the equipment does not mean everyone can perform the procedure well. The same applies to calf reduction surgery: success or failure depends on how the procedure is performed. If the nerve block is not done properly, there will be no effect or the nerve will regenerate and recurrence will occur. The key to nerve block is to identify many nerve branches within a short time and perform reliable electrical coagulation to reduce the recurrence rate. Blocking one or two nerves does not reduce the calves. People tend to think calf procedures are easy, but that is absolutely not the case.
Question) Is ultrasound-guided selective nerve block a procedure performed only at this hospital? General nerve block has a high recurrence rate, so ultrasound-guided selective nerve block was developed to improve it. Even if another hospital introduces a nerve blocker and ultrasound at the same time, simply having the equipment does not mean the procedure can be performed. The operator's experience and skill are important. Other than our hospital, there are no hospitals performing ultrasound-guided selective nerve block. We are the only hospital performing non-incisional ultrasound-guided selective nerve block.
Question) During calf muscle reduction surgery, other hospitals do it under local anesthesia, but do I really need sedation anesthesia? Nerve block for muscle reduction must be done under sedation anesthesia. When the nerve is electrically coagulated with a nerve finder, heat of around 100°C is generated to block the nerve, and this heat causes pain. Therefore, if sedation anesthesia is not used, the procedure is impossible because of pain. In addition, local anesthesia is also used during calf procedures, but this does not anesthetize the muscle; it only numbs the skin layer where the needle enters, so it is not very meaningful. If the muscle is anesthetized, the muscle will not respond to the nerve finder, so the procedure cannot be performed. There are cases where other hospitals perform the procedure without sedation anesthesia, yet there is little pain and the procedure can be tolerated. The reason is that during electrical coagulation they use weak heat at a low temperature, so there is little pain. In such cases, because the electrical coagulation of the nerve is not done properly, there is no effect immediately after the procedure, or the calf bulge seems to improve temporarily but recurs within a few months. An incomplete procedure using weak low-temperature heat will 100% recur, so please be aware.
Question) How much volume is reduced after calf muscle reduction surgery? As the muscle volume decreases, the calves become slimmer, but there are individual differences to some extent. The larger the muscle volume, the greater the reduction, while those with smaller volume will see less reduction. A simple example is the difference in change when a balloon is blown up large and then deflated versus when it is blown up small and then deflated.
Question) Are calf reduction surgery and muscle reduction surgery different? The meaning of calf reduction surgery is broad. Since it means reducing the calves, it includes muscle reduction surgery and liposuction. In a broader sense, it also includes calf plastic surgery. This includes all types of plastic surgery such as muscle reduction surgery, liposuction, varicose vein surgery, and scar revision. In other words, within the overall category of calf plastic surgery, there is calf reduction surgery, and within reduction surgery there are muscle reduction surgery and liposuction.
Question) Are calf muscle reduction surgery and nerve block different? They can be seen as having the same meaning. Muscle reduction surgery is a broad term. The method used for reducing calf muscle is nerve block, so the method is nerve block surgery. In other words, because muscle reduction is achieved using the method of nerve block, they can be regarded as the same.
Question) What is the most effective calf muscle reduction surgery? Various methods have been devised and performed so far, but the most effective procedure is ultrasound-guided selective nerve block. As an advanced version of selective nerve block, it addresses the biggest problems of the existing method: difficulty locating the nerve and difficulty performing a second confirmation treatment on the located nerve. As a result, the treatment effect was reduced and recurrence rates were very high. Ultrasound-guided selective nerve block was developed to solve this. Because the procedure is performed while directly checking the nerve on the ultrasound screen, it is found more accurately and quickly, and it has the advantage of allowing repeated confirmation treatment at the same site, so the effect can approach 100% and recurrence rates can be significantly lowered. In addition, because it causes almost no damage to tissues in other areas, swelling and pain are minimized and recovery is fast, among other advantages.
Question) What are the problems with the existing selective nerve block? The basis of selective nerve block is to reduce the muscle without scars and without damaging the muscle. The biggest problem with the existing selective nerve block was that, in order to find invisible nerves, one had to probe around with a search needle to locate hidden nerves. As a result, finding the nerve was very difficult, it took a lot of time, and when the nerve was not properly found, the procedure was less effective and recurrence occurred easily. Although selective nerve block is theoretically an ideal method for reducing muscle with minimal scarring and minimal tissue damage, the actual results do not meet expectations. Therefore, ultrasound-guided selective nerve block can be considered the best alternative.
Question) What is the difference between mid-frequency muscle reduction surgery and selective nerve block? Both procedures have the same purpose of reducing muscle. The difference is in the method: mid-frequency treatment directly burns the muscle to necrotize it and reduce muscle volume, while nerve block treatment causes the muscle to naturally atrophy by blocking only the nerves going to the muscle without damaging the muscle itself. In other words, the difference is whether the muscle is directly burned and reduced, or whether only the nerves going to the muscle are blocked to reduce it.
Question) What are the problems with mid-frequency muscle reduction surgery? Mid-frequency treatment is a method of directly burning and necrotizing muscle. Tissue damage is severe, and side effects and aftereffects occur frequently. Severe swelling and pain, inflammation from tissue necrosis, contour irregularities of the leg, and depressions due to accompanying necrosis of fatty tissue may occur. In addition, the effect of volume reduction is not very large, so it is not a recommended procedure for calf muscle reduction surgery.
