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A calf reduction procedure that does not require incisions and is not a muscle recession procedure using mid-/high-frequency muscle cauterization, which causes severe swelling and pain

A new concept in calf reduction surgery - non-incisional ultrasound-guided selective nerve block

The recent trend in the cosmetic surgery field is to actively reflect patients’ needs and to continuously seek minimally invasive methods that offer definite results and ensure procedural safety.

At our clinic, we perform procedures using a non-incisional selective nerve block device together with an ultrasound diagnostic device to achieve no side effects at all and to significantly lower the recurrence rate.

Introduction to the basic equipment for calf nerve block

The basic equipment for nerve block uses an all-in-one device that combines nerve search and nerve block into a single unit.

When the nerve search probe touches a nerve and the muscle moves in response, the mode is changed and the nerve is immediately blocked.

What is ultrasound-guided selective nerve block?

With the nerve search probe, which is the basic device for nerve block, it is very difficult and time-consuming to find invisible nerves.

Also, when a nerve deviates from its normal course, it becomes very difficult to locate, and in many cases the procedure is not performed properly.

If the nerve is not found correctly, the effect of the procedure decreases, side effects may occur, and the recurrence rate can be high, among other problems.

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

By checking with ultrasound and quickly and accurately locating the nerve, multiple nerve branches can be effectively blocked in a short time.

The procedure that improves treatment effectiveness, has fewer side effects, and significantly lowers the recurrence rate is ultrasound-guided nerve block.

Equipment for ultrasound-guided selective nerve block

In addition to the basic equipment for nerve block, an ultrasound diagnostic device, which is a visual examination device, is used so that nerve branches can be found quickly and accurately.

With only the basic equipment, there are limits to finding nerves, and in the case of nerves with many branches or nerves traveling along unexpected routes, finding them is very difficult.

The success or failure of the procedure depends on locating the nerve branches accurately within a short time.

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

Advantages of 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 the basic equipment.

3. Because the nerve branches are accurately located, other tissues are not damaged, so side effects are minimal.

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

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

Causes of thick calves

The causes of thick calves are muscle and fat, but in most cases where the calves are thick or the bulge is clearly visible, muscle is the main cause.

Anatomy of bulging calves

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

The gastrocnemius is divided into medial and lateral portions, and in general the medial portion is more developed.

Below the gastrocnemius is the soleus, and beneath the soleus are several other muscle layers distributed in overlapping layers.

The thickness of the gastrocnemius is usually 2 cm when relaxed and becomes 3–4 cm thick when contracted, creating the bulge in the calf.

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

Movement of the leg involves other muscle layers, including the soleus, in the movement of the calf and foot, and the outer gastrocnemius does not have a special function, so even without it there is no problem with leg function at all.

Selective nerve block works by blocking the gastrocnemius nerve, a branch from the tibial nerve to the gastrocnemius, so that the gastrocnemius loses its mobility.

A muscle whose nerve has been blocked can no longer contract and relax, so it loses mobility and gradually atrophies over time.

It blocks the nerve by using the principle that an unused muscle atrophies.

Conventional methods for reducing calf muscle size

■ Muscle resection through an incision

This method involves making an incision near the back of the knee and inserting instruments to pull out and tear away the gastrocnemius muscle.

This method leaves a large scar near the back of the knee and removes muscle unevenly, so the shape is not uniform and it is far from the cosmetic needs of the present.

■ Neurectomy through an incision

This method finds and cuts the nerve leading to the gastrocnemius through an incision near the back of the knee. Because only the medial side can be operated on, it can easily create bow legs, and because it requires an incision, it leaves a large scar near the back of the knee, making it a method far removed from cosmetic purposes.

■ "Muscle recession" using mid-/high-frequency energy to cauterize muscle

This method uses mid-/high-frequency energy to electrically coagulate the gastrocnemius, causing the muscle to atrophy.

It is a method that burns away the muscle, and due to the development of scar tissue from burns inside the muscle, the effect of calf muscle recession is reduced. Because swelling is severe and walking after the procedure is difficult, it is not a commonly used method.

■ Neurolysis using medication on the motor nerve that innervates the gastrocnemius

This method injects medication around the nerve leading to the gastrocnemius. It is difficult to inject precisely along the nerve’s path, and the effect of nerve block from the medication is also insufficient.

