Excessive gastrocnemius fibrosis developed after radiofrequency-induced cosmetic volume reduction

Cosmetic shaping of the lower leg is becoming increasingly popular. The use of radiofrequency therapy in cosmetic medicine also is growing. To date, no serious complications have been reported after the use of cosmetic radiofrequency therapy. This report describes a patient who presented at the author's clinic with a disabling ankle plantarflexion contracture in both calves that developed during a period of 18 months after cosmetic radiofrequency volume reduction. This reduction, performed at another clinic, involved applying a bipolar electrode with a mean power of 35 W at each of approximately 100 spots for 2 to 4 s. On each calf, 15 kJ was applied in a crisscross fashion. Magnetic resonance imaging and muscle biopsy indicated excessive gastrocnemius fibrosis. The patient was treated using botulinum toxin injections followed by serial castings and intensive physiotherapy. After treatment, the patient was able to walk with less difficulty and showed no tiptoeing. This appears to be the first report of serious muscle contracture after cosmetic radiofrequency volume reduction requiring extensive rehabilitation management.