Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations.
An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand all possible consequences of calf augmentation. Problems associated with calf implants can be inherent to this type of implanted medical device or relate to complications of a surgical procedure. Additional advisory information regarding this subject should be reviewed by patients considering surgery that involves calf implants.
It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood or blood transfusion. Intra-operative blood transfusion may also be required. Hematoma may contribute to capsular contracture, infection or other problems. Do not take any aspirin or anti-inflammatory medications for ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription "herbs" and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time following injury to the legs, such as aggressive exercise or stretching, direct blows to the leg that can cause soft tissue or bony damage. If blood transfusions are necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
Fluid may accumulate around the implant following surgery, trauma or with vigorous exercise that was started early after surgery. Additional treatment may be necessary to drain fluid accumulation around calf implants. This may contribute to infection, capsular contracture, or other problems.
In general, surgeries of the lower extremities carry a higher chance of infection than those of upper extremities or trunk. Although infection is unusual after this type of surgery, it may appear in the immediate post-operative period or at any time following the insertion of a calf implant. Subacute or chronic infections may be difficult to diagnose. Should an infection occur, treatment including antibiotics, possible removal of the implant, or additional surgery may be necessary. Infections with the presence of a calf implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the calf implant may have to be removed. After the infection is treated, a new breast implant can usually be reinserted. It is extremely rare that an infection would occur around an implant from a bacterial infection elsewhere in the body, however, prophylactic antibiotics may be considered for subsequent dental or other surgical procedures. In extremely rare instances, life-threatening infections, including toxic shock syndrome have been noted after any implant surgery. Individuals with an active infection in their body or weakened immune system should not implant augmentation.
All surgery leaves scars, some more visible than others. Excessive scarring can occur in people that are prone to Keloid or hypertrophic scar formation. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body). There is the possibility of visible marks in the skin from sutures. In some cases, scars may require surgical revision or treatment.
You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after calf implant surgery. Sever pain may be the result of improper implant size, placement, surgical technique, capsular contracture, compartment syndrome, or sensory nerve entrapment or injury. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue or due to tissue stretching.
Wound disruption or delayed wound healing is possible. Some areas of the leg skin incision may not heal normally and may take a long time to heal. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have poor circulation to their lower extremities, those with diabetes, those on steroids, and those that have had previous lower extremity surgery, trauma, or radiation, may be at increased risk for wound healing and poor surgical outcome. Smokers have a greater risk of skin loss and wound healing complications.
Skin Discoloration / Swelling
Some bruising and swelling normally occurs after calf augmentation. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires suture removal.
Calf implants, similar to other medical devices, can fail. Unlike silicone gel-filled breast implants, calf implants are made out of solid medical grade silicone which can not leak. Breakdown or fragmentation of a solid implant can occur as a result of an injury. Damaged implants require replacement or removal. Calf implants can wear out, they are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. A MRI (magnetic resonance imaging) study may be necessary to evaluate the possibility of implant fragmentation or breakdown, yet it may not be 100% accurate in diagnosing implant integrity.
Scar tissue, which forms internally around the calf implant, can tighten and make the calves look round, firm, and possibly painful. Excessive firmness of the calf implants can occur soon after surgery or years later. The occurrence of symptomatic capsular contracture is not predictable. The incidence of symptomatic capsular contracture can be expected to increase over time. Treating capsular contracture may require surgery, implant replacement, or implant removal. Capsular contracture may reoccur after surgical procedures to treat this condition.
Implant Extrusion / Tissue Necrosis
Lack of adequate tissue coverage or infection may result in exposure and extrusion of the implant through the skin. Tissue breakdown (necrosis) has been reported with the use of steroid drugs, after chemotherapy/radiation to the lower extremity tissue, due to smoking, microwave diathermy, sclerotherapy injections, skin burns, and excessive heat or cold therapy. In some cases, incision sites fail to heal normally. An implant may become visible at the surface of the calves as a result of the device pushing though layers of skin. If tissue breakdown occurs and the implant becomes exposed, implant removal may be necessary. Permanent scar deformity may occur.
Visible and palpable dimples or irregularities can usually be noted early after surgery, which usually resolve with time.
Implant Shifting or Displacement
It is possible for the implants to shift, move out of place, or show irregularities. This shifting of the implants can occur as a result of early aggressive exercise, external trauma to the implants, and/or manipulation. Therefore, it is prudent to follow your doctor’s instructions and not to start exercising or jogging too early. Additional surgery may be necessary to attempt to correct this problem. It may not be possible to resolve this problem once it has occurred.
No two calves of a person are identical. There are natural differences between the shape, size, and the contour of the two calves. Although surgery aims to improve symmetry, it is never possible to achieve it completely. Additional surgery may be necessary to attempt improvement of asymmetry after a calf augmentation.
Although not common, you might be able to feel and even see the contour or the edge of the implant. This depends on how thin your leg skin is and how large the implants are.
The nature of your leg’s soft tissue and bone structure can limit the size of a calf implant that could be placed safely. In order to go bigger, you might have to wait until your skin stretches with the first set of implants. At time it might not be even possible to place a too large of an implant.
In the immediate post-operative period there is normal edema or swelling of the legs. This usually dissipates over several weeks. People with history of poor circulation of their lower extremities are prone to the development of chronic or long term edema.
Excessive swelling of the legs as a result of bleeding, edema, or pressure from the implants can cause an elevation in the pressure of the anterior (front) and/or posterior (back) compartments of the leg. If noted early and the pressure relieved by the removal of the implants, usually there are no long term consequence. Otherwise, there could be permanent damage to the muscles and nerves of the leg. Therefore, it is prudent that patients, caregivers, and medical staff report any unusual and abrupt increase in the post-operative pain, associated with increased numbness of the foot, and lack of mobility.