The treatment effect may be somewhat reduced or the recurrence rate may be high.

In addition, side effects may occur due to the medication spreading to unintended areas.

Disadvantages of conventional surgical methods

● Neurectomy or muscle resection leaves an unattractive scar near the back of the knee after surgery, which is far from what patients want.

● Muscle resection can create a bumpy contour due to irregular removal of muscle, and muscle resection can cause varicose veins in the lower limbs.

● Neurectomy leaves a large scar near the back of the knee, and as a sequela it can cause bow legs.

● Neurolysis has inconsistent effects and may cause side effects due to medication spreading to unintended areas.

● In the case of mid-/high-frequency cauterization, scar tissue remains inside, the effect is not great, and swelling and pain are severe.

Non-incisional selective nerve block

Concept: Using a nerve blocker, the course of the motor nerves that innervate the gastrocnemius of the calf is identified, and then only the motor nerves of the gastrocnemius are selectively blocked while minimizing damage to other tissues.

Non-incisional selective nerve block uses local anesthesia and special medical devices (with functions to find, confirm, and block nerve branches) to selectively block only the branches of the motor nerves, so no scar remains, and there is no swelling or pain, only a slight pulling sensation due to muscle atrophy. After about 30 minutes of treatment, the patient can immediately return to daily life.

Non-incisional selective nerve block - procedure

Non-incisional selective nerve block selectively blocks only the branches of the motor nerves using local anesthesia and special medical devices (with functions to find, confirm, and block nerve branches).

1st step - Confirm the location of the nerve with ultrasound and mark it on the skin.

2nd step - In the prone position, lightly apply local anesthesia at the spot where the needle will be inserted.

3rd step - While checking with ultrasound, determine the nerve location and insert the needle into the area where the nerve is located.

4th step - Confirm with the nerve search device whether the gastrocnemius nerve is touching the needle.

5th step - Switch to nerve block mode and generate electrical heat from the needle tip to block the nerve by stopping nerve transmission.

If nerve block is performed on both the medial and lateral sides of the gastrocnemius, a total of four nerves are blocked on both sides combined.

6th step - Go home immediately after the procedure.

In the examination room, the course of the nerve is identified through ultrasound.

Because the course and depth of the nerve differ from person to person, accurately identifying the nerve’s course is an essential process for a successful procedure.

After locating the nerve, the site to be blocked is marked.

The course of the nerve is drawn with design ink on the marked area.

The nerve is divided into medial and right nerves, and branches out like tree limbs.

All of these smaller branches are also searched for and marked with ink.

In most cases, the nerves in both legs do not run in exactly the same way.

Even in the same person, the left and right nerves often have different courses and different numbers of branches.

Accurate nerve searching can increase the success rate of the procedure and minimize recurrence.

In the operating room, after sedation and local anesthesia are administered, the nerve block needle (search needle) is prepared in nerve search mode.

The nerve block needle is inserted into the locally anesthetized area.

After confirming that it has passed through the fascia, the needle tip is brought close to the location of the gastrocnemius motor nerve under ultrasound guidance.

The nerve branches are quickly searched for and blocked using ultrasound.

To improve the effect of the procedure, the nerve branches must be accurately found and firmly coagulated within a short time so that the nerves do not regenerate and recur.

In addition, side effects can be avoided by preventing damage to important tissues other than the nerves to be blocked.

It is not that difficult to find blood vessels on ultrasound, but locating nerves requires a great deal of experience.

Because the diameter of a nerve is only about 1–2 mm, searching is difficult, and with ordinary ultrasound it is almost impossible to locate nerves.

Search is possible with a high-frequency ultrasound of 7.5 MHz or higher, and accurate searching from the root of the nerve to its branches is necessary.

When the tip of the needle touches the gastrocnemius motor nerve, the gastrocnemius begins to contract repeatedly.

After confirming muscle contraction, the nerve search mode is switched to nerve block mode and electrical coagulation is performed.

After the electrical coagulation is complete, it is switched back to nerve search mode to confirm that the muscle does not contract.

If the muscle does not contract, the nerve has been blocked.

Because the blocking effect should be permanent, the proximal part of the nerve is checked again and treated.

