[Duhan Plastic Surgery Clinic Calf Contouring] - [Causes of Calf Contouring Failure]

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Causes of procedure failure

"When calf procedures do not produce good results"

DUHAN CALFS CLINIC

Insufficient experience and skill of the practitioner

​As with all plastic surgery-related operations, the surgeon's skill and experience are the most important factors.

Even if good equipment is available, if the surgeon performing the procedure lacks skill and experience, unsatisfactory results will occur and side effects will arise.

Choosing the wrong procedure method

The basis of calf contouring is muscle recession surgery.

The key issue is how effectively the gastrocnemius muscle, which causes bulging calves, can be reduced without side effects.

There are various methods of calf contouring, but most have advantages as well as many disadvantages.

The principle of calf contouring is to choose a method with a high treatment effect and no recurrence.

If a procedure is performed from the start using a method with no effect or a method with a high recurrence rate, the results will be unsatisfactory.

Only by recognizing the advantages and disadvantages of the procedure and receiving treatment accordingly can side effects or dissatisfaction with the procedure be avoided.

Procedure methods and development process for calf muscle recession

1. Muscle excision surgery

A method of making an incision of about 4 cm in the popliteal area and removing the gastrocnemius muscle with surgical instruments

2. Nerve excision surgery

A method of making an incision of about 4 cm in the popliteal area and excising the motor nerve leading to the medial gastrocnemius muscle

3. Neurolysis

A method of finding the nerve with a nerve finder and injecting phenol solution 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 ablation

A method of burning and necrosing the gastrocnemius muscle, which causes bulging calves, using a radiofrequency ablator

6. Selective nerve block

A method of finding the motor nerve to the gastrocnemius muscle with a nerve finder and electrically coagulating the nerve

7. Ultrasound-guided selective nerve block

A method of accurately identifying the location of the nerve with ultrasound and a nerve finder, then electrically coagulating it

Problems with procedure methods for calf muscle recession​

① Muscle excision surgery​

☆ Scarring and contour irregularities in the calf

This method involves making a 4 to 6 cm incision in the popliteal area and removing the gastrocnemius muscle itself with surgical instruments.

A large scar remains in the popliteal area, and because the muscle is removed irregularly, the shape is not good. Severe swelling and pain also 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 because it can leave a large scar and cause irregularities in the calf, it is a method that is hardly suitable for cosmetic purposes.

It is now a method that is rarely used.

② Nerve excision surgery​

☆ Scarring and bow legs

This method involves making a 4 to 6 cm incision in the popliteal area, finding and excising the medial motor nerve leading to the gastrocnemius muscle. It leaves a large scar in the popliteal area, and because only the medial nerve is excised, the lateral muscle can become relatively more developed, which may result in bow legs.

In other words, there is the problem of scarring and the potential to cause bow legs, so great caution is needed.

③ Neurolysis​

☆ Poor treatment effect and frequent recurrence

This method finds the nerve with a nerve finder and then injects medication (phenol) around the nerve to dissolve it.

Because the nerve search itself is not done properly, the procedure is not accurate, and what is expected after phenol injection is that the nerve will dissolve and disappear; however, the effect is often below expectations or almost nonexistent.

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

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

④ Botox procedure​

☆ Poor results and recurrence

This method temporarily paralyzes the calf gastrocnemius muscle with Botox to cause atrophy. However, the effect is weak, the cost is high, and it is only temporary, with recurrence after a few months, so it is not a recommended method for calf recession surgery.

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

⑤ Radiofrequency muscle ablation

☆ Poor results and severe swelling and pain

Radiofrequency muscle ablation is a method of burning and necrosing the gastrocnemius muscle with a radiofrequency ablator. Because it damages the muscle itself, the procedure is burdensome, and side effects from damage to tissues other than muscle may also occur.

As scarring forms as the muscle necroses, it can cause various problems such as poor results, recurrence, contour irregularities, and sensory disturbance, so caution is required.

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

⑥ Selective nerve block​

☆ Poor results and recurrence

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

A blocked muscle cannot contract and relax, so it loses mobility, and the muscle gradually atrophies over time.

However, it is very difficult to probe around with a nerve finder to locate an invisible nerve, and the biggest problem is that if the nerve is not found properly or if the found nerve is incompletely blocked, the treatment effect declines and recurrence is common.

⑦ Non-incisional ultrasound-guided selective nerve block​

☆ Requires expensive equipment and accumulated experience and skill

This is a method of accurately finding and blocking the nerve using both a nerve finder and an ultrasound imaging device, which are the basic equipment for nerve block procedures.

