Calf reduction

Last updated date: 21-Aug-2023

Originally Written in English

Calf reduction

Calf reduction

In the last two decades, lipoplasty of the lower extremities has grown in popularity. Although it was long seen to be a risky treatment with unsatisfactory results, advances in technique are addressing these concerns.

Previous experiences with liposuction, in which legs grew thinner but remained tubular and lacked curves, have now been replaced with a focus on an aesthetic lower extremity. Liposuction may now thin and taper the lower legs, reducing the bulky appearance of the calves.

The size of one's calf can have a significant psychological impact on daily living, affecting anything from outfit choices to self-confidence. While some bodybuilders attempt to develop calf muscle definition by using various weightlifting techniques, others desire calves that are thinner, smoother, and more feminine-looking. 


Definition of calf reduction

Calf reduction surgery is a cosmetic technique that involves removing fat or muscle tissue from the calf muscle and reshaping the lower leg into a more aesthetically attractive shape.



Understanding the anatomy of the individual locations and the variances in fat layers is critical when doing liposuction on the lower extremities.

Both deep and superficial fat layers are traditionally seen in numerous parts of the body. The midsection of the thigh, the calves, and the ankles shows a subdermal layer about 1-2 mm beneath the epidermis, the intermediate or superficial layer is 0.5-1 cm beneath the surface, whereas the deep layer is 1-2 cm beneath the surface. Understanding these layers, as well as the anatomy of the lower extremities, can assist in establishing if superficial or deep liposuction is possible, as well as the expected outcomes.

The intermediate or superficial layer is 0.5-1 cm beneath the surface, whereas the deep layer is 1-2 cm beneath the surface. Understanding these layers, as well as the anatomy of the lower extremities, can assist establish if superficial or deep liposuction is possible, as well as the expected outcomes.

The calf muscles are divided into three groups: the Medial Gastrocnemius, Lateral Gastrocnemius, and the Soleus Muscle. The medial is the most troublesome muscle because it generates a rough line throughout the legs.

Although the lateral gastrocnemius has a small number of muscles, if it is overdeveloped, it will protrude backward.

And if extra fat is added to it, it will result in a larger and rougher line on the calves. So, depending on the amount of muscle and fat in your calves, the best surgical approach to improve the line of your calves should be chosen.


Ideal Candidates for Calf Reduction

Calf reduction operations are best for people who want more symmetrical or smaller calves but are otherwise healthy. Patients who seek muscle resection surgery for optimal calf muscle reduction include individuals who are unhappy with the shapes of their lower legs, particularly those with congenitally thick or tubular legs, or those who have severe calf hypertrophy.

The ideal patient is healthy, between the ages of 20 and 30, and has even skin tone. If the patient is under the age of 50 and has a healthy skin tone, he or she is an excellent candidate.

Liposuction is more successful on the higher sections of the legs, such as the thigh area, according to the American Society of Plastic Surgery. When conducted on the lower parts of the leg, liposuction is less successful, and its slimming benefits are dependent on factors such as leg length and skin flexibility. Those with extra fat in their calves, on the other hand, are good candidates for ultrasound or laser-assisted calf liposuction.

Liposuction of the lower leg, from the thigh to the ankle, is a popular procedure among plastic surgeons. Lower extremity liposuction has progressed beyond removing specific bulges in the thigh to delivering a curvaceous lower extremity using circumferential and superficial liposuction procedures.

Patients who are considering this treatment should have their calves and ankles assessed to see if liposuction can appropriately address their concerns. Larger lower extremities can be caused by muscular tissue hypertrophy, in which case liposuction would be ineffective.

Legs are classed as circumferential or localized heavy legs when choosing a patient for calves and ankle liposuction. Specific fat distributions are not well-defined in the circumferential kind, and the leg as a whole is termed fat.

Lower calves and ankles of the localized form have obvious bulges over the lower lateral fibular, medial tibial, and ankle areas. A tubular-appearing leg can be caused by excess fat over the transition between the gastrocnemius muscles and the inferior leg.

Not everyone is a suitable candidate for leg liposuction, according to the American Society of Plastic Surgery, including individuals with excessive quantities of loose skin, such as those who have lost a lot of weight. Skin removal and fat reduction via liposuction may be required in certain circumstances to get smaller calves.