Usually 7–8 areas are blocked in one muscle, and the more nerve branches are blocked, the more effective the result.

If all four muscles on the medial and lateral sides of both calves are treated, about 30 nerve branches in total must be blocked to prevent recurrence and achieve a definite treatment effect.

Usually, when both the medial and lateral sides on both legs are treated, the procedure takes about 30 minutes to 1 hour.

If only the medial side is treated, the procedure takes about 30 minutes.

You can go home immediately after the procedure, and before leaving, you should raise your heels to confirm that the calf bulge does not reappear, then go home.

When leaving, simply wear a compression band and go home.

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The usefulness of ultrasound diagnosis in nerve block

The device used as an auxiliary tool in nerve block, in addition to the basic equipment, is an ultrasound imaging device.

An ultrasound diagnostic device equipped with a 7.5 MHz high-frequency probe is useful for identifying the location of structures such as blood vessels and nerves.

The key to a successful nerve block procedure is how accurately and effectively the nerve branches can be found.

The nerves that need to be found are the main trunk and branches of the nerves leading to the gastrocnemius.

Usually, the number of nerve branches blocked in one gastrocnemius is about 7–8.

The more nerve branches are blocked, the better the treatment effect becomes.

To effectively find nerve branches, rather than the conventional method of randomly poking around with the search needle, it is better to watch the ultrasound screen, accurately identify the course of the nerves, and guide the search needle directly to the nerve at once. This improves the accuracy and effectiveness of the procedure.

If there is no ultrasound device, in some cases the procedure may be almost impossible when the nerve does not respond well to the search needle.

The nerve must respond in order to perform electrical coagulation, and if the needle touches the nerve but there is no response, the procedure becomes impossible.

In such cases, if ultrasound confirms that the search needle is touching the nerve, it is useful because electrical coagulation can be performed even if the nerve does not necessarily respond.

Effect immediately after the procedure

After the procedure, if you raise your heels, you can visually confirm immediately that the bulging muscle does not tense up.

This surgical method can produce satisfactory results with a single treatment, and because there are no scars or uncomfortable post-procedure issues, it is a highly welcomed procedure.

Post-procedure course of non-incisional selective nerve block

◇ If only the medial side of the calf is treated, the procedure takes about 30 minutes, and after the procedure you simply wear the compression band provided by the hospital.

◇ Immediately after the procedure, by raising your heels, you can immediately confirm that the calf does not develop a bulge.

◇ There may be a 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, a slight pulling and tight feeling in the calf for about a month is a normal recovery process.

◇ A visible sense that the calf has become thinner can be noticed after about 15 days to one month.

◇ The maximum effect appears after 3 to 6 months, and if there is no recurrence, the effect is permanent.

Precautions after non-incisional selective nerve block

1. Due to gradual muscle atrophy, a slight pulling and tight feeling in the calf for about a month is a normal 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 be as short as 2 weeks or as long as more than a month.

2. It is better not to wear very high heels for about a month.

Because the muscle shrinks as it atrophies, there may be a pulling sensation.

To address this, walking in low-heeled shoes or sneakers and doing light exercise such as walking in small amounts can help stretch the muscle, improve the procedure’s effect, and relieve the pulling and tight feeling more quickly.

3. If you continue to wear high heels from immediately after the procedure, the length of the muscle may become shorter and a side effect of tiptoe walking, in which the heels do not touch the ground, may occur, so caution is needed.

However, this problem will absolutely not occur if you wear low-heeled shoes or sneakers for about a month.

4. Some hospitals with insufficient experience in calf procedures may tell patients to wear high heels after the procedure.

This should never be done.

If you wear high heels, the muscles remain contracted, so if that state continues, it is natural for the muscle length to become shorter.

If the muscle becomes shorter, the heels will no longer touch the ground.

Please note that this comes from not understanding the principle of muscle atrophy and can lead to side effects that should not occur.

Before-and-after results of non-incisional selective nerve block

The four principles of nerve block for calf recession surgery

There must be no recurrence.

It is most important to perform the procedure properly so that there is no recurrence.

The effect must be definite.

The result of muscle atrophy must be close to 100%.

There must be no side effects.

There must be no damage to other tissues so that side effects do not occur.

