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Causes of failure in calf plastic surgery procedures

Cases where calf procedures did not produce satisfactory results

These are the causes of failure in calf plastic surgery.

The operator’s experience and skill are insufficient

As with all plastic surgery procedures, the surgeon’s skill and experience are the most important factors.

Even if good equipment is available, insufficient skill and experience on the part of the surgeon can lead to unsatisfactory results and cause side effects.

Choosing the wrong procedure method

The foundation of calf plastic surgery is muscle atrophy surgery.

The key issue is how effectively to atrophy the gastrocnemius muscle, which causes bulky calves, without side effects.

There are many methods for calf plastic surgery, but most have advantages as well as many disadvantages.

The principle of calf plastic surgery is to choose a method with a high treatment effect and no recurrence, which is very important.

If a procedure is performed from the start using a method that has no effect, or one with a high recurrence rate, the results will not be satisfactory.

You should understand the pros and cons of the procedure before undergoing it in order to avoid side effects or dissatisfaction.

Procedures for calf muscle atrophy and their development process

Procedures for calf muscle atrophy and their development process

1. Muscle excision surgery

A method in which an incision of about 4 cm is made behind the knee and the gastrocnemius muscle is torn out with surgical instruments

2. Nerve resection surgery

A method in which an incision of about 4 cm is made behind the knee and the motor nerve leading to the medial gastrocnemius muscle is resected

3. Nerve ablation

A method in which a nerve is found with a nerve search device and phenol solution is injected into the nerve to dissolve it

4. Botox procedure

A method of using Botox to block neurotransmitters at the nerve endings and cause the muscle to atrophy

5. Radiofrequency muscle cauterization

A method of burning and necrosing the gastrocnemius muscle that causes bulky calves using a radiofrequency cauterizer

6. Selective nerve block

A method in which the motor nerve to the gastrocnemius muscle is found with a nerve search device and electrically coagulated

7. Ultrasound-guided selective nerve block

A method in which the nerve location is accurately identified with ultrasound and a nerve search device, then electrically coagulated

Problems with procedures for calf muscle atrophy

Muscle excision surgery

Scarring and contour irregularities in the calf

This is a method in which a 4 to 6 cm incision is made behind the knee and the gastrocnemius muscle itself is torn out with surgical instruments.

A large scar remains behind the knee, and because the muscle is removed unevenly, the shape is not good. Swelling and pain are severe, making it difficult to return to daily life right away.

In other words, it is not a method that allows quick return to social life after the procedure, and because it can leave a large scar and cause contour irregularities in the calf, it is hardly suitable for cosmetic purposes.

It is now rarely used.

Nerve resection surgery

Scarring and O-shaped legs

This is a method in which a 4 to 6 cm incision is made behind the knee to find and resect the medial motor nerve going to the gastrocnemius muscle. It leaves a large scar behind the knee, and because only the medial nerve is resected, the lateral muscle can develop relatively more, which may result in O-shaped legs.

Because it leaves a scar and can cause O-shaped legs, great caution is needed when performing this procedure.

Nerve ablation

Insufficient treatment effect and frequent recurrence

This is a method in which a drug (phenol) is injected around the nerve after locating it with a nerve finder to dissolve the nerve.

Because the nerve search itself may not be done properly, the procedure is not accurate. After phenol is injected, one expects the nerve to dissolve and disappear, but the effect is often below expectations or nearly absent.

As phenol spreads, it can damage important nerves or blood vessels.

In other words, caution is needed because insufficient treatment effect, recurrence rate, and side effects from drug spread may occur.

Botox procedure

Unsatisfactory results and recurrence

This is a method that temporarily paralyzes and atrophies the calf gastrocnemius muscle with Botox, but 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 atrophy surgery.

Botox is effective mainly when used for the chewing muscles that cause a square jaw, but using it on calf muscles, which are dozens of times larger, is an excessive approach and is rarely used.

Radiofrequency muscle cauterization

Unsatisfactory results, severe swelling, and pain

This method burns and necroses the gastrocnemius muscle with a radiofrequency cauterizer, directly damaging the muscle itself, so the procedure is burdensome and can be accompanied by side effects from damage to tissues other than muscle.

As the muscle necroses and forms scar tissue, it can cause various problems such as unsatisfactory results, recurrence, contour irregularities, and sensory impairment, so caution is needed.

In other words, the effect is limited, and contour irregularities and recurrence are common.

Selective nerve block

Unsatisfactory results and recurrence

The principle is to block the gastrocnemius nerve branching from the tibial nerve so that the gastrocnemius muscle loses motility.

