Calf Implants: What You Need to Know

Patients get calf augmentation surgery for a variety of reasons:

• To enhance the size and curvature of the calves. Some bodybuilders, for example, have found that they can’t dramatically increase the size of their lower leg with exercise and weight lifting alone.
• To create a more proportional, balanced look. Patients who feel their legs look disproportional or too thin may seek this surgery.
• To correct a congenital deformity. People with certain medical conditions (like spina bifida, club foot, or polio) that lead to underdeveloped or asymmetrical calves may choose to enhance their lower legs with implants.
• To reconstruct the calves after an injury. Implants can also mask muscle deformities due to trauma.
• For masculinizing gender confirmation surgery. Implants can give the lower legs a more traditionally masculine appearance.

A board-certified plastic surgeon who specializes in body contouring with calf implants can help you determine whether you’re a good candidate for this type of enhancement. After examining and measuring your calves, they’ll discuss the best implant size and type for you, and whether you’ll benefit most from inner and/or outer calf muscle implants.

Pros

• Results are long-lasting, and most often permanent, though you can have the implants removed or replaced at any time. “Some patients who want very large, muscular calves will come back to safely upsize their implants after just six months of healing,” notes Dr. Ryan Stanton, a board-certified plastic surgeon in Beverly Hills, California.
• If your lower legs are a source of insecurity, enhancing the calves can help boost confidence.
• A calf implant procedure is considered very safe, and complications are rare. Side effects are usually limited to bruising, redness, soreness, and swelling in the calf area.
• It’s an outpatient surgery, so you’ll be able to go home the same day.
• Reviewers on RealSelf give this cosmetic surgery a 73% Worth It Rating.

Cons

• Most patients need two weeks of downtime before resuming normal activities. 
• Some aren’t comfortable walking without assistance and crutches for the first few days of recovery.
• Serious complications are very rare in the hands of a specialist, but issues like infection or compartment syndrome can occur, requiring immediate medical attention.
• As with breast implants, calf implants can develop capsular contracture, in which the scar tissue that forms around the implant tightens. In severe cases, this condition can lead to pain, deformity, and the need for implant removal.
• When this surgery is performed for aesthetic reasons alone, it’s not covered by health insurance. And according to Dr. Stanton, most insurance companies do not cover it for medical reasons either.

• Average Cost:
• $7,425

• Range:
• $6,100 - $21,500

Your cost will depend on your surgeon's level of experience and surgical technique, their practice location, who administers your anesthesia, and the specifics of your procedure. 

Insurance plans don’t cover the calf implant surgery—unless it’s done as part of orthopedic reconstruction from a club foot or an injury, in which case it may be deemed medically necessary.

The calf implant photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

The total procedure time for calf implant surgery is about an hour and a half, but with prep and general anesthesia, you can expect to devote most of your day to the surgery. The good news is that it's an outpatient procedure, so you’ll be able to leave the surgery center the same day, once the anesthesia wears off.

Here’s how the operation typically works:

• You’ll be put under general anesthesia and fully asleep for the procedure.
• Your surgeon will make a small incision (approximately 4 centimeters long) in the natural crease behind the knee, to minimize visible scars. 
• According to Dr. Gregory A. Wiener, a board-certified plastic surgeon in Chicago, the implants are typically “placed beneath the fascia, which is a thick covering over the muscle.” (This is considered subfascial placement, not submuscular, which is more invasive and involves making a pocket for the implant underneath the muscle.) “In many cases, two implants are placed in each leg, to mimic the natural shape of the calf muscle,” he adds.
• Most patients have implants placed in both legs, to ensure symmetrical results. People with pre-existing muscle imbalances may require calf implants of different sizes.
• Your doctor may insert a small plastic drain, to prevent fluid buildup, before closing the incisions with sutures. They’ll remove the drain at a follow-up appointment several days after surgery.
• Your lower legs will be wrapped in compression bandages.
• You will be groggy and sore, so make sure you have someone there to take you home and help you with walking.

Most patients take about two weeks off work. While “recovery usually progresses at a smooth, steady pace after the initial two weeks,” says Dr. Stanton, the full healing process after calf implant surgery can take up to six weeks. 