Immediate return to daily life must be possible.

By minimizing bruising, swelling, and pain, daily life should be possible immediately after the procedure.

Important key to a successful nerve block procedure

The key to a successful nerve block procedure is how accurately and quickly the nerve branches can be found.

Because the procedure is performed without an incision, the invisible nerve branches must be found quickly and as many branches as possible blocked in order to achieve a satisfactory muscle atrophy effect.

The biggest weakness of nerve block is that the search needle of the basic search equipment cannot find the nerves quickly.

Depending on the individual, the nerve may not respond properly to the search needle, and some nerves do not run along the normal course. In such cases, the operator must poke around with the search needle to find the passing nerve branches with difficulty.

Therefore, if the nerve branches cannot be found properly, the procedure may not be performed correctly, the effect may be greatly reduced, or in some cases there may be almost no effect at all.

Only by finding as many nerve branches as possible within a short time and coagulating them can the desired muscle atrophy effect be achieved, so the practitioner must have extensive experience and know-how, and the ultrasound imaging device must also be used to improve the treatment effect.

Causes of nerve block failure

▶ Inexperienced nerve block technique

▶ A constitution in which the nerve does not respond well to the search needle

▶ An insincere procedure that blocks only one or two proximal areas without blocking many nerve branches in the proximal and distal areas

▶ The nerve deviates from its normal course, making it impossible to find with the search needle

▶ Blocking the nerve to the deep soleus muscle instead of the nerve leading to the gastrocnemius, or blocking the sural nerve

▶ Blocking the gastrocnemius nerve too close to the back of the knee and damaging the tibial nerve as well

The greatest key to success in nerve block is to find the nerve accurately and block as many branches as possible.

If the nerve is not found properly, there is no effect or recurrence occurs quickly.

For this reason, using an ultrasound imaging device together allows the practitioner to identify the nerve’s course accurately and improve the treatment effect as much as possible.

Side effects of nerve block

Pain in the heel area or reduced sensation due to injury to the tibial nerve

Weakness in the leg due to damage to the nerve leading to the soleus

Irregular bulging or uneven contour in the calf due to partial nerve block or recurrence

Side effects of nerve block occur when the exact position of the nerve cannot be found.

Only when the procedure is performed accurately in principle based on extensive experience can the treatment effect be improved and side effects prevented.

Guidance at our clinic for problems after calf recession surgery at another hospital

◎ In cases of recurrence where the muscle bulge returns

Recurrence due to nerve regeneration after nerve block

All tissues regenerate when damaged.

Nerves also have very strong regenerative ability, so if the procedure is incomplete, the nerves regenerate again.

Nerve regeneration means recurrence.

If recurrence occurs, nerve block must be performed again, but repeat surgery is much more complicated and difficult than the initial procedure.

The reasons are as follows.

First, firm scar tissue forms around a nerve that has already been treated once and wraps around it like a protective layer, so the nerve does not respond to the search needle and cannot be found with the conventional method.

Second, even if the nerve is found, a nerve wrapped in firm scar tissue cannot be blocked properly with the existing coagulation heat.

The coagulation temperature does not exceed 90 degrees at most, so with heat of around 90 degrees it is difficult to break through the firm scar tissue and block the nerve.

To solve this problem, the nerve must be visually confirmed and its exact position located, and ultrasound imaging is essential for this.

In recurrent cases, repeat treatment is almost impossible without the help of an ultrasound imaging device.

In addition, the found nerve must be reached as closely as possible by the needle, which must pass through the scar tissue layer, and electrical coagulation must then be performed.

The coagulation time must also be made longer.

Recurrence due to muscle regeneration after mid-/high-frequency treatment

All tissues regenerate when damaged.

Muscle tissue also has very strong regenerative ability, so if the procedure is incomplete, the muscle regenerates again.

Also, areas that do not regenerate are filled in by hard scar tissue, which reduces the effect of volume reduction.

The reasons for recurrence are:

First, even if the muscle is partially damaged and necrosed by mid-/high-frequency energy, other muscle fiber cells are replaced and regenerate.

Therefore, with most procedures, muscle cells regenerate almost entirely, so the effect is inevitably reduced.