The blocked muscle cannot contract or relax, so it loses motility, and over time the muscle atrophies.

However, it is very difficult to locate the invisible nerve by probing it with a search device, and the biggest problem is that if the nerve is not found properly or if the found nerve is incompletely blocked, the effect decreases and recurrence is common.

Non-incisional ultrasound-guided selective nerve block

Requires expensive equipment plus accumulated experience and skill

This method uses both the nerve finder, which is the basic equipment for nerve block procedures, and an ultrasound imaging device to accurately locate and block the nerve.

Finding invisible nerves is difficult and takes time.

Also, if the nerve deviates from its normal path, finding it becomes very difficult, and the procedure is often not performed properly.

If the nerve is not found properly, the treatment effect decreases, side effects may occur, and the recurrence rate is high.

To make nerve searching faster and more accurate, an ultrasound imaging device equipped with a radiofrequency probe is used.

By checking with ultrasound while searching for the nerve, multiple nerve branches can be effectively blocked within a short time through accurate localization.

This is a non-incisional ultrasound-guided selective nerve block, which has the advantage of increasing treatment effect and significantly lowering recurrence rates without side effects.

It is the most advanced method for muscle atrophy surgery, but it requires expensive equipment and extensive procedural experience and skill.

Advantages of non-incisional ultrasound-guided selective nerve block

① Because nerve branches can be found quickly and accurately, the treatment effect is very high.

② It significantly shortens the procedure time compared with using only basic equipment.

③ By accurately locating the nerve branches, it does not damage tissue in other areas, so side effects are minimal.

④ Because the procedure time is shorter, there is less pain after the procedure and recovery is faster.

⑤ Because the procedure is performed with accurate nerve searching, the recurrence rate drops significantly.

Problems with general selective nerve block procedures

◎ Because invisible nerve branches must be found, the procedure is technically difficult.

◎ If the nerve branches are not found properly, the treatment effect is very low or recurrence is likely.

◎ In inexperienced hands, other nerves or blood vessels rather than the gastrocnemius motor nerve may be damaged.

∴ In general, performing a procedure by finding invisible nerves with the basic nerve finder is difficult because the nerves cannot be located properly, so in many cases there is little effect from the start, and the effect may seem present at first but then recur frequently within a few months.

A poorly performed nerve block can produce worse results than not doing it at all, so caution is needed.

Therefore, selective nerve block must be effective, nearly 100%, and non-recurrent. If the procedure is not performed while directly locating the nerve with an ultrasound imaging device and confirming it visually, it is difficult to obtain good results.

The calf procedure method that is right for me -

Appropriate calf procedure methods according to the cause

Muscle atrophy surgery - Non-incisional ultrasound-guided selective nerve block

This method blocks only the motor nerves going to the gastrocnemius muscle, causing the muscle to atrophy naturally without damaging the muscle.

At Duhan Plastic Surgery Clinic’s calf plastic surgery clinic, the nerves are precisely located with ultrasound and effectively blocked, significantly reducing side effects and recurrence rates.

Bulges from subcutaneous fat - Calf liposuction

This method reduces volume by suctioning the fat between the calf muscle and the skin.

It is used when there is a limit to how much calf volume can be reduced with muscle atrophy surgery, or when there is more fat than muscle.

Leg veins (varicose veins) - scarless surgery and sclerotherapy

This is a method of effectively removing unsightly veins in the legs with minimally incisional surgery or sclerotherapy.

If thick veins are visible in the legs, they are not aesthetically pleasing no matter how slender the legs are.

Our clinic has been introducing the advanced European approach, the center of varicose vein treatment, since 2001 and performs varicose vein procedures quickly and safely.

Diagnosis of varicose veins

The simplest and most accurate diagnostic method for varicose veins is Doppler ultrasound, which accurately identifies the vessel diameter and reflux status.

During the examination, with the patient standing, the ultrasound probe is applied to the area with veins, and while the screen is checked, the causative vein is identified. The examination takes about 5 to 10 minutes.

Varicose vein treatment methods

Broadly, there are three types: surgery, sclerotherapy, and laser procedures.

Surgical methods have developed in various ways over the centuries, and treatment has often used methods that remove the causative vein from the body.

Even in advanced European countries today, surgical methods such as vein stripping or ambulatory phlebectomy are widely used, with sclerotherapy used as an adjunct.

Sclerotherapy is a treatment method that does not involve surgery; a sclerosant is injected into the blood vessel. It has the advantage of requiring no anesthesia and causing no scar at all.

