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What are the types of calf reduction surgery?

Various procedure methods for creating slim calves

Guide to types of calf reduction surgery

Guide to calf plastic surgery for creating attractive calves

1. Selective calf nerve block

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

2. Intermediate and high-frequency calf muscle cauterization

A method that burns and necrotizes the gastrocnemius muscle with an intermediate- and high-frequency cautery device

3. Medial calf neurectomy

A method that makes an incision behind the knee, cuts the medial motor nerve going to the gastrocnemius muscle, and causes the muscle to atrophy

4. Calf muscle excision

A method that makes an incision behind the knee and removes the gastrocnemius muscle with an instrument

5. Calf nerve ablation

A method that injects a phenol solution near the motor nerve going to the gastrocnemius muscle to dissolve the nerve and cause the muscle to atrophy

6. Calf Botox procedure

A method that administers Botox into the gastrocnemius muscle to temporarily paralyze the muscle and cause it to atrophy

7. Calf liposuction

A method that reduces volume by suctioning fat between the calf muscle layer and the skin layer

What is selective calf nerve block?

Selective calf nerve block works by blocking the gastrocnemius nerve that branches from the tibial nerve to the gastrocnemius muscle,

so that the gastrocnemius loses its motor function.

Because a blocked nerve muscle cannot contract or relax, it loses motor function,

and over time the muscle inevitably atrophies.

This method blocks the nerve by applying the principle that unused muscles degenerate.

Advantages of selective calf nerve block

By selectively blocking nerve branches, the calf muscle can be reduced without damaging the muscle.
It does not leave scars.
It is done under local anesthesia, the procedure is simple, and daily life can resume immediately.
It can be performed on both the inner and outer sides of the calf.

Disadvantages of selective calf nerve block

Finding invisible nerves with a nerve finder, which is the basic equipment for nerve block procedures, is difficult and time-consuming.

In addition, when 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 procedure may be ineffective or much less effective, side effects may occur, and the recurrence rate may be high.

Because invisible nerve branches must be found, it is technically difficult.
If the nerve branches are not found properly, the procedure effect is greatly reduced or recurrence is likely.
If the practitioner lacks experience, other nerves or blood vessels instead of the gastrocnemius motor nerve may be damaged.

What is intermediate and high-frequency calf muscle cauterization?

Intermediate and high-frequency muscle cauterization

is a method that burns and necrotizes the gastrocnemius muscle with an intermediate- and high-frequency cautery device.

It works by burning the gastrocnemius muscle with heat so that the muscle becomes necrotic and disappears.

Because the muscle itself is damaged,

there are limitations to the procedure,

and side effects from damage to tissues other than muscle may also occur.

Advantages of intermediate and high-frequency calf muscle cauterization

Leaves a small scar.
The procedure is simple under local anesthesia.
It can be performed on both the inner and outer sides of the calf.

Disadvantages of intermediate and high-frequency calf muscle cauterization

Swelling and pain are severe, making immediate daily life difficult.
The effect of calf muscle recession is limited.
Recurrence is frequent, and the effect of muscle recession is often not uniform.
Heat damage to other tissues may cause contour irregularities in the calf.
If sensory nerves are also heat-damaged, sensory disturbance may occur.

What is medial calf neurectomy?

Medial calf neurectomy means

making a 4–6 cm incision behind the knee,

finding and cutting the medial motor nerve going to the gastrocnemius muscle,

which leaves a large scar behind the knee,

and because only the medial nerve is cut,

deformity of the medial muscle can occur,

and there is also the problem that the outer muscle may develop relatively more, resulting in O-shaped legs.

Advantages of medial calf neurectomy

If the nerve is cut accurately, the surgical effect is large.
It is done under local anesthesia and the surgery is simple.

Disadvantages of medial calf neurectomy

Leaves a large 4–6 cm scar behind the knee.
Because only the medial side can be treated, the outer muscle may become relatively larger, creating O-shaped legs.
It is difficult to return to daily life immediately.
If the practitioner lacks experience, side effects may occur due to mistakenly cutting another nerve.

What is gastrocnemius resection?

Gastrocnemius resection means

making a 4–6 cm incision behind the knee and removing the gastrocnemius itself with an instrument.

It leaves a large scar behind the knee.

And because the muscle is removed irregularly, the shape is not good,

and swelling and pain are severe, making immediate daily life difficult,

so this method is rarely used now.

Advantages of gastrocnemius resection

Compared with other methods, there are almost no advantages.