A drawback is that finding nerves that are not visible is complicated and time-consuming.

In addition, if the nerve deviates from its normal course, finding it becomes very difficult, and in many cases the procedure is not performed properly.

If the nerve cannot be found properly, the treatment effect decreases, side effects may occur, and the recurrence rate becomes high.

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

By searching while confirming with ultrasound and accurately locating the nerves, multiple nerve branches can be effectively blocked within a short time.

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

It is the most advanced procedure for muscle recession surgery, but it requires expensive equipment and a great deal of procedural experience and skill.

Advantages of ultrasound-guided selective nerve block

Nerve branches can be found quickly and accurately, resulting in a very high treatment effect.
It significantly shortens the procedure time compared with using only basic equipment.
Because nerve branches are identified accurately, other tissues are not damaged, so side effects do not occur.
Since the procedure time is shortened, there is less pain after the procedure and recovery is faster.
Because the procedure is performed with accurate nerve searching, the recurrence rate is significantly reduced.

Problems with general selective nerve block​

It is technically difficult because invisible nerve branches must be found.
If the nerve branches are not found properly, the treatment effect drops significantly or recurrence occurs easily.
If the practitioner lacks experience, other nerves or blood vessels, not the motor nerve to the gastrocnemius muscle, may be damaged.

In general, using the basic nerve finder to locate and treat invisible nerves often results in little to no treatment effect from the beginning because the nerves cannot be properly found, and it is common for the procedure to seem effective at first but recur within a few months.

A poor nerve block can produce results worse than not having the procedure at all, so caution is needed.

Therefore, selective nerve block must be nearly 100% effective and non-recurrent, and unless the nerves are directly located and visually confirmed with an ultrasound imaging device and the procedure is performed accordingly, it is difficult to achieve good results.

Four principles of calf recession surgery

1. It must not recur.

It is most important to ensure that it does not recur through a proper procedure.

2. The effect must be certain.

The result of muscle recession must be near 100% and clearly reliable.

3. There must be no side effects.

There must be no side effects so that no other tissues are damaged.

4. Daily life must be possible immediately.

Bruising, swelling, and pain must be minimized so that daily life is possible immediately after the procedure.

Frequently asked questions and answers about calf reduction surgery​​

Question) Is calf muscle recession surgery a procedure that anyone can undergo?

Answer) Calf procedures are absolutely not something just anyone can do.

As with all surgeries, results vary depending on the surgeon's experience and know-how.

Simply having equipment does not mean everyone can perform the procedure well.

The same applies to calf recession surgery; success or failure depends on how the procedure is performed.

If 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 find many nerve branches within a short time and definitely perform electrical coagulation to reduce recurrence.

Blocking one or two nerves does not reduce the calf.

People may think calf procedures are easy, but they are absolutely not.

Question) Is ultrasound-guided selective nerve block performed only at this clinic?

Answer) General nerve block procedures have a high recurrence rate, so ultrasound-guided selective nerve block was developed to improve this.

Even if other hospitals introduce nerve finders and ultrasound at the same time and can perform the procedure, simply owning the equipment does not mean the procedure can be done.

The practitioner's experience and skill are important.

Other than our clinic, there are no hospitals that perform ultrasound-guided selective nerve block.

We are the only hospital that performs non-incisional ultrasound-guided selective nerve block.

Question) During calf muscle recession surgery, other hospitals use local anesthesia, but is sleep anesthesia absolutely necessary?

Answer) Nerve block for muscle recession must be performed under sleep anesthesia.

When electrically coagulating the nerve with a nerve finder, heat of around 100°C is generated to block the nerve, and this heat causes pain.

Therefore, if sleep anesthesia is not used, the procedure becomes impossible because of pain.

In addition, local anesthesia is also used during calf procedures, but this only anesthetizes the skin layer where the needle enters, not the muscle, so it is not very meaningful.

If the muscle is anesthetized, it cannot respond to the nerve finder, so the procedure cannot be performed.

There are cases in other hospitals where the procedure is performed without sleep anesthesia, and even then there is almost no pain and the procedure is tolerable.

The reason is that the heat used during electrical coagulation is kept low, so the procedure is performed at a low temperature and there is little pain.

In such cases, the electrical coagulation of the nerves is not properly done, so there is no effect immediately after the procedure or a temporary effect appears, only for the bulging calf muscle to recur within a few months.