Question) What side effects can occur with selective nerve block? These problems occur when the operator lacks experience and skill. Side effects include blocking the wrong nerve and weakening leg strength, damaging sensory nerves and causing sensory disturbance, severe pain caused by damaging tissues other than nerves, contour irregularity or asymmetry due to incomplete nerve block, and tiptoe side effects caused by incorrect instructions after the procedure. However, if you receive a proper procedure according to the principles, you do not need to worry about these side effects.
Question) Will there be scars after selective nerve block? Because this is not a surgery with a scalpel incision and is performed using a 1 mm blunt search needle, there are almost no scars. There is a 1 mm mark at the procedure site, but it is too small to be visible, so it cannot really be considered a scar. Therefore, there is no need to worry about scars.
Question) I heard that a tiptoe side effect where the heel does not touch the ground can occur after the procedure. Why does that happen? The tiptoe side effect where the heel does not touch the ground is caused by wearing high heels continuously starting immediately after the procedure. It is not a side effect caused by the procedure being done incorrectly. If the tiptoe side effect occurs, you should walk around barefoot as much as possible so that the contracted muscle can be stretched and lengthened again. Walking barefoot indoors or wearing almost flat shoes outdoors will naturally stretch and straighten the muscle. If the side effect occurs and you take off your shoes, walking may become uncomfortable and you may end up continuing to wear high heels, but this only worsens the condition. In the early stage of a tiptoe problem, the best approach is to quickly stop wearing high heels, switch to flat shoes, and keep practicing walking until the muscle lengthens and straightens again. Usually, if walking practice in flat shoes is done within six months after the procedure, the tiptoe problem can resolve on its own in most cases. In conclusion, if you do not wear high heels for about a month after the procedure, this side effect will not occur.
Question) Other hospitals say that even if you wear high heels immediately after the procedure, tiptoe side effects will not occur. Is that true? After the procedure, as the muscle atrophies, the muscle length shortens, which causes the tiptoe side effect. Wearing high heels is the main cause. When you wear high heels, the muscle remains contracted, causing the muscle length to shorten and the tiptoe side effect to occur. However, in many cases, even people treated at other hospitals do not develop the tiptoe side effect despite continuing to wear high heels from immediately after the procedure. The reason is that the procedure was not performed properly, so the muscle did not atrophy, and therefore the tiptoe side effect did not occur either. In other words, it is similar to a person who did not receive the procedure at all but still wears high heels continuously and does not develop the tiptoe side effect. If you wore high heels continuously from immediately after calf treatment and did not develop a tiptoe side effect, that proves the procedure had almost no effect, and if you check your calves, the original bulges will likely still be there.
Question) When can I return to daily life after selective nerve block treatment? After selective nerve block surgery, you can return to daily life the next day. On the day of the procedure, there may be a little weakness in the legs and a dull, stiff pain. However, starting the next day, normal daily life is fully possible, and you just need to wear the compression band provided by the hospital for about a week.
Question) What happens if the condition recurs after the procedure? After a general selective nerve block, the recurrence rate is very high. In hospitals with high recurrence rates, more than 80% recurrence is common. In other words, if 10 people are treated, 8 to 9 recur, and if the recurrence rate is that high, the procedure is meaningless. DuHan Plastic Surgery's calf contouring clinic developed the non-incisional ultrasound-guided selective nerve block to minimize recurrence. Currently, the recurrence rate at DuHan Plastic Surgery's calf contouring clinic is 3% or less, and we are continuously researching and making efforts with the goal of a 0% recurrence rate. If recurrence does occur, we provide repeat treatment to correct it.
Question) If I had selective nerve block at another hospital and it recurred, can I get treatment again here? After nerve block at another hospital, recurrence rates are high. When recurrence occurs or there is no effect, many people resign themselves and think it may be due to their constitution. In most recurrence cases, constitutional factors are only a small minority. Most are caused by the operator's lack of experience and skill, and by insufficient equipment. Once a procedure has been performed, the tissue becomes firm and dull, so the nerves often do not respond to the nerve finder. If the nerves do not respond, their location cannot be identified, so the procedure cannot be performed. Therefore, for repeat treatment, good results cannot be obtained unless the nerves are found directly with ultrasound imaging and treated. After recurrence, only ultrasound-guided selective nerve block can properly perform repeat treatment.
Question) I had mid-frequency treatment at another hospital and did not see results. Can I still receive nerve block treatment here? Mid-frequency treatment is a method of directly burning the muscle with an ablation device to cause necrosis, but in most cases the effect is weak or the condition recurs. In some cases, a contour irregularity occurs due to a height difference between the treated and untreated areas. Even in such cases, non-incisional ultrasound-guided selective nerve block can be performed. Because nerve block causes almost no damage to the muscle and blocks only the nerves, it induces natural muscle atrophy and can create a natural shape even in cases of recurrence or contour irregularity.
Question) I have tried all kinds of procedures such as nerve block and high-frequency treatment at other hospitals, but why is there no effect? As with all surgeries, results vary depending on the surgeon's experience and know-how. Without ultrasound equipment, repeat treatment with nerve block is almost impossible. Mid-frequency treatment itself is not a procedure that is highly effective for muscle reduction surgery. The lack of results is due to choosing the wrong procedure and the operator's lack of equipment, experience, and skill. A proper procedure can produce permanent results with just one treatment. Even if you have failed after many procedures at other hospitals, at our clinic you can usually see satisfactory results with just one treatment.