In other words, it is a method of injecting the sclerosant into the vein with a syringe, similar to a regular blood vessel injection.

Other treatment methods include transilluminated powered phlebectomy (Ttrivex), endovenous laser therapy (EVLT), and dye laser treatment for capillaries. However, there are concerns about various side effects, and the treatment effect is often inferior to surgery or sclerotherapy. Because the usable vessels are limited, European phlebologists caution against using these treatments.

Types of varicose vein procedures

● High ligation of the saphenous vein

This method blocks the reflux area of the saphenous vein valve. Unlike saphenous vein stripping or ambulatory phlebectomy, which completely remove diseased, enlarged veins, this method preserves the vessel while blocking only the reflux area.

In other words, it is similar to repair work to close a hole in a dam.

This is a surgical method used to block reflux areas in the early stage when the vessels are not severely dilated.

The key to surgery is that all branches of the vein must also be blocked to prevent recurrence.

These branches cannot be resolved by laser-based treatment.

● Saphenous vein stripping

This is a method of stripping and removing the vein at the starting point of a superficial vein with reflux.

When there is severe blood reflux and excessive dilation, this method removes the vein while performing high ligation at the same time, making it a fundamental way to block reflux.

It is applied when there is reflux and the vessel is severely dilated.

● Ultrasound-guided sclerotherapy

This is a procedure that can replace high ligation when high ligation is needed due to reflux.

It is a method of blocking reflux with medication by injecting a sclerosant into the point where reflux begins.

It is performed when there is fear of surgery or when scar formation is not desired.

However, it has the disadvantage of being less effective than surgery and having more recurrence.

● Compression sclerotherapy

This is used when treating vessels with a diameter of 4 mm or less.

If very thin and small vessels are spread out, it is difficult to resolve them, so sclerotherapy is used as the main procedure.

After sclerotherapy, compression stockings are worn to reduce the occurrence of thrombosis and promote faster recovery; this is called compression sclerotherapy.

● Simple sclerotherapy

This is performed by injecting a sclerosant in cases of localized red telangiectasia or blue reticular vein dilation.

When the area is small, wearing compression stockings is not particularly necessary, so treatment is done with sclerotherapy alone.

Before-and-after results of varicose vein and telangiectasia procedures

Aftercare for varicose vein procedures

▨ Pre-procedure precautions

1. Do not drink alcohol the day before the procedure. - It may interfere with anesthesia.

2. Do not overeat on the day of the procedure.

3. If possible, do not drive to the clinic on the day of the procedure; use public transportation instead. - Driving after sedation may be dangerous.

▨ Recovery and precautions after high ligation, saphenous vein stripping, and ambulatory phlebectomy

1. After the procedure is finished, go home only after the sedation has fully worn off.

2. On the day of the procedure, the legs may feel weak and painful, so avoid walking too much and rest at home as much as possible.

3. Return to the clinic after 2 days to remove the bandages.

4. Showering is allowed on the second day after the procedure, after the bandages are removed.

5. Return to the clinic on the 7th day after the procedure to remove the stitches.

6. Wear the compression stockings provided by the clinic for about 1 to 2 weeks.

7. Avoid strenuous exercise for about 1 to 2 weeks after the procedure, and running exercises may be resumed after one month.

8. A pulling and tight sensation in the calves is a normal part of the healing process as tissues recover.

9. The scars from ambulatory phlebectomy remain dark red for about 3 to 6 months and then gradually fade and become less noticeable.

▨ Recovery and precautions after sclerotherapy

1. After the procedure, walk for about 1 hour if possible so that the sclerosant does not remain in the vein.

2. Showering is allowed starting the next day after the procedure.

3. Compression stockings may be washed with soap, but do not wring them out or iron them.

4. Wear the stockings continuously for the prescribed period, usually 1 to 3 months.

5. Put the stockings on in the morning after getting up and take them off before going to bed.

6. Bruising along the vein and the presence of hematoma after sclerotherapy are understood to be normal parts of the treatment process.

7. Bruising along the vein varies in degree, and the time it takes to disappear also varies, but it usually fades almost completely in 2 to 3 weeks.

8. The period required for sclerotherapy to be completed and for the vein to be fully closed and disappear is about one month.

▨ Follow-up plan after sclerotherapy

1. After the initial procedure, visit the clinic 3 to 4 times at intervals of 1 to 2 weeks.

2. Return 1 to 2 weeks later; if there is thrombosis, remove the thrombus with a needle and then wear the compression stockings again. - Additional treatment may be performed on areas that were not fully treated.

