If you are talking about free silicone injected into the leg, absolutely a dangerous idea and should not be performed. Calf Implants, on the other hand, have become a very popular procedure with exceedingly high patient satisfaction and very low complication rates. Most of the new calf implants are made of a very soft, solid silicone. The implant company should have two distinct implant shapes, one for the medial calf and one for the lateral calf. Only some of the implants, however, are very finely tapered to blend in more seamlessly with the tissues especially when placed in a subfascial plane. Even some of the current implants are too round and thick on the sides to blend nicely, in my opinion. The reality is that calf implants were made and designed to be just that...calf implants. They were not designed to extend into the lower leg. In saying that, i would say that we can cheat to certain degrees and lower the implant to certain degrees in some patients. The fascia that covers the muscle blends and joins the bottom of the gastrocnemius calf muscle. Once that fascia at the bottom is broken through, the implant becomes subcutaneous at that point. Generally one can get away with some of the implant in a deep subcutaneous plane, but once you break completely through the covering and supporting fascia, there is a much greater chance of problems. Problems including inferior displacement, visability of the implant, a more palpable implant, pain, etc. There are some designs that combine a long thin extension to a standard type implant, however those long thin extensions become essentially subcutaneous and are prone to be palpable and movable / unstable. Problems equal dissatisfaction. This is not to say that it always produces a problem or bad result, however, problems and complications are alot more likey. Fat augmentation of the ankle and lower leg is also unpredictable. I inject and transfer fat all over the body very successfully all the time. But the lower leg is more unpredictable. I have seen it do a good job and i have seen it heal without result and even worse with darkening of the skin with firmness, taking months to resolve. To sum it up, calf augmentation with the right implants is a popular and wonderful procedure with low complications. The more you vary from this standard procedure, by attempting to augment the calf into the lower leg, the more likely you are to encounter complications.
