No recurrence in calf reduction

No recurrence in calf reduction ?

Partial resection of Gastrocnemius muscle has no risk of recurrence . 

1. How does muscle resection work ?

Partial resection of Gastrocnemius muscle removes muscle directly and reduce the number of muscle fibers in Gastrocnemius muscle.
Surgical removal is the only way to reduce the number of muscle fibers.
Because the number of muscle fiber doesn't change after adolescent, the result of surgery is permanent.

In calf reduction, about 70 % of Gastrocnemius muscle is removed and only 30% remains to maintain the shape of natural calf.
The remained 30 % of muscle fiber can become bigger in volume with excessive exercise like body building, the change is minimal after surgery because there are few remained.
So, patients can do any exercise after calf muscle resection without fear of recurrence. 




2. The other muscles in calf
How about the other muscles in calf ?
Can it grow more after calf muscle resection ?

The other muscles in calf can grow bigger with exercise of course.
But the other muscles in calf are deep muscle which is encircled in strong muscle fascia.
So, growing of other muscles in calf is not noticeable.
Because Gastrocnemius muscle is superficial muscle, slight volume change in Gastrocnemius muscle is noticeable and makes calf look awful.
In other words, reducing Gastrocnemius muscle effectively change the shape of calf and makes calf look much thinner and longer.

 

3. Recurrence in nerve ablation and radiofrequency
Nerve block to muscles in calf can make the muscle atrophied.
Why is nerve block recurred so frequently ?

Even though muscle can't be regenerated, nerve can be regenerated very easily.
Nerve is the most easily regenerating structure in our body.

As you can see in below picture, nerve injury can make the distal muscle atrophied in 2 weeks.
After 3 weeks of nerve injury, the atrophy of muscle becomes peak.
That's the reason why most calf nerve block pictures are taken after 3 to 4 weeks.
After 3 weeks, nerve can grow and innervate distal muscle easily and muscle can become normal again.
This means nerve block is destined to be recurred.

 

During this atrophy and regeneration of nerve, the distal muscle loose some volume.
But the change is so inntoceable that most patients can't be satisfied with the result of calf nerve block.
In the second nerve block, the effect is less noticeable than the first trial.
This means repeated nerve block has little meaning.

Most patients seek muscle resection after disappointing and being tired of repetition of nerve block.
What a waste of time, money, and pain !
In addition, this patients may have less satisfactory result with muscle resection because of the scarring from nerve block.

Even though most people know nerve block is ineffective, many patients still undergo this because it is less scary, cheaper, and simpler.
But that is not wise choice for calf surgery.
The more you know, the better you can choose.

4. 2 years after surgery
One of my patients visited me after 2 years of calf reduction because of other procedures.
Not only her upper calf but also her lower calf looked slimmer. 
Before surgery, she had muscular and heavy looking calf with circumference of 36 cm.
After 2 year of surgery, she still had slimmer and longer looking calf with circumference of 32 cm.
Her Achilles tendon in lower calf was reduced also in size because it was atrophied with smaller Gastrocnemius muscle.
In addition, she is no longer afraid of recurrence and is actively participating in her extreme sports.
What a surprise !

She asked me to advertise this calf muscle resection more because many patients are still wasting their time, money, and pain for ineffective calf nerve ablation.
If she knew this procedure earlier, she should have been happier in her younger days and didn't have to undergo many times of nerve block. 



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Hyuncheol Park MD
www.ozclinic.com

The simpler, the better ?

The simpler, the better ? Of course, I like simple things. But the simple is not always the better. In calf reduction, simple procedures don't mean better procedures. Even though there are many simple methods in calf reduction, partial resection of Gastrocnemius muscle is the only effective and safe method of calf reduction surgery. Long recovery period, complex procedures, higher price are worth it surely. Modern people are easily seduced and fantasized by exaggerated advertisement, fake reviews, and cooked up before and after photos in SNS nowadays. And they end up in wasting their time and money to ineffective procedures and make their revision surgery more difficult.  Even if simple procedures have shorter recovery and are safer usually, it is not true in calf because calf has big muscles with little fat. Simpler calf procedures are not only ineffective and can make severe sequela (aftereffects). Liposuction on calf, Botox on calf, nerve block on calf, radiofrequency calf reduction are examples. Even if these procedures are cheaper, simpler and recovers faster, these are not only ineffective but also not so safe. I can't recommend these calf procedures to my family and acquaintances at least. Some people make the plan to try simpler procedures first and try muscle resection later if the result of the first surgery is disappointing. But that is not wise strategy because the simpler calf reduction can make muscle resection more difficult and complex. Always, it is the best to undergo right procedures in the first place. Liposuction on calf is not only ineffective but also harmful to calf except extremely fatty person. Because the fat layer in calf is very thin, liposuction can make irregularity so easily and can't make noticeable change in calf. Thinned fat layer in calf can make the outline of muscle more noticeable and can make the calf look more masculine. You can't see noticeable change after Botox injection to calf muscle because calf muscle is too big. Botox in calf means just a waste of money. Nerve block to calf muscle is simple and has some effects. But it is recurred in most of cases because the blocked nerve can be connected by themselves easily in calf. About half of my patients underwent many times of nerve block before coming to my clinic and gave up to the recurrence. In some cases, recurrence is happened in one leg and can't be cured with repeated nerve block. Radiofrequency muscle ablation should be avoided because it makes a lot of scar tissue in calf which is very hard to be removed in calf muscle resection. Because contracted and burned muscle (like too much cooked steak) are in calf, it is hardened with scar tissue in irregular shape. One of the saddest moment in my office is to see the patients who can't be improved much with muscle resection because of the sequela of the previous ineffective calf procedures and regret their previous unwise choice.  If they could come to my office at first... Fear arises from ignorance. If you understand calf muscle resection better, you may have little fear for this. Because muscle is encircled in strong fascia and there is no important structures in the facia, the other muscles and important structrues like vessels and nerves in calf are not injured in calf muscle resection and there is no risk of walking difficulty. Because muscle resection doesn't leave any residue or foreign body in calf muscle, it doesn't make much scar in calf muscle and the result is permanent and predictable. Because 30 % of Gastrocnemius muscle is remained, calf can maintain the natural shape of calf and compensatory hypertrophy is not happened. Because the site and amount of muscle resection can be adjusted, calf shape can be improved more accurately and effectively. Simple procedures don't mean better and safe procedures. In calf reduction, partial resection of Gastrocnemius muscle is the most effective and the safest method. I add one funny picture from my former patient. Her purpose of calf reduction was to be able to buy boots on the street without tucking in the middle of calf. (Because she had very big calf, there was no available off the rack boots for her). She sent me her pictures wearing off the rack boots after 1 month of surgery. LOL Hyuncheol Park MD OZ Cosmetic Clinic www.ozclinic.com