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Calf implants – calf lipofilling

Calf surgery, whether reconstructive or cosmetic, aims to increase the size of the calf.

In the majority of cases, the operation is carried out as part of repair surgery and involves malformations or sequelae of accidents in the leg. This includes, for example, the consequences of polio, clubfoot, congenital atrophy of the calf, myopathy, and burns. In this context there is often an atrophied calf and the other is normal. An asymmetry is then present and the operation aims to correct this.

In some cases the operation is performed purely in the context of cosmetic surgery because the calf is too thin, not curved enough, and an increase in volume and curve is desired.

Augmentation des mollets par implants de mollets ou prothèses de mollets
Calf augmentation with calf implants or calf prostheses

The two main techniques used are lipofilling (also known as lipomodelling or fat transfer), the principle of which is to remove fat by liposuction from one place and inject it into another, and silicone prostheses or calf implants. Sometimes these two techniques are associated with one another (calf implant plus lipofilling). Another technique consists of injecting hyaluronic acid but, unlike implants or lipofilling, there is a problem in the resorbable nature of hyaluronic acid. It is necessary to repeat the procedure every year and the cost quickly becomes astronomical (2000 to 2500 euros approximately every year according to the quantity of product necessary) this is why I rarely carry out the injection of hyaluronic acid in calves.

Calf implants

The most used technique, sometimes associated with lipofilling.

The implants are oval and elongated and several sizes and volumes are available (from 60 to 220 cc). The average gain in diameter of the calf is 3 to 4 cm. The implants are filled with cohesive silicone gel (no leakage in case of rupture unlike the older generations of implants). These implants do not cause cancer or autoimmune disease. They can break after several years however (on average 10 to 15 years, but sometimes more than 20 years) and must therefore be changed.

An implant is placed at the level of the internal gastrocnemius muscle (plural gastrocnemii) on the internal surface of the calf. Sometimes a second implant is placed on the same leg, at the level of the external gastrocnemius muscle on the external face of the calf.

To avoid any visibility of the implant, the 3 cm scar is located behind the knee, at the level of the popliteal fossa (kneepit), horizontal to the natural fold which is present. The implant is placed under the fascia which covers the muscle in order to conceal it as much as possible. The implant should not be seen.

The operation lasts on average for 30 minutes to 1 hour and takes place under general or spinal anesthesia.

Before the operation you must meet the surgeon twice, the anesthesiologist once, and have a blood test. Tobacco use must be stopped 3 weeks before and after the operation. Hospitalization is usually for 24 hours. Convalescence is from 7 to 21 days depending on the case and your profession. No sport is allowed for 4 to 8 weeks.

Post-operative care is as follows: shower every day, disinfect the wound, and place a bandage on it every day for 10 days. A compression stocking is to be worn for 1 month and a shoe with a small heel is recommended for the first few weeks in order to relax the muscle and avoid pain. Walking is possible the day after the operation, and possibly with crutches for the first few days. Pain is present for 7 to 15 days and relieved by painkillers.

In order to avoid any risk of phlebitis, an injection of anticoagulant is given every day for the first 10 days, either by yourself or a nurse.

The result is visible immediately but due to bruising it will not be definitive until after three to six months.

The potential complications are: hematoma, infection, lymphatic effusion, a defective scar, implant visibility, implant migration, the implant shell (rejection of the implant), implant rupture, and compartment syndrome.

Calf lipofilling

This is a technique which is used less often than calf implants. The principle is to take fat where it exists in excess by liposuction. The fat is then treated and reinjected into the calf.

You must have a sufficient reserve of fat (where 1 liter will be taken there will remain, after absorption, only 100 to 150 cc of fat on the calf, which is a fairly small volume).

The operation is performed under general anesthesia and lasts for an average of 1 to 2 hours. It often requires a 24-hour hospitalization period. The post-operative effects are quite similar to those for implants. The scars are less significant (1 to 3 mm). The result is final after 3 to 6 months. About 30% of the fat injected is absorbed. The fat that has taken hold is permanently implanted (except for massive weight loss).

The advantage compared to implants is the flexibility of the calf, its natural character, and the absence of foreign body implantation. The disadvantages: there is often less increase than with an implant, and two interventions, six months apart are often necessary.

Is it covered by health insurance?

In the case of reconstruction, the costs may be covered by health insurance, at least partially.

What is the cost of calf implants and calf lipofilling?

The price depends on the technique, on the unilateral or bilateral side of the procedure, whether or not health insurance is involved, and the number of implants required. It costs on average 3000 euros for reconstructive surgery and 5000 euros for cosmetic surgery.


Dr Vincent Masson is a plastic surgeon with a post-graduate diploma in plastic, reconstructive and aesthetic surgery and a gold medal in surgery from the Paris Hospitals. He is a former senior registrar and attaché at the Hôpital Saint Louis.

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