Advantages of Calf Reduction Procedures

Calf reduction procedures can help patients feel better about themselves and boost their self-esteem, especially if they've always avoided wearing shorts, skirts, leggings, and high heels because of their calves' size. Successful calf reduction operations can give some people the thinner calves they've always desired.

It helps to simplify the shape and size of the calves, slimming and defining the transition from ankle to calves. It can tighten loose skin and remove extra fat. Botox and other non-invasive procedures offer low-risk, no-downtime solutions.


Types of Calf Reduction Procedures

Calf reduction surgery is becoming increasingly popular, particularly among women in South Korea who wish to imitate the lithe appearance of Los Angeles celebrities with long and slim calves. Some women with short and thick calves desire thin legs, especially when high heels accentuate their calf size. Some of the most frequent techniques for reducing the size of huge, bulging calves are as follows:


Calf Liposuction

Liposuction of the calves and ankles is the gold standard for treating large calves and ankles, and it usually produces great results. Liposuction can reduce calf size and contour the lower leg if you have bulky calves or ankles owing to excess fat. Liposuction in the calf area aids in fat reduction and skin tightening. This operation just removes extra fat from the calves and is best used to define the contours of the calves around the knees and ankles. Additional operations will be required if the patient is concerned about big calves as a result of hypertrophied muscle tissue.

This has a one-week recuperation period and is more expensive than nonsurgical treatments, but the effects are more predictable, you'll notice them sooner, and the fat that's sucked out is gone for good. Expect to be out of duty for roughly a week.


Calf Reduction by Muscle Resection

Muscle resection is one form of plastic surgery for adjusting the shape of the lower leg. A part of the gastrocnemius muscle in the calves is removed during this invasive plastic surgery. Muscle excision is the most invasive and dramatic of all calf reduction surgeries, with mixed results. Some studies have found that removing a section of the muscle does not affect athletic abilities, while others have found that patients' ability to walk is temporarily impaired and that scarring is uncomfortable.

Muscle resectioning is an option if your major issue is a bulky (hypertrophic) calf muscle rather than extra fat. To minimize the size of your calves, your surgeon will make the first incision behind the knee and gently remove muscle fibers while avoiding nerves. The effects of this procedure are permanent and irreversible.

It can take up to six weeks to recover following partial muscle removal. As you recuperate from the more intrusive procedures, expect to rest and avoid walking. To assist recovery and prevent swelling, you may need to wear elastic or compression socks.


Calf Reduction by Selective Nerve Blocking

Selective nerve blocking can be used to diminish calf muscles. Calf neurectomy is a minimally invasive surgical treatment that includes removing nerves that govern the calf muscles. The lower leg muscles begin to atrophy and shrink as the calf muscles receive fewer signals to flex.

Because the only incisions are behind the knee, this technique is considered minimally invasive. It severs nerves to allow the calf muscles to atrophy, eventually slimming thick calves. Accidental injury to nearby nerves, which can impede calf function, is the most dangerous associated with neurectomy. Because this is a permanent operation, thoroughly assess the risks and possibilities for knee joint pain before proceeding.


Calf Reduction by Botox Injections

Calf Reduction by Botox Injections

Patients seeking a minimally invasive technique to progressively diminish large calf muscles can rely on muscle relaxing injections similar to those used for anti-wrinkle treatments in other sections of the body. Botox® injections can reduce calf size in the same way that botulinum toxin shots relax facial muscles that cause wrinkles to appear.

Botox® injections directly into the gastrocnemius muscle have been demonstrated in studies to reduce overall circumference while having no significant influence on calf function. To keep the results, you'll need to get maintenance treatments.


Calf Reduction by Radiofrequency Nerve and Muscle Ablation

Other popular ways of reshaping the lower legs include radiofrequency calf reduction and muscular ablation, which use RF energy to shrink the calf muscle by damaging the surrounding nerves. To stop the growth of portions of the calves, pieces of the gastrocnemius muscle are burned off, and nerve bundles are cut.