Second, even if there are areas where muscle tissue has necrosed due to the heat of mid-/high-frequency energy and does not regenerate, those areas are filled in with collagen formed within the tissue, which then turns into firm scar tissue and reduces the effect of volume reduction.

In other words, scar tissue takes the place of the muscle.

To solve this problem, rather than burning away the muscle again with mid-/high-frequency energy, it is necessary to replace it with ultrasound-guided selective nerve block and naturally induce muscle atrophy.

Even if there is recurrence after a mid-/high-frequency procedure, selective nerve block can still be performed.

◎ In cases where a contour irregularity develops in the treated calf

Incomplete nerve block

After nerve block, the calf line may become uneven and irregular.

This is a recurrence, but it can be considered partial recurrence rather than complete recurrence.

That is, among several nerve branches, some may have been blocked while others were not.

The muscles innervated by the blocked nerves atrophy and shrink in volume, but the muscles innervated by the unblocked nerves will remain the same as before, so the difference in volume between the blocked and unblocked areas causes the irregular contour.

Ultimately, this is an incomplete procedure or partial recurrence, so if the nerve branches that were not properly treated are found and treated again accurately, the irregularity will naturally disappear.

Incomplete muscle ablation with mid-/high-frequency energy

When muscle is cauterized with mid-/high-frequency energy, some areas of the muscle regenerate, some are replaced by scar tissue, and some areas may become somewhat sunken.

The reasons for contour irregularity are:

First, some areas of the muscle necrose due to the heat of mid-/high-frequency energy and shrink in volume, while other areas do not, causing a height difference and thus an uneven contour.

In other words, the treatment effect is not uniform and only takes effect in some areas.

Second, due to excessive necrosis of the muscle tissue, part of the calf may become hollowed out like a depression.

This is a case where, along with muscle necrosis, the fat layer above the muscle also necroses as a complication of muscle necrosis, resulting in a severe indentation.

Third, if scar tissue fills in the place where the muscle necrosed, the area where scar tissue forms keeps the same volume, while areas where scar tissue does not form well lose volume.

This causes contour irregularity.

To solve this problem, rather than burning away the muscle again with mid-/high-frequency energy, it is necessary to replace it with ultrasound-guided selective nerve block and naturally induce muscle atrophy.

If nerve block induces uniform muscle atrophy overall, the contour irregularity can be alleviated.

Also, if there is excessive indentation accompanied by fat necrosis, fat grafting can be performed after the muscle has fully atrophied to naturally fill in the sunken area.

◎ In cases where the lateral muscle developed relatively after medial neurectomy, resulting in bow legs

Bow legs due to lateral muscle development

In cases of neurectomy performed at another hospital, where an incision is made in the back of the knee and the medial nerve is removed, the lateral muscle often develops compensatorily because it was not operated on.

In such cases, only the outer part of the calf becomes protruding, resulting in very unattractive bow legs.

Neurectomy is a drastic surgery that causes complete muscle atrophy, so to avoid possible side effects, the lateral nerve is excluded from the surgical target. As a result, bow legs often occur.

If bow legs develop, the lateral nerve can be treated with nerve block rather than surgery to balance the legs, so it is a good idea to consider nerve block in such cases.

◎ Tiptoe side effect caused by incorrect instructions after the procedure

Tiptoe walking with the heels not touching the ground

The side effect of tiptoe walking, where the heels do not touch the ground, is caused by wearing high heels continuously from immediately after the procedure.

It is absolutely not a side effect caused by a mistake in the procedure.

If tiptoe walking side effects occur, you should walk barefoot around the room as much as possible so that the contracted muscle is stretched and lengthens again.

Walking barefoot in the room or outside in shoes with almost no heel will naturally stretch and straighten the muscle.

After the tiptoe side effect occurs, if you take off your shoes, it may become uncomfortable to walk, and you may end up continuing to wear high heels.

However, this worsens the condition.

At the early stage of tiptoe walking problems, the best approach is to quickly stop wearing high heels, switch to shoes with no heel as much as possible, and keep practicing walking until the muscle lengthens and straightens again.

In most cases, if walking practice is done in shoes without heels within six months after the procedure, the tiptoe problem can resolve on its own.

Repeat treatment after recurrence of calf recession surgery

★ What happens if recurrence occurs after the procedure?