Notes on calf contouring

There are many calf reduction methods, but only a few are suitable.
The choice of procedure depends on the shape and cause of the thick legs.
A good procedure is one that has no side effects and clear effectiveness.
The method chosen should minimize swelling and pain after the procedure.
For muscle reduction surgery, the preferred method is non-incisional ultrasound-guided selective nerve block.
In cases of calf fat, liposuction is performed.
For vascular enlargement, scarless surgery or sclerotherapy is performed.

http://www.duhans.com

At DuHan Plastic Surgery's calf contouring clinic,

the world's first ultrasound-guided non-incisional selective nerve block is being performed,

and its advantages are that it minimizes the biggest problem of nerve block procedures, which is the difficulty of properly locating the nerves, while also improving procedure accuracy and minimizing recurrence problems.

By quickly searching for nerve branches through ultrasound, accurate treatment is possible.

Through local anesthesia for non-incisional selective nerve block,

special medical equipment with the functions of locating, confirming, and blocking nerve branches is used,

and because only the motor nerve branches are selectively blocked, no scar remains,

and there is no swelling or pain, only a slight pulling sensation due to muscle atrophy.

After the procedure, the patient can return to daily life immediately.

Immediately after the procedure, if you lift your heel,

you can visually confirm at once that the bulging calf muscle does not tense up.

The procedure takes about an hour,

and there are no special precautions after the procedure.

The effect gradually appears over one to six months as the muscle atrophies and the thickness decreases.

You can return to daily life starting the next day after the procedure.

http://www.calfs.co.kr