Preparation before the procedure

Instruct the patient to discontinue aspirin, nonsteroidal anti-inflammatory drugs, vitamin E, alcohol, and all tobacco products two weeks before surgery, and to reduce sodium intake. Preoperatively, the patient should be properly hydrated. If fitted compressive garments are to be used postoperatively, the patient should be fitted before the procedure.


Intraoperative Details

Typically, the patient should be placed in a supine position. It is possible to use either general anesthesia or spinal anesthesia with sedation.

With the patient's legs straight and fanning out from the groin, do liposuction of the anterior legs. With the patient in a frog-leg position, suction the inner thighs.

The patient can be rotated at the waist and placed in the lateral decubitus posture to treat the lateral thigh area. The patient can be put in the prone position or the leg can be elevated into a knee-cheek posture for the posterior thigh.

The use of super wet local anesthetic, pretunneling, 2- to 4-mm accelerator cannulae, and a 1-hole concave and convex cannula are all important concepts to follow to get excellent outcomes.

The quantity of super wet infiltration in the ankle and calf combined is about 750-800 mL on average. It is around 200-300 mL for the ankle alone. To reduce postoperative edema, sterile tourniquets can be utilized at the start of surgeries.


Thigh liposuction  procedure

Liposuction of separate fat accumulations in the thigh, such as the outer and inner thighs, can be done in the normal way. Liposuction at all three fat levels is required to circumferentially liposuction a thigh. First, insert the cannula into the deep subcutaneous level, which is 1-2 cm below the skin. Second, liposuction should be performed at the intermediate level, which is 0.5-1 cm beneath the skin at the base of the subdermal fat. Third, liposuction should be performed 1-2 mm below the skin's surface, with the hole facing away from the skin. To produce circumferential liposuction, the cannula must be passed beyond the anterior and posterior midline areas through each incision.

At a superficial and intermediate level, liposuction of the calves and ankles is performed. In the calf, pretunneling is 0.5 cm below the skin (2-3 mm in the ankle). Calves should be suctioned. Suction down via the medial knee incision with the patient's legs abducted in the frog-leg position for the medial calf. Turn the body at the waist and place the legs in a lateral decubitus posture for the lateral calf.

Suction down and circumferentially past the anterior and posterior midlines for each incision. To minimize a tubular appearance and maintain the transition from the muscular calf to the thinner ankle, less liposuction is performed in the proximal part of the leg.


Postoperative recovery

The recovery time for calf reduction operations varies depending on the treatment. Patients will be recommended to wear compression socks or tights for at least three months after calf reduction surgery to aid the healing process and develop thinner calves.

While dressings are applied, tourniquets are inflated. Roll out the fluid accumulation through the incision after suctioning the first leg, essentially milking the leg. Before suctioning the opposite leg, wrap it in a sterile 6-inch elastic bandage. Unwrap both legs, measure them, and inspect them for contour after suctioning the second leg.

2 × 2 gauze pads should be used to cover wounds. Then, using 0.5-inch soft, nonadhesive foam, wrap both legs. Wrap a 6-inch elastic bandage around the entire leg. At this point, tourniquets are deflated.

Elevate the legs and use compression boots in the recovery room. For the first week after surgery, patients should try to stay supine with their legs raised. On the first postoperative day, let the patient ambulate to the bathroom, and gradually increase activity. To avoid heel-cord shortening, instruct the patient to place his or her heel down.

On the day after surgery, change the dressing. During the night, sequential compression is applied for two months. During the day, the compression stockings are maintained.

Leg elevation should continue to be encouraged, and manual lymphatic massage should begin as soon as the patient can bear it. At 2-3 months after surgery, postoperative edema is minor when these interventions are used.

Because the treatment affects the muscles and nerves of the lower legs, there will likely be pain and a change in walking patterns for two weeks after surgery. During recuperation from calf reduction surgery, you may be unable to execute explosive muscular movements until the area recovers.

It is recommended that you stay off your feet for roughly a week after more intrusive treatments like severing the muscle or nerve.

The full effects of the surgery should appear 6 months to a year following the procedure. Results from non-surgical treatments should be seen during the first month and can last for up to six months. They should be done every couple of months for continuous improvement or to maintain results.



The most common consequence is chronic ankle thickness)10% of patients), which is caused by edema and under resection of the ankles. As with other locations of liposuction, contour abnormalities might emerge.