After a general selective nerve block procedure, the recurrence rate is very high.

In hospitals with high recurrence rates, there are many cases showing recurrence rates of over 80%.

In other words, if 10 people are treated, 8 to 9 of them recur, and if the recurrence rate is that high, the procedure is meaningless.

The non-incisional ultrasound-guided selective nerve block at Duhan Plastic Surgery Clinic was designed to minimize the recurrence rate.

At present, the recurrence rate at Duhan Plastic Surgery Clinic’s calf contouring clinic is under 3%, and we continue to research and work toward a 0% recurrence rate.

If recurrence occurs, we provide repeat treatment to supplement it.

★ If recurrence occurred after selective nerve block at another hospital, can repeat treatment be done here?

After nerve block at another hospital, the recurrence rate is high, and if recurrence occurs or there is no effect, many patients give up, thinking their constitution is the reason it did not work.

In recurrent cases, constitutional causes account for only a small number.

In most cases, the problem is due to the operator’s lack of experience and technique, or insufficient equipment.

Once a procedure has been performed, the tissue becomes firm and insensitive, so the nerve often does not respond to the nerve search device.

If the nerve does not respond, its location cannot be determined, so the procedure becomes impossible.

Therefore, for repeat treatment, good results can only be obtained if the nerve is directly found through an ultrasound imaging device and then treated.

For recurrence cases, repeat treatment can only be properly performed with ultrasound-guided selective nerve block.

★ I had mid-/high-frequency treatment at another hospital but did not see any effect. Can I still receive nerve block here?

Mid-/high-frequency treatment is a method that directly burns the muscle with a cauterizing device to cause necrosis, but the effect is usually weak or there is recurrence.

In some cases, contour irregularity also 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 barely damages the muscle and blocks only the nerve, it induces natural muscle atrophy and can naturally improve the shape even in cases with recurrence or contour irregularity.

★ I tried all kinds of procedures such as nerve block and radiofrequency treatment at other hospitals, but why was there no effect?

As with all surgeries, the outcome depends on the surgeon’s experience and know-how.

Without ultrasound equipment, repeat treatment for nerve block is almost impossible.

Mid-/high-frequency treatment itself is not a procedure that easily produces strong results for calf recession surgery.

The lack of effect comes from the wrong choice of procedure, and from the operator’s lack of equipment, experience, and technical skill.

A properly performed procedure can produce permanent results with just one treatment.

Even if multiple treatments at another hospital failed, in most cases our clinic can achieve satisfactory results with just one treatment.

Guidance at our clinic for problems after calf recession surgery at another hospital

Category	Incisional muscle resection	Incisional nerve block	Mid-/high-frequency muscle recession	Neurolysis	Selective nerve block
Scar	3–4 cm near the back of the knee	3–4 cm near the back of the knee	No scar	No scar	No scar
Procedure time	1–2 hours	1–2 hours	40 minutes to 1 hour	Around 30 minutes	Around 30 minutes
Effect and prognosis	The effect is large, but irregular muscle removal can lead to bumpy legs.	The effect is high. The calves become much thinner. Only the medial side is operated on, so the lateral side becomes compensatorily thicker. It may appear bowed into an O shape.	The effect is low. There is only a small reduction in thickness.	The effect is inconsistent, and medication spread may act on unintended areas and cause side effects.	The effect is high. The calves become much thinner. Both the medial and lateral sides are treated, sufficiently atrophying the muscle.
Discharge and function	Severe swelling, bruising, and pain require 1–2 weeks of rest. Walking is very inconvenient for about a month.	It is uncomfortable and difficult to walk for about 15 days. There is pulling pain for about a month.	Severe swelling and pain make walking inconvenient for about a month.	Immediate return to daily life is possible, but there may be pulling pain for 3–4 weeks.	Immediate return to daily life is possible, but there may be pulling pain for 3–4 weeks.

Precautions regarding the procedure

Even if there are many calf reduction methods, there are not many appropriate methods.
The choice of procedure method is determined according to the shape and cause of the thick legs.
A good procedure method is one with no side effects and definite results.
A method that minimizes swelling and pain after the procedure should be selected.
Among muscle recession procedures, ultrasound-guided selective nerve block is the preferred method.

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