A “cankle” is a non-medical term used to describe the area where the calf and ankle meet. In some patients, this area is disproportionate or large. In some patients, the cankle is as large or even more significant than the calf. In some patients, the cankle is larger than the thigh. In some patients, due to swelling, the cankles fluctuate in size.
Normal lower leg anatomy
There are several main muscles in the lower leg. In the upper half of the lower leg, there are the gastrocnemius muscles. There is the medial gastrocnemius muscle on the inside of the calf and the lateral gastrocnemius muscle on the outside of the calf. These muscles fuse into the Achilles tendon and attach to the calcaneus or heel bone. Usually, there is minimal to no fat over the Achilles tendon and lower leg.
In general, your calf size should be in proportion to your shoe size. If your shoe size is 6M and your calf width is 15 3/4-inch, you are considered wide calf. If your shoe size is 6M and your calf width is 17 1/8-inch, you are considered extra wide calf. If your shoe size is 6M and your calf width is 18-inch, you are considered super wide calf. If your shoe size is 6M and your calf width is 19 3/4-inch calf, you are deemed super plus wide calf. If your shoe size is 12WW and your calf width is 19 1/8-inch, you are considered wide calf. If your shoe size is 12WW and your calf width is 21-inch, you are considered extra wide calf. If your shoe size is 12WW and your calf width is 22 3/4-inch, you are considered super wide calf. If your shoe size is 12WW and your calf width is 24 3/4-inch, you are deemed super plus wide calf.
Types of patients with large cankles
Every patient is different and, therefore, a physical examination is necessary before any surgical treatment plan can be created. There are two distinct types of cankles.
Type I Cankle patients have excess lower leg fat. The Type 1 Cankle patient is the most common type of patient. The lower leg fat may be just isolated to the ankle. The leg fat may extend to the lower border of the gastrocnemius muscle, or the fat may go up to the knee. Type II Cankle patients are more uncommon than Type 1 Cankle patients. The second type of patients not only have excess lower leg fat but also have lower leg skin. Usually, patients with excess cankle skin have had a history of significant weight gain and weight loss. Often, patients with either Type 1 or Type 2 cankles have some component or form of lipedema.
Why have cankle surgery?
There are many reasons to have cankle surgery. Some patients want more calf and ankle definition. These patients want more definition between their calf and ankle. Other patients want to show off the results of hours of training at the gym on the stair master or equally tortuous machine. Some patients are just looking to wear particular shoes or boots. Some patients have excess overhanging skin on the inner and outer ankle and want it gone. These patients are looking to have the hanging skin removed.
Treatment options for cankles
Type I Cankle patients are best treated with targeted, selective VASER liposuction. During this procedure, tumescent solution is injected into the calf and ankle. Tumescent solution is a mixture of anesthetic and medication to minimize bleeding. Injecting tumescent solution allows the cankle fat to float in solution. After several minutes, the VASER probe is inserted, and the fat is liquefied. These maneuvers allow for better fat removal. An added benefit to the VASER is that the undersurface of the skin is simultaneously heated. When the undersurface of the skin is heated, this leads to skin contracture. Skin contracture leads to a smoother final result with fewer chances of rippling.
Type II Cankle patients are best treated with skin and fat resection. During Type II Cankle reduction surgery, the lower leg is liposuctioned first. Then, during the same operation, an incision is made from the inner ankle (medial calcaneus) up the inner calf. The length of the incision depends on the amount of excess fat in the cankle.
Where are the incisions?
Usually, for the treatment of Type 1 cankles, five incisions are placed. One incision is placed on each side of the knee. One incision is placed on the back of each side of the ankle. Another incision is placed in the center of the calf. These tiny liposuction access ports allow for excellent removal of calf fat. Also, these ports provide for accurate sculpting of the underlying calf musculature.
Usually, for the treatment of Type 2 cankles, the incision begins just above the medial malleolus or inner ankle. Typically, the incision is extended towards the knee. Since most patients with Type 2 cankles have fat up to the inner knee, often the incision is extended to the knee. Sometimes, the cankle surgery is combined with a medial thigh lift, and the incision is extended to the groin.
How big are the incisions?
For the treatment of Type 1 cankle patients, each liposuction port incision is tiny and measures approximately 5 mm. For the treatment of Type 2 cankle patients, the length of the incision depends on the patient’s unique physical condition. The incision length can measure from several millimeters to the length of the entire inner thigh and leg.
Do the sutures need to be removed?
No. Almost always, sutures used to close liposuction port sites are absorbable. That means these sutures will fall out on their own and do not need to be to be removed. For the treatment of Type 2 cankles, almost all the sutures are absorbable and will fall out on their own.
How long is the procedure?
For Type 1 cankle patients, the length of surgery depends on the amount of fat that needs to be removed. The more fat that needs to be removed, the longer the operation will take. The less fat there is, the shorter the surgery will take. However, in general, for the treatment of Type 1 cankles, the procedure lasts about two to three hours.
For Type 2 cankle patients, the length of the surgery depends on the amount of ankle and subcutaneous fat that needs to be removed. On average, if the incision extends from the knee to the inner ankle, the procedure takes about four to five hours.
How long is the recovery?
For Type 1 cankle patients, the recovery time is about one to two weeks. You should be able to return to activities of daily living about two weeks after your surgery. You should be able to return to your work out routines three to four weeks after your surgery.
For Type 2 cankle patients, since the surgery is more invasive and more work is needed, the recovery time is longer. You should be able to return to activities of daily living about three to four weeks after your surgery. You should be able to return to your work out routines four to six weeks after your surgery.
How long will I be swollen?
Liposuction of the cankles is different from liposuction of the abdomen. Treatment of the calf and ankles is a more intricate process, and swelling from cankle liposuction takes some time to dissipate. Most cankle swelling is gone at about four weeks. Most, if not all, cankle swelling should be gone at about eight weeks. If cankle skin and fat are removed, most swelling should be gone at about six to eight weeks. Lymphatic massage treatments are recommended to minimize swelling. Lymphatic massage is recommended two to three times a week for two to three weeks.
Are there drains?
If you are having liposuction, no drains are involved. If you are having skin removed and an incision is made, one or two drains are placed on each leg. Once the drainage fluid subsides, the drains are removed. Every patient is different, but usually, drains remain in place for seven to ten days.
How long do I need to wear a compression garment?
After any leg procedure, especially leg liposuction, there is ankle and foot swelling. After lower leg liposuction to reduce and define the cankles, there will undoubtedly be swelling. At the end of your surgery, Dr. Katzen will place a compression stocking to minimize foot and ankle swelling. You will need to wear your compression garment for approximately four to six weeks. However, if you have swelling beyond six weeks, you will need to continue wearing your compression garments.
So, are you concerned about your cankles? Do you want to get rid of your cankles? Are you looking for more definition of your ankles or do you need to finally get rid of all that excess hanging skin that hangs over your shoes?
Whatever your reasons for getting rid of your cankles, call Dr. Katzen today for a free consultation. Dr. Katzen specializes in plastic surgery and has expertise in the treatment of cankles. For your convenience, he has offices in Las Vegas, NV and Beverly Hills, CA. Call Dr. Katzen today to finally get rid of those cankles once and for all.