[Calf Bulge Removal at Duhan Plastic Surgery] - [Ultrasound-Guided Selective Nerve Block]

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Muscle reduction surgery - Nonincisional 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 itself.

At our clinic, we precisely locate the nerves with ultrasound

and effectively block them, significantly reducing side effects and recurrence rates.

What are the requirements for success with nonincisional ultrasound-guided selective nerve block?

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

Because the procedure is performed without an incision, the invisible nerve branches must be found quickly so that as many branches as possible can be blocked in order to achieve satisfactory muscle reduction.

The biggest limitation of nerve block procedures is that the basic search device's exploration needle cannot locate the nerve quickly.

Depending on the person, the nerve may not respond properly to the exploration needle, and some nerves do not run along the normal course, so if the nerve branches cannot be found properly, the procedure may not be performed correctly, leading to reduced effectiveness or no visible result.

To achieve muscle reduction, as many nerve branches as possible must be found and coagulated within a short time, so the practitioner must have extensive experience and know-how.

In addition, ultrasound imaging equipment must be used at the same time to improve the procedure's effectiveness.

Using a nerve-blocking device, the course of the motor nerves that innervate the gastrocnemius muscle in the calf is identified, and then only the gastrocnemius motor nerves are selectively blocked while minimizing damage to other tissues.

The nonincisional selective nerve block procedure is performed under local anesthesia using special medical equipment (with functions to locate, confirm, and block nerve branches). Because only the motor nerve branches are selectively blocked, no scar is left, 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 that the calf bulge muscle does not tense up.

This surgical method can produce satisfactory results with a single procedure, and because there are no scars or postoperative discomfort, it is a procedure that is very well received by patients.

What is the procedure for nonincisional ultrasound-guided selective nerve block?

The nonincisional ultrasound-guided selective nerve block selectively blocks only the motor nerve branches through local anesthesia using special medical equipment (with functions to locate, confirm, and block nerve branches).

Step 1 - The nerve location is confirmed by ultrasound and marked on the skin.
Step 2 - While lying face down, a slight local anesthesia is given at the site where the needle will be inserted.
Step 3 - While checking with ultrasound, the nerve location is identified and the needle is inserted into the nerve area.
Step 4 - The nerve locator is used to confirm whether the gastrocnemius nerve is in contact with the needle.
Step 5 - The device is switched to nerve block mode, and electrical heat that blocks nerve transmission is generated at the tip of the needle to block the nerve. If both the medial and lateral gastrocnemius nerves are blocked, a total of four nerve sites are blocked on both sides combined.
Step 6 - Once the procedure is complete, the patient goes home immediately.

▲ In the examination room, ultrasound is used to determine the course of the nerves.

Because the course and depth of the nerves differ from person to person, accurately identifying the nerve pathway is an essential step for a successful procedure.

▲ After locating the nerve, the area to be blocked is marked.

The nerve pathway is drawn with ink on the marked area.

▲ The nerve is divided into medial and lateral nerves, and it branches out like a tree.

These small branches are also located and marked with ink.

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

Even in the same person, the nerve pathways on the left and right sides of the legs differ, and the number of branches is often different as well.

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

▲ In the operating room, after sedation and local anesthesia are administered, the nerve block needle (exploration 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 guided under ultrasound to the area where the gastrocnemius motor nerve is located.

▲ The nerve branches are quickly located with ultrasound and blocked.

To improve the procedure's effectiveness, the nerve branches must be found accurately and coagulated firmly within a short time, so that nerve regeneration and recurrence do not occur.

It also prevents damage to other important tissues besides the nerves to be blocked, allowing the procedure to be performed without side effects.

▲ It is not very 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 to 2 mm, it is difficult to locate, and it is almost impossible to search for nerves with standard ultrasound.

It is possible with a high-frequency ultrasound of 7.5 MHz or higher, and accurate identification must be done from the nerve root to the various branches.

▲ When the tip of the needle contacts the gastrocnemius motor nerve, the gastrocnemius begins repeated contractions.

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

After the electrical coagulation is completed, the device is switched back to nerve search mode to confirm that the muscle no longer contracts.

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

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

Usually, 7 to 8 sites are blocked in one muscle, and blocking multiple nerve branches is more effective.

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 definitive procedure result.

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

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

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

When leaving, wear a compression band.

Comparison of nonincisional ultrasound-guided selective nerve block with other calf surgery methods

Category	Incisional Muscle Resection	Incisional Nerve Block	Middle/High-Frequency Muscle Reduction	Nerve Ablation	Nonincisional 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	Removal of irregular muscle may result in bumpy legs.	Highly effective. Only the medial side can be operated on, so the lateral side becomes thicker as compensation. It may appear bow-legged.	Low effectiveness. There is little reduction in thickness.	The effect is inconsistent, and due to the spread of medication, the drug may act on unintended areas and cause side effects.	Highly effective. Calves become much slimmer. Both the medial and lateral sides are treated, sufficiently reducing the muscle.
Discharge and function	Severe swelling, bruising, and pain require rest for about 1 to 2 weeks. Walking is very uncomfortable for about a month.	Uncomfortable for about 15 days and walking is difficult. Pulling pain lasts for about a month.	Severe swelling and pain make walking uncomfortable for about a month.	Immediate return to daily life is possible, but there is pulling pain for about 3 to 4 weeks.	Immediate return to daily life is possible, but there is pulling pain for about 3 to 4 weeks.

Muscle reduction surgery - Examples of applying nonincisional ultrasound-guided selective nerve block

What is the pre- and post-care method for muscle reduction surgery - nonincisional ultrasound-guided selective nerve block?

★ Precautions before the procedure 1. Do not consume alcohol the day before the procedure. - Anesthesia may not work well. 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.

★ Post-procedure course and precautions 1. After the procedure is finished, go home only after the sedation has completely worn off. 2. On the day of the procedure, your legs will feel weak and you may have pain, so try not to walk too much and rest at home. 3. Wear the calf band provided by the clinic for about one week only. 4. For 1 to 2 weeks after the procedure, it is advisable not to do strenuous exercise, and you may resume running after 2 weeks. 5. Because of the risk of toe-standing side effects, do not wear high heels for about one month. 6. A pulling sensation in the calves is a normal part of the muscle atrophy process. 7. If the pulling sensation in the calves is somewhat strong, walk barefoot around the room so that natural stretching occurs. 8. Muscle atrophy takes place over 6 months, so observe carefully during that period to make sure there is no recurrence.

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