Disadvantages of gastrocnemius resection

Swelling and pain are severe, making immediate daily life difficult, and hospitalization is required.
Leaves a large 4–6 cm scar behind the knee.
Because the muscle is not removed evenly, it creates bumpy legs.

What is calf nerve ablation?

Calf nerve ablation means

searching for the nerve with a nerve finder and then injecting medication (phenol) around the nerve to dissolve it.

First of all, nerve detection itself does not work well, so the procedure is not accurate,

and after injecting phenol, one expects the nerve to dissolve and disappear,

but the effect is often below expectations or nearly absent.

In addition, as the phenol spreads, there is a high possibility of damaging important nerves or blood vessels.

Advantages of calf nerve ablation

It does not leave scars.
It is done under local anesthesia, the procedure is simple, and daily life can resume immediately.
It can be performed on both the inner and outer sides of the calf.

Disadvantages of calf nerve ablation

It is very difficult to find the nerve with a nerve finder, so accurate treatment is difficult.
The effect is weak or recurrence is frequent.
As the injected medication spreads, it may damage nearby important nerves or blood vessels as a side effect.

What is a calf Botox procedure?

Calf Botox procedure means

using Botox to temporarily paralyze the calf gastrocnemius muscle and cause it to atrophy,

but the treatment effect is weak,

the cost is high,

and because it is only temporary, it is not a recommended method for calf recession surgery.

Botox is mainly effective 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 excessive method and is rarely used.

Advantages of calf Botox

Before discussing advantages and disadvantages, it is not a suitable method for calf procedures.

Disadvantages of calf Botox

The procedure effect is almost nonexistent or very weak.
It is temporary and recurs after 3 to 6 months.

What is calf liposuction?

Calf liposuction means

suctioning the fat between the muscle layer and skin layer of the calf to reduce calf volume.

It is used when the fat layer is relatively thicker than the muscle.

Because many sensory nerves pass through the calf area,

excessive suction can cause sequelae such as sensory disturbance,

so it is important to perform suction carefully and delicately to avoid side effects.

Indications for calf liposuction

Applied when the calf has a thicker fat layer than muscle.
Applied when partial liposuction is performed after muscle recession surgery to reduce volume further.

How is Director Shin Duhan’s

NO-incision - ultrasound-guided selective nerve block procedure performed?

The non-incisional ultrasound-guided selective nerve block

uses a special medical device under local anesthesia

(functions to find, identify, and block nerve branches)

to selectively block only the branches of the motor nerve.

Step 1 - Use ultrasound to identify the nerve location and mark it on the skin.
Step 2 - While lying face down, give a light local anesthetic at the site where the needle will enter.
Step 3 - While checking with ultrasound, identify the nerve location and insert the needle toward the nerve.
Step 4 - Confirm with a nerve finder whether the needle is touching the gastrocnemius nerve.
Step 5 - Switch to block mode and generate electrical heat that blocks nerve transmission at the needle tip to block the nerve. If blocking both the inner and outer gastrocnemius sides, a total of four nerves are blocked on both sides.
Step 6 - After the procedure, go home immediately.

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

Because the nerve course and depth differ from person to person, identifying the exact nerve pathway is an essential process for a successful procedure.

▲ After nerve detection, mark the area where the nerve will be blocked.

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

▲ The nerve is divided into medial and right nerves, and it extends with many branches like tree limbs.

All of these small branches are also detected and marked with ink.

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

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

Accurate nerve detection can increase the procedure’s success rate and minimize recurrence.

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

▲ Insert the nerve block needle into the locally anesthetized area.

After confirming that it has passed through the fascia, guide the needle tip toward the area where the gastrocnemius motor nerve is located under ultrasound guidance.

▲ Quickly search for nerve branches with ultrasound and block them.

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

In addition, by preventing damage to other important tissues besides the nerves to be blocked, the procedure can be performed without side effects.

▲ 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, detection is difficult, and it is almost impossible to find nerves with ordinary ultrasound.

Detection is possible with a 7.5 MHz or higher high-frequency ultrasound, and the nerve must be accurately checked from the root to the branches.

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

After confirming muscle contraction, switch the nerve-search mode to block mode and perform electrical coagulation.

After electrical coagulation is finished, switch back to nerve-search mode to confirm that the muscle no longer contracts.

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

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

Usually, 7–8 points are blocked in one muscle, and the more nerve branches that are blocked, the more effective the procedure becomes.

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

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

If only the inner side is treated, the procedure ends in about 30 minutes.

You can go home immediately after the procedure, and before leaving, you lift your heel to check whether calf bulging occurs, then go home.

