Calf reduction with botox is a simple & safe procedure

Aim of treatment To slim the calves or correct asymmetry between them. Clinical assessment Take a full history including their reason for seeking treatment, time of onset (longstanding or recent change?), current exercise regime and if they have

calf-Reduction-Treatment

Aim of treatment

To slim the calves or correct asymmetry between them.

Clinical assessment

Take a full history including their reason for seeking treatment, time of onset (longstanding or recent change?), current exercise regime and if they have discussed the issue with other health professionals eg podiatrist/ orthopedic surgeon.

Past History

What could have led to large calf muscles; exercise, sports, high heels.

Assess the patient from in front and behind standing and then rising up onto their toes. Photos are essential for supporting the consultation and for record keeping. If the bulky calves relate to hypertrophic or enlarged muscles then Botox may be a suitable treatment. If the two gastrocnemius muscles are undefined on contraction then assess extent of subcutaneous fat. If this is the cause of their large calves then discuss diet, exercise and possible referral for liposuction.  Mark the areas of the gastrocnemius causing maximum bulging.

Anatomical considerations

Botox will weaken the superficial fibers of the gastrocnemius muscles causing them to atrophy through disuse. Medial, lateral or both muscle heads can be injected depending on the clinical presentation.

Dosing & Injection technique

Whilst the patient stands on tiptoes mark the areas of muscle bulk to be targeted. The patient should then be positioned supine face down. A 30G needle is adequate and typical doses are 50 Botox / 125 azzalure units per gastrocnemius. Injections are spaced around 1cm apart and if necessary gridlines can be drawn to ensure systematic placement of Botox.

Cautions and complications

Patients with enlarged calves secondary to subcutaneous fat are poor candidates for this treatment.

Counsel patients that initial treatments to debulk the muscles are typically every 3/12 and they may require three treatments to achieve the desired effect. Maintenance treatments are typically every 9-12 months but this could be dependent on lifestyle.

Contouring the calves can be unpredictable and uneven areas of flattening or bulging can occur depending on Botox diffusion. Residual areas of bulk can be targeted at follow-up treatments.

Deep injections can lead to problems with leg weakness and balancing if diffusion into the soleus muscle occurs.

I graduated from the Royal College of Surgeons Medical School in Ireland, am a full member of the British Association of Cosmetic Doctors and lead the in-house training at CosmeDocs clinics. I specialise in a variety of minimally invasive cosmetic treatments, like Botox for cosmetic / medical use, dermal fillers & PDO Threads for anti-ageing & facial contouring. I enjoy reading extensively on cosmetic skin treatments related to photo-ageing, as well as formulations of ingredients useful in these treatments. I also provide training to aspiring cosmetic physicians in advanced cosmetic treatments at the Harley Street Institute.

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