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Calf Augmentation with Autologous Tissue Injection

2009; Lippincott Williams & Wilkins; Volume: 123; Issue: 6 Linguagem: Inglês

10.1097/prs.0b013e3181a3f4d0

1529-4242

Igor Niechajev,

Mesenchymal stem cell research

Sir: Erol, Gürlek, and Agaoglu published an original method of using autologous fat and tissue cocktail injection for the correction of hypoplastic calves (Plast Reconstr Surg. 2008;121:2127–2133). The senior author has vast experience with the use of autologous diced cartilage, dermis, and fat for improving facial form in general and particularly the nasal dorsum.1 Similar techniques were applied during the years 1992 to 2003 in 77 patients with the aim of restoring the deficient medial contour of their calves. The authors presented a good historic review of calf augmentation techniques and a well-illustrated description of their method. They listed possible complications and disadvantages associated with the use of the silicone implants, but the most dreadful complication—compartment syndrome—was omitted (Fig. 1).2,3 They reported that “the planned shape was achieved in all patients after one to four injections.” This included good improvement in 67 (87 percent) and moderate improvement in 10 patients. “None of the patients showed minimal or no clinical improvement.”Fig. 1.: Photograph demonstrating compartment syndrome in 28-year-old body builder after calf augmentation with two implants, 165 cc on the medial side and 90 cc on the lateral side. The patient is shown 1 year later, after fasciotomies and multiple débridements in the anterior tibiofibular compartment.The problem is that the three—presumably the best—cases in Figures 2 through 4, illustrating the virtues of their method, did not support the aforementioned favorable statistics of clinical outcomes. I see no change in the preoperative and postoperative photographs in Figures 3 and 5 and minimal but aesthetically insufficient improvement in the case in Figure 4. Reported results were calculated on the basis of assessment of the preoperative and postoperative photographs by the three independent physicians. An evaluation would have been more objective if instead patients were assessed and the preoperative and postoperative calf circumferences was compared.4,5 Three patients depicted in Figures 1, 3, and 4 are bow-legged (genu varum). In such cases, insertion of an implant with the larger height (projection) will counterbalance bow deformity by creation of the convex medial contour (Fig. 2). Frequently, liposuction in the lower third of the crus, lateral to the Achilles tendon, will further improve the total aesthetic impression.4,5 After reading this article, I do not think that “fat injection is very effective” for improvement of the calf contour. The described method is biologically correct, attractive in theory, and opportune, but in my opinion the authors failed to prove that it actually works in calves.Fig. 2.: Photograph of a 25-year-old woman with thin bow legs 3 years after calf augmentation with 220-cc symmetric implants with 30-mm projection, placed medially and camouflaging the bow deformity. The arrow indicates the convex medial contour. (Modified with permission from Niechajev I. Calf implant techniques. Body Language 2005;16:12–14.)Igor Niechajev, M.D., D.Sc. Lidingö-clinic Torsvägen 30 181 32 Lidingö-Stockholm, Sweden [email protected]