A small incision is made in the crease behind the knee. A pocket is then made under the sheath that envelopes the muscle. A silicone implant is placed in this pocket. A size is chosen to provide the desired fullness without too much tension on the skin, which is the judgment call that needs to be made during surgery. While some surgeons place two implants in the calf at once, my preference is to use just one, placed in the posterior compartment where the deficiency is most obvious. If any additional augmentation is needed laterally, I prefer to use fat injection rather than a second implant. I believe this approach helps to minimize complications.

Because the implant is placed under the muscle sheath, it appears and feels natural. The implant is made of solid silicone and feels like rubber. A soft consistency ("durometer") is chosen to help mimic the feel of the muscle.

Like a breast augmentation, the benefits are immediately apparent. Patients may go on to work out again in the gym as before, after about a month. Any increase in muscle size will compliment the result. The scar is relatively inconspicuous, located in the crease behind the knee.