3. Second follow-up visit after the procedure - 1 to 2 weeks after the second treatment

Hematoma removal from the treated vein area and additional treatment of areas that were not fully treated may be performed.

4. Third follow-up visit after the procedure - 1 to 2 weeks after the third treatment

Hematoma in the treated vein area is removed.

The number of hematoma removals varies by individual, usually about 2 to 4 times.

Frequently asked questions and answers about varicose veins and telangiectasia

If veins are visible in the legs, does that mean they are all varicose veins?

Not all of them are.

In people who are naturally thin-skinned or have large blood vessels, veins may be visible even though the venous system is normal.

However, even if there is no abnormality in the venous system, if capillaries or large vessels are visible under the skin and are aesthetically displeasing, you may consider treatment to make the vessels less visible.

Can varicose veins be treated with laser?

No.

For very fine capillary telangiectasia, pigment lasers may be effective, but for larger vessels beyond that diameter, laser is not effective.

There are currently methods for treating thick vessels by inserting a laser-emitting catheter and burning the inner wall of the vessel with laser, but in terms of effectiveness, the results are not as clean as surgery, and treatment is difficult for vessels that are too large or too small, so the indications are more limited than for surgery.

In advanced countries, surgical treatment for varicose veins is common, and lasers are rarely used because of various side effects and limited use.

Will sclerotherapy remove unsightly veins?

The sclerosing agents currently in use are medications with proven safety, and their effect can be seen immediately after injection into the vein. Usually, good results can be obtained with 1 to 2 treatments.

If the area is small, a single treatment may be enough.

Is it true that sclerotherapy recurs easily?

If veins are visible, you should not simply undergo sclerotherapy without proper evaluation.

Before that, Doppler ultrasound should be used to accurately identify the cause of the varicose veins in order to achieve a cure.

In other words, to prevent recurrence, the area causing venous reflux must be accurately diagnosed and both the root cause and the localized dilated veins must be treated at the same time.

If only sclerotherapy is done without treating the source of the reflux, recurrence will continue.

Can only the legs be treated, and not the hands, arms, or face?

Veins may be visible on the hands, arms, or face, and this can be considered more a matter of individual constitution than varicose veins.

In obese people, veins are buried deeper and are less visible, while in thin people, veins are more visible; this can be thought of as a difference caused by body type.

These cases can also be treated with sclerotherapy.

Do surgical treatments leave many scars?

In the past, conventional surgical methods were performed under general anesthesia and left many scars, but the treatment methods currently used involve making incisions of about 2 mm in each area under local anesthesia, so scars are hardly left.

The clinic recommends surgery, but I do not want surgery. Is there another option?

Surgery is indicated when venous reflux is severe.

However, depending on the vessel diameter, treatment may be possible with ultrasound-guided sclerotherapy without surgery.

If reflux is severe, surgery may be unavoidable, but the exact treatment should be determined through accurate ultrasound diagnosis.

If sclerotherapy is performed on the legs, is it necessary to wear compression stockings?

In the case of varicose veins in the legs, better results can be achieved by wearing medical compression stockings after sclerotherapy.

After the sclerosant is injected, the vein must be compressed so that fibrosis occurs in the inner wall of the vein, and only then is the treatment complete.

During this period, proper compression of the vein is necessary to achieve maximum effect.

They are usually worn for 3 to 6 weeks.

However, if the treated area is very small or if it is only a small capillary telangiectasia, they may not be necessary.

Won’t compression stockings feel too tight and uncomfortable?

Not at all.

Medical compression stockings are ergonomically designed to assist venous return, so they are comfortable to wear.

They serve a different purpose from ordinary medical stockings.

They help improve blood circulation in the legs after wearing them.

At our clinic, we import and use German Sigvaris products certified by the European Textile Association (EMPA).

After surgery or sclerotherapy, do I need to lie down?

No.

Doing moderate exercise for 1 to 2 hours a day actually helps recovery and promotes venous circulation.

You can return to normal daily life immediately after surgery or sclerotherapy.

Notes on calf procedures

♥ For calf plastic surgery, choose the appropriate method according to the desired shape or the cause.

♥ For muscle atrophy surgery, nerve block procedures are performed.

♥ For obesity, liposuction is performed.

♥ For vascular dilation, scarless surgery or sclerotherapy is performed.

♥ The procedure should be effective, have no side effects, and allow immediate return to daily life.

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