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there is no universally accepted definition of the ideal or attractive lower leg. Apart from aesthetic concerns, another presenting complaint is not being able to fit into kneehigh boots, as mentioned previously.
Patient selection
Treating the Calf with Botulinum Toxin Dr Varna Kugan explores the use of botulinum toxin to treat the lower leg and calf muscle A popular treatment in East Asia is the use of botulinum toxin A (BoNT-A) for the slimming and contouring of the lower leg, namely the calf muscles. It is a safe and effective non-surgical alternative treatment modality and this article will draw upon my experience in successful outcomes.
Treatment popularity In this demographic of patients, generally they tend to have short legs relative to their torsos and this coupled with thick calves further accentuates this physical disproportion.1,2 In the West, treatment with BoNT-A is not as popular, there is growing awareness, especially for those struggling to fit into knee-high boots.3 I believe that it would be beneficial for practitioners to be aware that BoNT-A can be used safely and effectively in calf contouring with satisfactory results. It is worth mentioning that this is a common treatment request in my practice where many of my patients are East Asian. In addition, all the patients I have performed this treatment on are women and I have not had any requests or concerns about calf bulkiness from men at this time.
Aesthetic ideals
There are many factors to consider before performing this treatment to ensure optimal patient satisfaction and outcomes. It is imperative to note a full medical and social history including exercise habits and physical activity. For example, an athlete or a patient who participates in regular activity which requires leg contraction, such as running, badminton, and cycling would not be a suitable candidate as there would not be a significant improvement.4-7 Similarly, patients with oedema of the lower legs or excess subcutaneous fat would also not be suitable.8 Practitioners can assess the calves to determine if bulges are caused by muscle or fat and asking the patient to stand on their tiptoes and palpating the lower leg. This can also help delineate areas of maximal bulging. The ideal patient is one with thin subcutaneous fat over the calf and bulky medial and or lateral gastrocnemius muscles.9
Anatomy The triceps surae muscle, or calf muscle, is defined as the gastrocnemius and soleus muscles (Figure 1). The gastrocnemius is comprised of two muscle bellies, a medial and lateral head, that originate from the medial and lateral condyles of the femur, respectively. These reconvene to insert into the achilles tendon and calcaneus. The soleus muscle originates from the posterior aspect of the tibia and fibula and inserts into the achilles tendon and calcaneus. However, the soleus lies deep to the gastrocnemius.
There are conflicting opinions on the aesthetic ideals of the lower leg in females. A plastic surgeon based in Casablanca named Dr Fahd Benslimane described the concept of a ‘perfect’ lower leg shape.4 He concluded that in the Western world, attractive legs are straight and in continuity with the thighs. In addition, the importance of the similarity of curve distribution and progression from knee to ankle.4 Lateral belly of In my experience, gastrocnemius some individuals will find muscular or well-defined calves attractive, whereas others will disagree, preferring slimmer Lateral belly of gastrocnemius and less bulky calves. A study published in the Aesthetic Plastic Surgery Journal Medial belly of gastrocnemius Soleus concluded that Asian women prefer small lower legs with a straight line in the medial aspect.4 It is important to note that Figure 1: Anatomy of the calf muscle
Reproduced from Aesthetics | Volume 8/Issue 11 - October 2021
Peroneus longus