Poor procedures performed with low-temperature, weak heat will definitely recur, so caution is needed.

Question) How much volume is reduced after calf muscle recession surgery?

Answer) As the muscle volume decreases, the calves become slimmer, but the extent varies from person to person.

The greater the muscle volume, the larger the reduction; the smaller the volume, the smaller the reduction.

A simple example is like the difference in how much change occurs when a balloon that was inflated a lot deflates compared with one that was only slightly inflated.

Question) Are calf reduction surgery and muscle recession surgery different?

Answer) The meaning of calf reduction surgery is broad.

Since it means reducing the calf, it includes muscle recession surgery and liposuction.

In a broader sense, there is also calf contouring.

This includes all cosmetic procedures such as muscle recession surgery, liposuction, varicose vein surgery, and scar revision.

In other words, calf reduction surgery falls within the overall scope of calf contouring, and within reduction surgery there are muscle recession surgery and liposuction.

Question) Are calf muscle recession surgery and nerve block surgery different?

Answer) They can be considered to mean the same thing.

Muscle recession surgery is a comprehensive term.

Since muscle recession surgery means reducing the calf muscles, the method used for that is nerve block surgery.

In other words, because muscle recession is achieved by using the nerve block method, they can be seen as having the same meaning.

Question) What is the most effective calf muscle recession method?

Answer) Many methods have been devised and used so far, but the most effective procedure is ultrasound-guided selective nerve block.

It is an advanced version of selective nerve block, addressing the biggest problems of conventional selective nerve block: difficulty finding the nerves and difficulty rechecking and treating the found nerves.

Therefore, treatment effectiveness was reduced and the recurrence rate was very high.

Ultrasound-guided selective nerve block was developed to address this.

Because the nerves are directly confirmed on the ultrasound screen during the procedure, they are found more accurately and quickly, and there is the advantage of being able to recheck and treat the same area, so the treatment effect is nearly 100%, and the recurrence rate can be significantly lowered.

It also causes almost no damage to other tissues, so swelling and pain are minimized and recovery is fast, among several other advantages.

Question) What are the problems with conventional selective nerve block?

Answer) The basis of selective nerve block is to reduce muscle without causing scars or damaging muscle tissue.

The biggest problem with conventional selective nerve block was that, in order to find invisible nerves, the practitioner had to poke around with a probing needle to locate hidden nerves.

As a result, finding the nerves was very difficult, time-consuming, and if the nerves were not found properly, the treatment effect declined and recurrence occurred easily.

Selective nerve block is theoretically an ideal method for reducing muscle with minimal scarring and minimal tissue damage, but in reality the results do not meet expectations.

Therefore, ultrasound-guided selective nerve block can be said to be the best alternative.

Question) What is the difference between radiofrequency muscle recession surgery and selective nerve block surgery?

Answer) Both procedures have the same goal of reducing muscle.

There is a methodological difference: radiofrequency treatment directly burns and necroses the muscle to reduce muscle volume, whereas nerve block treatment blocks only the nerves going to the muscle with almost no damage to the muscle, allowing the muscle to atrophy naturally.

In other words, the difference is whether the muscle is directly burned to reduce it, or whether only the nerves going to the muscle are blocked so that it reduces.

Question) What are the problems with radiofrequency muscle recession surgery?

Answer) Radiofrequency treatment is a method that directly burns and necroses the muscle.

The tissue damage is severe, and side effects and aftereffects are frequent.

Severe swelling and pain, inflammation from tissue necrosis, contour irregularities in the leg, and depressions caused by accompanying necrosis of fatty tissue can occur.

In addition, the reduction in volume is not large, so it is not a recommended method for calf muscle recession surgery.

Question) What are the side effects of selective nerve block?

Answer) These problems occur when the practitioner's experience and skill are lacking.

Side effects include blocking the wrong nerve and reducing leg strength, damaging sensory nerves and causing sensory disturbance, severe pain caused by damage to tissues other than nerves, contour irregularities or asymmetry due to incomplete nerve block, and tiptoe-related side effects caused by incorrect post-procedure instructions.

However, if you receive a proper procedure that follows the principles, you do not need to worry about these side effects.

Question) Will there be no scars after selective nerve block?

Answer) Because this is not a surgery that uses a scalpel incision and instead uses a blunt probing needle with a thickness of 1 mm, scars are almost nonexistent.

A mark of about 1 mm may be visible at the procedure site, but it is so small that it is not noticeable, so a 1 mm mark cannot be considered a scar.

