Although hypoplastic calves can be caused by unusual disorders that affect muscle development and spinal cord problems, most cases are presumed genetic and are resistant to the patient’s efforts to bulk up with exercising.
Solid or gel-filled implants (not available in the United States) can be inserted in the posterior compartment of the leg to augment the medial calf. Some operators also use implants for lateral calf augmentation.
A posteromedial transverse incision along the popliteal crease provides access. The medial sural cutaneous nerve is preserved. The scar tends to be well concealed, although it may hypertrophy or become hyperpigmented. The subfascial plane is ideal for implant insertion. This plane is located between the muscle investing fascia and the thin epimysium on the muscle surface.
Fat injection is a useful alternative to implants and can provide a modest degree of improvement. Frequently the author uses subcutaneous fat injection simultaneously with an implant.
Calf skin typically has little capacity to stretch. The surgeon must be cautious to balance implant size with tissue tolerance or face serious complications that include skin necrosis, extrusion, and compartment syndrome. Superior malposition is avoided by adequate distal blunt dissection of the pocket. Infection is unusual.
Patients wear an Ace wrap for 1 month. Patients typically return to nonphysical jobs in 1–2 weeks and exercising in 1 month.