Calf augmentation and volumetric restoration: A systematic review and meta-analysis.

Abstract

<h4>Background</h4>Because of the recent attention focused on the aesthetics of the leg, outcomes in the literature are under-reported and require further investigation. We summarized the available evidence on the surgical techniques to augment the volume and dimension of the calf based on clinical outcomes and satisfaction rates.<h4>Methods</h4>An electronic search was conducted across PubMed MEDLINE, Web of Science, Scopus, and Ovid MEDLINER(R) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Data collection included the patients' characteristics, surgical techniques, and postoperative outcomes. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model.<h4>Results</h4>This review included 48 articles reporting outcomes of 2455 patients. The average age and follow-up were 33.15 years and 33.58 months, respectively. The most common indications for calf augmentation were esthetic concerns (48.7%). Most patients underwent subfascial implant placement (70.2%) followed by fat transfer (17.6%), submuscular implant placement (10.1%). Overall, the pooled satisfaction rate following calf augmentation was 95.4% (95% CI: 93.7%-97%). The pooled satisfaction rate for implant placement and fat transfer was 96.7% (95% CI: 94.4%-97.9%) and 87.2% (95% CI: 78.5%-96%), respectively. The pooled incidence of implant removal was 1.3% (95% CI: 0.7%-2%). The pooled estimate for additional fat grafting procedures following initial fat transfer was 54.1% (95% CI: 38.3%-70%).<h4>Conclusions</h4>While fat transfer has an exceptional safety profile, additional procedures to achieve satisfactory outcomes are usually necessary. Subfascial implant placement provides the best volumetric expansion with a lower implant removal rate and optimal safety profile.