Calf Muscle Shortening after Radiofrequency Muscle Reduction: A case report

Thirty-year old female developed limited range of motion (ROM) of both ankles after radiofrequency muscle reduction procedure for one month prior to her visit. Dorsiflexion of both ankles was severely limited to zero degree. Plantar flexion of both ankles was limited to 20 degree on the right and 15 degree on the left. The electrodiagnostic study and MRI showed normal nerve conduction study and inflammatory change of both gastrocnemius and soleus muscles. She received ROM and stretching exercise for 1 hour per day and twice per week for 4 weeks as an outpatient with continuous home programming. After 2 weeks of treatment, ROM improved to 20 degree plantar flexion and to 20 degree dorsiflexion on the right ankle and to 20 degree plantar flexion to 10 degree dorsiflexion on the left ankle. This is a case of severe muscles contracture after radiofrequency procedure reversible after intensive strengthening exercise.

Neurectomy of Nerve Branch to Medial Gastrocnemius Muscle for Calf Reduction

In Orientals, hypertrophy of calves frequently found. In 1990, Mladick and Watanabe presented extensive and specific operative techniques for reduction of calves and ankles. however, they cautioned that liposuction should be restricted in the muscular type of calf because their anatomic characteristics led easily to complications and low satisfaction rate. the chief reason for this problem is due to hypertrophy of lower legs that is caused by muscular hypertrophy. In preoperative considerations for the patient selection, most patients have hypertrophy of the gastrocnemius muscles. Calf muscles composed of the medial, lateral gastrocnemius and soleus muscles. To identify the muscle hypertrophy clinically, the patient should stand on toe-tip posture and check out the pinch test for the measurement of fat thickness. Muscular hypertrophy of the calves is divided into 3 types, such as medial upper half, lateral upper half and total hypertrophy with or without excess fat of lower legs. The indications of calves reduction depends on the excess fat of lower leg, calf muscle hypertrophy and combined excess fat and muscle hypertrophy. The methods of calves reduction are as follows weight control, liposuction, calf muscle resection and combined procedures. But the postoperative results are not as dramatic as abdomen and have low satisfaction rate because there are many postoperative complications, such as surface irregularities, asymmetrical shape, scars with hyperpigmentation and infection. I reported that the neurectomy of medial gastrocnemius muscle is the new ideal method on calf muscle hypertrophy with medial bulging by the contraction of medial gastrocnemius muscle on toe tip stance especially in 1993. Recently this method are popular but the procedure needs expert skill. So muscular disuse atrophy by botox injection to medial gastrocnemius muscle is introduced temporarily. Other method such as muscle reduction by RF, denervation method by RF or alcohol injection to the area near nerve branches to medial gastrocnemius below popliteal fossa are also introduced but they are effected temporarily due to reinnervation of neurotization and neuroma in conduits. The surgical procedure is simple, easy and safe method and it can be done under the local anesthesia with sedation. The transverse incision 2 cm in length was done over the distal crease of popliteal fossa, and divided fascia and exposed the tibial nerve. and identify and confirm the 4 branches of medial gastrocnemius, sural, soleus and lateral gastrocnemius with nerve stimulation by electric current and then the nerve branch to medial gastrocnemius muscle has to be divided and removed above 3 cm in length. Skin closure was done with meticulous hemostasis. The postoperative care is simple. The wound was dressed with mild compression and changed daily. The patients can walk and go home immediately after surgery. We recommended early exercise and wearing the pressure garments to support shrinkage and smooth contouring of medial bulging area on calves during 3 months. The postoperative results are very satisfied from 1 to 3 month and there are no functional deficit and no edema, indurations and irregularity. The calf reduction rate was about 10% shrinkage(34cm in diameter on the superior 1/3 calves portion was reduced to 31cm in diameter, mean reduction is 2.5-3cm in diameter.) due to the muscular atrophy caused by neurectomy of medial gastrocnemius. In this report, I described that neurectomy of nerve branch to medial gastrocnemius muscle is a new ideal method for calf reduction and this procedure induce the superior results than the other procedures on calf muscle hypertrophy with 13 years long term follow up. I think my procedure is more rational and also effective, simple, easy, and safe for significant reduction of calves circumference and improvement of cosmesis on hypertrophy of lower leg.

Calf Reduction Using Radiofrequency(RF) Directed to the Gastrocnemius Muscle

According to recent research, Korean women are very interested in calf reduction. Asian women want to have slim and straight legs more than Occidental women. Thick calves are divided by three types. One is muscular hypertrophy type and another is lipodystrophy type, and the other is mixed type. The authors focused on medial gastrocnemius muscle hypertrophy using radiofrequency generator. From July 2004 to July 2007, We did calf reductions for women who wanted to have aesthetically slim legs. Under intravenous anesthesia, we made a tiny pin hole with 18 gauze needle and injected local anesthetics. Radiofrequency probe(Dr. Oppel(R) radiofrequency, Sometech Medical Co.) was inserted and then We produced radiofrequency energy with a foot switch and made mean 150-200 points focal coagulation necrosis at each medial gastrocnemius muscle. There were little major complications such as seroma, hematoma, infection, gait disturbance, scar, sensory change etc. Some patients had moderate swelling during first week, but it was improved soon. Calf reduction using radiofrequency energy is very useful tool for hypertrophied medial gastrocnemius muscle. But we need more study for standardization of energy power, for certain amount of muscle damage to have reproducibility for predictability of durability and for possibility of rebound hypertrophy.

The Effect of Botulinum Toxin A on Calf Reduction

Botulinum toxin type A is widely used for anti-wrinkling therapy, and correction of the square face. The toxin ultimately prevent the release of membrane-bound acetylcholine at the neuromuscular junction of striated muscles and thus produce chemical denervation and paralysis of the muscles. Our purpose of study is to know if application of botulinum toxin type A on calf reduction is effective, how much dosage is effective, and what are the possible complications. We reviewed data of 30 consecutive patients subjected to calf reduction in Dong-A University Hospital from February 2003 to April 2003. We injected normal saline 2cc on both calves region in 15 control group patients, and the other patients was divided 3 group. Group 1, Group 2, Group 3 was injected 50U, 100U, 150U botulinum toxin A on each calf region and followed up for 6 month. Maximal circumference of calf was not changed in the control group but an average of 0.7 cm reduction was noted in group 1, average 1.34 cm (right calf) and 1.26 cm(left calf) in group 2, average 1.44 cm(right calf) and 1.58 cm(left calf) in group 3. Maximal area of calf was not changed in the control group but average reduction of 12.5%(right calf) and 12.7%(left calf) was obtained in group 1, average 19.4% (right calf) and 19.9%(left calf) in group 2, average 24.8%(right calf) and 21.07%(left calf) in group 3, as measured on CAT scan. Total fat amount and fat amount in the lower extremity was no change in all the groups, but lean body mass was decreased average 1.27%(right calf) and 1.15%(left calf) in group 1, average 3.47%(right calf) and 2.98%(left calf) in group 2, average 3.58%(right calf) and 3.95%(left calf) in group 3. Photography of the preoperative and postoperative 6 month state revealed higher satisfaction in Group 2, 3 compared to Group 1. Use of botulinum toxin type A in calf reduction is a very simple, safe, non-invasive method and effective in terms of calf contouring rather than reduction of calf circumference.