Surgical Procedures

Body Procedures


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Calf Reduction

Long, thin calves are considered beautiful. It not only makes a person appear taller, but also conveys a sense of grace and elegance. Calf reduction surgery was first developed in Korea to address a bane of many Asians, disproportionately prominent calves that are both short and muscular.

Calf reduction surgery eliminates the top heavy look that disproportionately prominent gastrocnemius muscles give you, resulting in a top-heavy looking calves that body builders crave, but are problematic for normal individuals. Not only is it difficult to wear fashionable knee high boots, but both women and men feel self-conscious about the shape of their calves, making it embarrassing to wear shorts during the summer time.

Ideal calf circumference is between 32 to 34 cm. Many procedures have been developed to make calves look less prominent. The right procedure for a patient depends on both your calf anatomy, size of your gastrocnemius muscles, and the overall appearance of the calf. These include liposuction, Botox injections, radiofrequency nerve ablation, and partial muscle resections.

Calf reduction can be accomplished via several different techniques:

  • Botox Injections
  • Liposuction
  • Radiofrequency nerve and muscle ablation
  • Highly Selective neurectomy
  • Partial resection of the gastrocnemius muscle

These procedures can also be combined for more effective and better aesthetic results. There is a sixth procedure that Dr. Liu does not perform or believe in, which is the complete resection of both heads fo the gastrocnemius muscles. This procedure is still performed in Asia, but Dr. Liu feels it gives inferior results with increased patient morbidity and calf contour irregularities.

Botox Injections

There are many protocols for Botox calf treatments. They can be spaced out in 2 to 3 sessions. Dr. Liu prefers a higher dose, single calf reduction treatment session, with an additional treatment sessions, only if necessary, to supplement the initial treatment.

Advantages: Reversible. Non-invasive. Effective. Let’s patients preview what it would be like to have your gastrocnemius muscle knocked out and the resulting weakness. If you don’t like the result, it’s reversible.

Disadvantages: Reversible (lasts 9 months to 1 year) so you need repeated injections to maintain result. No down time. Expensive for the temporary results you get. Results are gradual in onset. Takes 1-2 months to start seeing the results.

Radiofrequency Nerve/Muscle Ablation

Many centers offer “calf reduction” surgery but refer to radiofrequency calf reduction. Traditionally, this procedure involves making small puncture holes in your skin and inserting a small probe that burns your nerve and muscle. Older machines, mostly from Korea, blindly burns your calf muscle and nerves in a grid-like pattern.

The nerves of the gastrocnemius muscle are small and difficult to identify. As a result, blindly burning the nerve and muscle in a methodical grid pattern increases the probability that the surgeon is able to burn the nerve branches. In the process, some of the muscle is burned and dies off, thereby contributing to the shrinkage of the calf muscles. However, if the energy applied is too strong, the muscle may scar up and you’ll firm hard areas in your calves.

Dr. Liu uses a revolutionary new radiofrequency device, the ThermiRF, which has the ability to identify exactly where the nerves are located and can selectively burn the nerves. No grid like blind burning of the nerves is needed. The energy used is also strictly controlled so that it is less likely to cause side effects such as muscle fibrosis, which results in firm hard areas in your calf muscles.

Advantages: Minimally invasive surgery. Less likely to get contour irregularities. Immediate results. Virtually no scarring except for needle like puncture holes which heal well. Minimal downtime.

Disadvantages: Less accurate procedure. May need multiple sessions. In some cases, nerves may grow back, so results may not be lasting.

Selective Neurectomy

Advantages: Permanent results and irreversible. Minimal scarring (2 cm scar behind your knees that like in one of the skin creases). Effective in reducing size of calves in a uniform fashion and you will not get contour irregularities as you would with partial muscle resection. Takes time for the muscle to atrophy from lack of use and nerve stimulation. Minimal post-operative discomfort and fast recovery. Potential alternate gastrocnemius innervation from the underlying  soleus muscle that may not be addressed.

Disadvantages: Potential for compensatory hypertrophy of other muscles in the calves to compensate for weakness. Not Reversible (Relative disadvantage)

Partial Muscle Resection

Advantages: Permanent immediate results. May be combined with Selective Neurectomy to decrease likelihood of contour irregularities.

Disadvantages: High potential for contour irregularities. May get compensatory muscle hypertrophy from remaining calf muscles, or remaining gastrocnemius muscle. Longer post-operative recovery period (2-3 weeks) secondary to pain and calf swelling. Obvious surgical scar on the sides of your calf that slowly fade with time.

Each of the above procedures can be performed by itself, or in combination. For example, a partial muscle resection combined with selective neurectomy, or a selective neurectomy procedure can be combined with radiofrequency nerve/muscle ablation surgery.

Many of Dr. Liu’s patients are from out of town. We are able to set up skype consultations and also help you with your travel and hotel arrangements. After surgery, we are also able to arrange post-operative care for you. Prior to setting up either a telephone or Skype conference call, it would be helpful to send us pictures of your calves with a few different views:

  • Posterior image of your calves, with you flat on your feet
  • Posterior image of your calves, with you standing on your tippy toes
  • Anterior image of your calves, with you flat on your feet
  • Anterior image of your calves, with you on your tippy toes
  • Lateral view of your calves

For more information you can check out Dr. Liu’s calf reduction website.

Patient Before & After Photos

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Do you have any questions about plastic surgery or wish to schedule an appointment for an initial consultation?


Call Us: (888) 405 7978 Have Questions?