While every recovery is different, this is generally what you can expect post-op:

• You may find that you need pain medication for a few days to the first week, so your surgeon will recommend over-the-counter options or prescribe something stronger.
• For the first few days, you’ll need to keep your legs elevated, for healthy blood circulation.
• You’ll probably need some assistance getting to the bathroom. 
• Your doctor may recommend that you begin to walk around occasionally, within your home (and, again, with assistance), to boost circulation and prevent blood clots, as early as the first day. “The first two weeks after surgery are the most difficult, because walking is painful. Patients find they can move about just fine without crutches—however, some choose to use them for the first three to five days,” explains Dr. Stanton. 
• During the initial two weeks of recovery time, you’ll need to wear compression bandages or socks.
• Your surgeon might suggest massaging the area gently, to help acclimate your leg to the new implant.
• Driving a car is usually allowed after 7 to 10 days.
• Low-intensity, seated, upper-body workouts can resume at two to three weeks, then standing exercise at four weeks. Leg workouts are prohibited for six weeks.
• Most surgeons ban running and bicycling for 4 to 8 weeks after surgery.

Calf implants are permanent, unless you choose to remove them or swap them out for a different size. Because calf implants are made with solid silicone, rather than gel, they cannot rupture and do not need to be replaced over the course of a lifetime, says Dr. Barry Eppley, a board-certified plastic surgeon in Carmel, Indiana.

The implant will not drop and shouldn’t change shape over time. “Calf implants are secured in place and cannot move on their own. If done properly, with an experienced surgeon, your calf implants will stay in place forever,” notes Dr. Z. Paul Lorenc, a board-certified plastic surgeon in New York City.

Soft, semi-solid silicone rubber implants in the calf are widely considered to be safe, with a low complication rate when performed by an experienced plastic surgeon, according to the journal Plastic and Reconstructive Surgery. 

However, all implants come with risks. Your provider should talk you through these potential side effects.

• Hematoma, a severe bruise
• Seroma, a build-up of fluid under the skin
• Capsular contracture, in which scar tissue forms a hard capsule around the implant, has a reported incidence of up to 4% for calf implant patients
• Infection, which occurs at a rate of less than 2%
• Visible scarring
• Nerve and/or muscle damage
• Implant rejection
• Compartment syndrome, which increases pressure in the calf muscle, at a rate of less than .1%
• Extrusion
• Asymmetry

Rarely, the implant can dislodge. This most frequently occurs from a poorly positioned implant pocket, excessively large implants, trauma, or not strictly following post-op instructions. If this happens, revision surgery may be necessary. 

If your implants have been placed appropriately, you shouldn’t be able to feel them once you’ve healed.

According to Dr. Lorenc, “Properly placed calf implants cannot be felt by the patient. The implants get incorporated into the patient's body image to the point that patients even forget they have had the calf augmentation surgery.”

Emsculpt is a nonsurgical treatment that creates subtle muscle definition.

• The Emsculpt device uses electromagnetic energy to contract your leg muscles up to 20,000 times a minute, much like a high-intensity workout, to build muscle tissue.
• A series of four sessions over a two-week period is recommended.
• Annual maintenance treatments and regular exercise are required, to keep up your results.
• Over time, this can become as expensive as surgery.
• However, Emsculpt comes with fewer risks than surgery and has one major advantage: it can actually make the calf muscles stronger.

Calf augmentation with fat grafting is a surgical procedure that removes fat from one area of the body (such as the thighs) via liposuction and transfers it to the calves.

• Fat grafting isn’t quite as invasive as implant surgery, so it can often be done under local anesthesia.
• In some cases, doctors use fat grafting in conjunction with implants, for added padding around the implants. As highlighted in this 2013 study, subfascial calf implants can be placed via an endoscopic technique and complemented with liposuction and fat grafting, to reshape the lower leg and increase the diameter of the calves, “with minimal discomfort during the postoperative period,” researchers say.
• Not all surgeons recommend this method because fat survival is unpredictable—and typically poor in this area, notes Dr. Stanton. Because of this, i’s possible to have uneven distribution and unnatural contouring problems.