Calf implants: a 25-year experience and an anatomical review.
Body contouring in the calf region is becoming a more frequently requested procedure. There are several techniques for calf enhancement, including implants, liposuction, and free flaps. Alloplastic augmentation can be performed with several implant types and several layers of pocket dissection. We present our 25 years of experience using the subfascial technique for calf implantation along with an anatomical study to illustrate all the important steps and relevant anatomy of this augmentation technique. The subfascial technique was performed in 25 cadavers, in which the important layers were dissected for high-resolution photos of the surgery to learn about the relevant anatomy of the region. Also, we did a retrospective study of our experience with calf implants, studying the aesthetic outcome, the presence of early complications, and the presence of late complications. We performed dissections in 25 cadavers and surgery in 63 patients (126 implants). In our series of patients the final aesthetic index was of 9.8. The early complications were severe postoperative pain (11.11%), infection (0.79%), seroma (21.42%), hematoma (0%), and wound dehiscence (7.14%). The late complications were capsular contracture (Baker grades III and IV) (3.17%), implant rupture (1.58%), implant leaking (0%), implant displacement (3.96%), numbness at the ankle (2.38%), and palpability of the implant (0%). The subfascial technique for calf augmentation has complication rates low enough and surgical outcomes good enough to recommend it as the gold standard for alloplastic calf augmentation.