Perforation of the capsule articularis has been documented as a knee-specific consequence. To avoid this problem, a blunt cannula, several incisions, and a knee extension are recommended. If this happens, apply an elastic bandage and medicines to the wound.

Hyperpigmentation, telangiectasia, and depressions in the ankle have all been documented as a result of the dependent placement and thinness of the overlying fat. Blisters on the surface of the Achilles tendon are uncommon and are most likely caused by increased pressure. Remove the compression stocking from the Achilles tendon if this happens.

A decrease in big toe sensation has also been documented in the postoperative period, however, this resolves over time. Postoperative pain can be excruciating. Due to issues such as edema, the recovery period following liposuction in the calves and ankles is greater than in other body locations.


Infection, sloughing of the skin, phlebitis, posttraumatic tendonitis, and arthritis are all uncommon complications.


While some discomfort is to be expected after calf reduction surgery, especially when recuperating from more invasive treatments, it is crucial to contact your clinician if something goes wrong. Contact your doctor right away if you have chronic side effects like swelling, numbness, or severely painful symptoms that don't seem to be getting better.


Outcome and Prognosis

Although lower extremity liposuction was originally thought to be risky, improvements have resulted in a better outcome. There are few risks, but patients and doctors should anticipate a slower and longer recovery than with liposuction in other parts of the body.

Because of the dependent position of the legs and the greater risk of edema, this is the case. Patient and physician satisfaction can be achieved with reasonable expectations and good perioperative treatment.



Contraindications of Calf reduction

Surgery should not be performed on patients who have a history of hypercoagulability, such as deep venous thrombosis or thromboembolic events. This surgery is not recommended if you have active phlebitis. It's crucial to look for superficial vascular patterns and symptoms of venous insufficiency (such as hemosiderin deposits, edema, varicose veins, and spider veins). For severe varicosities, vein stripping should be done at least three months before liposuction.

Check the patient for edema or venous problems in the lower extremities. Lipoplasty does not usually worsen peripheral edema, although it can lead to unsatisfactory long-term effects. Refer the patient to a vascular surgeon for examination prior to liposuction if venous competence is in doubt.

Furthermore, for overweight patients, calf reduction surgery may cause greater complications. In obese patients, calf reduction surgery to minimize muscle hypertrophy may aggravate knee joint deterioration because the knees sustain a greater weight strain after surgery.


Calf reduction surgery before and after

Patients should schedule numerous consultations with skilled board-certified plastic surgeons before deciding on a calf reduction procedure to fully understand all of the dangers associated with each technique. A knowledgeable medical specialist can help you determine if calf reduction surgery or a combination of treatments is right for you. Patients are frequently encouraged to wear elastic or compression stockings for several months after calf reduction.


Calf Reduction Cost in South Korea

The price of this operation will differ based on how long the results will last. Prices vary depending on patient-specific characteristics, geographic region, and surgeon expertise. Prices for more invasive treatments would vary from $1500-$4000 in South Korea, while non-invasive procedures will cost around $800.

This is still competitive pricing, as in the United States, the average price for invasive procedures is around $7300, while non-invasive therapies can cost up to $1000.



Calves that are large and shapely may appear attractive to certain people, but they can also be regarded as bulky. There are several distinct contouring methods that plastic surgeons use to reduce bulky calves for individuals wanting slender legs via calf reduction procedures. Thick calves can be treated with non-surgical therapies like Botox injections, as well as surgical ones like calf liposuction and more invasive surgeries like muscle excision.

If you've been self-conscious about the size of your calves for a long time, it might be time to try calf reduction. In case you're still undecided, there are a variety of solutions available, ranging from temporary to permanent. In comparison to other countries, the pricing in South Korea is likewise very good. Another factor to consider is how frequently this surgery is carried out in this location. Not to mention the fact that because the treatment was developed in South Korea, the majority of the surgeons doing it will have more experience with it.

If you have trouble fitting into particular shoes or refuse to wear anything that does not cover this portion of your body, it may be time to make a change. The technique is both safe and effective, with a low chance of side effects. Recovery is crucial, so make sure you follow all of your doctor's directions to get the best outcomes possible.