Therefore, there is no need to worry about scarring.

Question) I heard that a tiptoe side effect can occur after the procedure, where the heel does not touch the ground. Why does this side effect happen?

Answer) The tiptoe side effect, in which the heel does not touch the ground, is caused by continuously wearing high heels immediately after the procedure.

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

If the tiptoe side effect occurs, you should walk barefoot as much as possible so that the contracted muscle is stretched and lengthened again.

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

After the tiptoe side effect occurs, if you take off your shoes, walking may become uncomfortable, making it necessary to keep wearing high heels again.

However, this worsens the condition.

In the early stage of tiptoe problems, the best approach is to take off the high heels quickly, switch to shoes without heels, and keep walking to stretch the muscle again until it lengthens and straightens.

Usually, if you practice walking in shoes without heels 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 there is no tiptoe side effect even if you wear high heels immediately after the procedure. Is that correct?

Answer) As the muscle atrophies after the procedure, the muscle shortens, which causes the tiptoe side effect. High heels are the main cause of this.

When high heels are worn, the muscle contracts and its length becomes shorter, which causes the tiptoe side effect.

However, among people treated at other hospitals, in most cases the tiptoe side effect does not occur even if they keep wearing high heels immediately after the procedure.

The reason is that the procedure was not done properly, so the muscle did not atrophy, and therefore the tiptoe side effect did not occur either.

In other words, it is the same as someone who did not receive the procedure continuing to wear high heels without developing a tiptoe side effect.

If you continuously wore high heels immediately after a calf procedure and did not develop the tiptoe side effect, that proves the procedure had almost no effect, and if you check your calves, the original bulges will still be there.

Question) When can daily life resume after selective nerve block treatment?

Answer) After selective nerve block surgery, daily life is possible from the next day.

On the day of the procedure, the leg feels slightly weak and has a dull ache.

However, from the next day onward, daily life is fully possible, and you only need to wear the compression band provided by the clinic for about a week.

Question) What happens if recurrence occurs after the procedure?

Answer) After general selective nerve block, the recurrence rate is very high.

In clinics with a high recurrence rate, many have rates above 80%.

In other words, if 10 people undergo the procedure, 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’s calf contouring clinic was designed to minimize recurrence.

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

If recurrence does happen, we provide a repeat procedure to correct it.

Question) If recurrence happened after selective nerve block at another clinic, can it be performed again here?

Answer) After nerve block treatment at another clinic, the recurrence rate is high, and when recurrence occurs or no effect is seen, many people resign themselves to thinking it must not be suitable for their body type.

In cases of recurrence, constitutional factors account for only a small number.

Most cases are caused by the practitioner's lack of experience and skill, or 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, it is impossible to determine their location, so the procedure cannot be performed.

Therefore, for a repeat procedure, good results can only be achieved if the nerves are directly found through ultrasound imaging and the procedure is performed accordingly.

After recurrence, repeat treatment can only be properly done with ultrasound-guided selective nerve block.

Question) I received radiofrequency treatment at another clinic but did not see results. Can I receive nerve block treatment here?

Answer) Radiofrequency treatment is a method of directly burning and necrosing the muscle with an ablator, but in most cases the effect is weak or recurrence occurs.

In some cases, contour irregularities occur due to a height difference between the treated and untreated areas.

Even in such cases, treatment with non-incisional ultrasound-guided selective nerve block is possible.

Because nerve block treatment almost does not damage the muscle and blocks only the nerves, it induces natural muscle atrophy and can naturally refine the shape even when there is recurrence or contour irregularity.

Question) I have had all kinds of procedures at other clinics, including nerve block treatment and radiofrequency treatment, but why is there still no effect?

Answer) As with all surgeries, results vary depending on the surgeon's experience and know-how.

Without ultrasound equipment, repeat nerve block procedures are almost impossible.

Radiofrequency treatment itself is a procedure that is difficult to achieve a major effect in muscle recession surgery.

The lack of effect is due to choosing the wrong procedure, and the practitioner's lack of equipment, experience, and skill.

A proper procedure can produce a permanent effect with just one treatment.

Even if you have failed multiple times at other clinics, you can usually see a satisfactory effect with one treatment at our clinic.​

Precautions regarding the procedure

♥ For calf contouring, the appropriate method is selected according to the desired shape or cause.

♥ For muscle recession surgery, nerve block surgery is performed.

♥ In cases of obesity, liposuction is performed.

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

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

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