When leaving, you can wear the compression band provided.

What is the usefulness of ultrasound diagnosis in nerve block procedures?

The auxiliary device used in nerve block procedures, 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 the procedure in nerve block treatment 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 going to the gastrocnemius muscle.

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

The more nerves blocked, the better the procedure effect.

To find nerve branches effectively, rather than the traditional method of randomly probing here and there, accuracy and effectiveness can be improved by looking at the ultrasound screen, accurately identifying the nerve pathway, and approaching the nerve with the probe at once.

Without ultrasound equipment, there may be cases where the procedure is almost impossible if the nerve does not respond well to the probe.

Electrical coagulation can only be performed if the nerve responds; if the probe touches the nerve but there is no response, the procedure becomes impossible.

In such cases, if the ultrasound screen confirms that the probe is touching the nerve, electrical coagulation can still be performed even if the nerve does not respond, which is useful.

What is the immediate effect after the no-incision - ultrasound-guided selective nerve block procedure?

After the procedure, when you raise your heel, you can visually confirm immediately that the bulging calf muscle does not tense up.

The non-incisional ultrasound-guided selective nerve block can produce satisfactory results with a single procedure, and because there are no scars or post-procedure discomfort, it is a very welcomed treatment.

What is the post-procedure course after the no-incision - ultrasound-guided selective nerve block procedure?

If only the inner side of the calf is treated, the procedure takes about 30 minutes. After the procedure, wear the compression band provided by the hospital.
Immediately after the procedure, you can lift your heel and confirm right away that the calf does not bulge.
There may be slight pulling pain after the procedure, but it does not interfere with daily life.
Swelling and bruising are almost absent.
Due to gradual muscle atrophy, a slight pulling or stiff feeling in the calf for about a month is a normal part of the recovery process.
A visible feeling that the calf thickness has decreased can be noticed after about 15 days to one month.
The maximum effect appears after 3 to 6 months, there is no recurrence, and the procedure effect is permanent.

What are the precautions after the no-incision - ultrasound-guided selective nerve block procedure?

① Due to gradual muscle atrophy, a slight pulling or stiff feeling in the calf for about a month is a normal part of the recovery process.

There may be some discomfort while walking, but if you naturally stretch the muscle while walking, the pulling sensation will gradually disappear.

The period until the pulling sensation disappears may 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, wearing shoes with low heels or sneakers and doing light exercise such as walking little by little can improve the procedure effect and help relieve the muscle pulling and stiffness more quickly.

③ If you wear high heels and continue daily life immediately after the procedure, the muscle length may become shorter, causing a tiptoe-like side effect in which the heel does not touch the ground, so caution is needed.

However, this problem will not occur at all if you wear low heels or sneakers for about a month.

④ In hospitals with insufficient experience in calf procedures, patients are sometimes told to wear high heels after the procedure.

This should absolutely not be done.

Wearing high heels keeps the muscle in a contracted state, 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.

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

What should be noted regarding calf procedures?

♥ Although there are many methods for calf reduction surgery, there are not that many suitable methods.

♥ The choice of calf procedure depends on the shape and cause of the thick legs.

♥ A good calf procedure is one that has no side effects and produces definite results.

♥ A method should be selected that minimizes swelling and pain after the calf procedure.

♥ For calf muscle recession, ultrasound-guided selective nerve block is the most preferred method.

If you have calf bulges, you need muscle recession surgery.

http://www.calfs.co.kr

At Duhan Plastic Surgery Clinic,

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

and its advantages are that it addresses the biggest problem with nerve block procedures—difficulty in properly finding the nerves—

and improves procedural accuracy to minimize recurrence.

<Examples of applying the non-incisional ultrasound-guided selective nerve block procedure>

With ultrasound, nerve branches can be rapidly detected for accurate treatment.

By using a special medical device for nerve block under local anesthesia (functions to find, identify, and block nerve branches),

only the branches of the motor nerve are selectively blocked, so no scar remains,

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

and after the procedure the patient can immediately return to daily life.

The immediate effect after the procedure can be visually confirmed by lifting the heel after the procedure,

as the bulging calf muscle does not tense up right away.

<Examples of applying the non-incisional ultrasound-guided selective nerve block procedure>

The procedure takes about 1 hour,

and there are no special precautions after the procedure.

The effect appears gradually over 1 to 6 months as the muscle atrophies and the thickness decreases.

Normal daily life is possible starting the day after the procedure.

<Examples of applying the non-incisional ultrasound-guided selective nerve block procedure>

​http://www.duhans.com​