Injury to the sensory nerves as well as motor nerve of the leg and foot is possible as a result of direct damage, increased pressure, and/or compartment syndrome. It is normal to experience some numbness and/or tingling of parts of the leg and foot after surgery. This is not alarming, is caused by general swelling, and usually dissipates over several months. On the other hand, rarely there could be direct injury to the common and lateral Popliteal Nerve which can cause a "foot drop". According to reports in the literature this is usually reversible. Other nerve such as the Tibial or the Seural Nerve could also be injured, but this is very rare.
Surface Contamination of Implants
Skin oil, lint from surgical drapes, or talc may become deposited on the surface of the implant at the time of insertion. The consequences of this are unknown.
Unusual Activities and Occupations
Activities and occupations that have the potential for trauma to the calf implants could potentially break or damage calf implants or cause bleeding/Seroma.
Both local and general anesthesia involve risks. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.
In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Thrombosed Superficial Veins
Thrombosed superficial veins, which resemble cords, occasionally develop in the area of the legs and knee and usually resolve without medical or surgical treatment.
Deep Venous Thrombosis and Pulmonary Embolism
With any surgery, especially those that involve the lower extremities, there is a chance of developing blood clots in the leg veins. Those who remain very inactive after surgery, or have had a history of deep venous thrombosis (DVT) are at a higher risk of developing DVT. Such blood clots can dislodge and travel to the lungs and heart. This is a serious event that can even cause death.
Cardiac and Pulmonary Complications
Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary emboli can be life-threatening or fatal in some circumstances. Inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of swelling in your legs or blood clots that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. Should any of these complications occur, you may require hospitalization and additional treatment. If you experience shortness of breath, chest pains, or unusual heart beats after surgery, seek medical attention immediately.
Damage to Deeper Structures
There is the potential for injury to deeper structures including nerves, blood vessels, muscle, joint, and bone during this surgical procedure. The potential for this to occur is rare. Injury to deeper structures may be temporary or permanent.
In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.
Large Size Calf Augmentation
Patients who request an outcome of calf augmentation that produces disproportionately large calf size must consider that such a choice can place them at risk for a less than optimal long-term outcome and the need for re-operation and additional expenses. The placement of excessively-sized calf implants that exceed the normal dimensions of the legs produces irreversible tissue thinning, implant drop out, and visible/palpable rippling.
Mental Health Disorders and Elective Surgery
It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of surgery. Asymmetry in implant placement, displacement, unanticipated calf shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Calf size may be not optimal. Unsatisfactory surgical scar location may occur. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. It may be necessary to perform additional surgery to improve your results, change implant size or remove and not replace implants.
Calf Implant Technology / Technologic Improvements in Calf Implants
The technology of Calf implant design, development and manufacture will continue to progress and improve. Newer or future generations of implants may be better in some way from those currently available.
Female Patient Information
It is important to inform your plastic surgeon if you use birth control pills, estrogen replacement, or if you suspect that you are pregnant. Many medications including antibiotics may neutralize the preventive effect of birth control pills, allowing for conception and pregnancy.
There are potential adverse reactions that occur as the result of taking over-the-counter, herbal, and/or prescription medications. Be sure to check with your physician about any drug interactions that may exist with medications that you are already taking. If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.
Smoking, Second-hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)
Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at a greater risk for significant surgical complications of skin dying and delayed healing. Individuals exposed to second-hand smoke are also at potential risk for similar complications attributable to nicotine exposure. Additionally, smoking may have a significant negative effect on anesthesia and recovery from anesthesia, with coughing and possibly increased bleeding. Individuals who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of this type of complication. Please indicate your current status regarding these items below:
Most health insurance companies exclude coverage for cosmetic surgical operations such as a calf augmentation or any complications that might occur from surgery. Please carefully review your health insurance subscriber-information pamphlet. Most insurance plans exclude coverage for secondary or revisionary surgery due to complications of cosmetic surgery.
The cost of surgery involves several charges for the services provided. The total includes fees charged by your surgeon, the cost of surgical supplies, anesthesia, laboratory tests, and possible outpatient hospital charges, depending on where the surgery is performed. Depending on whether the cost of surgery is covered by an insurance plan, you will be responsible for necessary co-payments, deductibles, and charges not covered. The fees charged for this procedure do not include any potential future costs for additional procedures that you elect to have or require in order to revise, optimize, or complete your outcome. Additional costs may occur should complications develop from the surgery. Secondary surgery or hospital day-surgery charges involved with revision surgery will also be your responsibility. You may be advised some time in the future to have a MRI (magnetic resonance imaging) scan to determine the condition of your implants. You would be responsible for future costs of such imaging studies. In signing the consent for this surgery/procedure, you acknowledge that your have been informed about its risk and consequences and accept responsibility for the clinical decisions that were made along with the financial costs of all future treatments.
Dr. Younai is a Board Certified Plastic, Cosmetic, & Reconstructive Surgeon who is experienced in body contouring with the use body implants such calf, pectoral, buttock implants.
During your consultation Dr. Younai will review your treatment options for Calf augmentation with Implants. He will discuss if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, and recovery course, as well as what to expect after surgery. At that time, Dr. Younai will also show you before-and-after pictures of other patients who might be similar to you and have had Calf Augmentation with implants.
Dr. Younai serves patients from both southern and northern California, including those from Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Calabasas, Woodland Hills, Thousand Oaks, Westlake, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.