How Bow Leg Correction Surgery Is Performed

Bow Leg Correction Surgery

Do you feel insecure about the bowed shape of your legs, preferring to cover them up rather than wear shorts or skirts in the summer? If so, a simple, minimally invasive plastic surgery procedure can be performed to remodel your legs, giving them a straighter, more balanced and shapely appearance.

In the mid nineties, New York plastic surgeon Dr. Leonard Grossman developed a unique cosmetic procedure that has given patients the opportunity to fix their bow legs, in most cases without the need for invasive orthopedic surgery.

Having successfully treated close to one thousand men and women, Dr. Grossman reports that the patient satisfaction rate for this same-day procedure is extremely high. Patients regain confidence, women feel more comfortable wearing high heels or shorter garments, and the results of the procedure are long term, if not permanent.

What causes bow legs

Genu varum, commonly known as bow leggedness, usually occurs during childhood development. It is caused by abnormal bone development that occurs due to two factors:

  • Blount’s disease, a growth disorder of the tibia which can be the consequence of an incorrectly healed fracture.
  • Rickets, a condition that causes softening and weakness in the bone due to vitamin D or calcium deficiency.

Most children grow out of their bowed legs without the need for braces or surgical intervention when these deficiencies are corrected early.

If you search the internet, you will likely be surprised and feel anxious about what the corrective surgery involves — cutting the bone, applying a rod, and wearing a device on your leg that resembles scaffolding. And you’d be required to wear this unattractive clunky device for quite sometime.

Thankfully, you may not be destined for this fate.

While it is popular belief that bow leggedness is a condition associated with deviation of the bone, Dr. Grossman assures that “genu varum is a very rare condition in this day and age. Malnutrition is very rare, as is the severe deficiency of vitamin D that is seen in rickets, especially in the United States”.

In these rare cases, genu varum may warrant surgical intervention, in which case you would need to consult with an orthopedic surgeon to discuss your bow leg correction options. However, if your case is not severe and has never been officially diagnosed, the likely cause is cosmetic in nature.

When is surgery necessary?

An official diagnosis of bowed legs or genu varum requires a physical examination, an X-ray, as well as special tests to determine the degree of abnormality in the bones. If you’re an adult and have never had an official diagnosis, chances are you don’t have true genu varum.

“In the twenty two years that I’ve been performing bow leg plastic surgery, I have only seen one patient who had true genu varum, affecting both the upper and lower portion of the leg,” says Dr. Grossman. “This gentleman, who was 70 years old when he finally decided to seek treatment, would have benefited from orthopedic surgery to straighten out the bones at a young age. Interestingly, his whole family had the trait.”

Generally, an orthopedic surgical procedure is reserved for severe bow leg deformity. “I’m not an orthopedist, but I can tell you that besides that one case, I have never seen a patient who required orthopedic involvement,” says Dr. Grossman.

Dr. Austin Fragomen is a highly accomplished orthopedic surgeon associated with Weill Cornell University and the Hospital for Special Surgery in New York City. We reached out to him to find out more about bow leg surgery as it is performed on patients whose condition warrants this type of specialized medical intervention.

“Bow legs are both a cosmetic and mechanical problem,” says Dr. Fragomen. “Young patients find their bow legs embarrassing, while older patients and athletes find them painful and need to recognize that they are traveling down the path towards knee arthritis.”

Dr. Fragomen’s goal as an orthopedic surgeon is to treat the mechanical problem created by malalignment of the tibia, with cosmetic improvement being a secondary benefit of the procedure.

“Fat grafting and other non-invasive procedures are purely cosmetic treatments — they do not help address mechanical issues at all,” he says. “For patients who have small calves and normal alignment I agree that fat injections or implants will make their legs look better, but for patients with true genu varum these treatments are incorrect — and insufficient.”

Dr. Fragomen also warns that is a difference between genu varum and Blount’s disease, the latter being “a severe condition that merits its own discussion.” Patients with these and other types of serious limb deformities should be seen by orthopedic surgeons who specialize in limb reconstruction and realignment procedures.

Fat grafting for bow legs

Fat grafting is a minimally-invasive option for patients who simply wish to give their legs a straighter appearance.

“In my opinion and experience, a majority of women and men who have bowed lower legs are simply missing the medial (inner) portion of the gastrocnemius (calf) muscle and a significant layer of fat to boot,” says Dr. Grossman. “This lack of bulk in muscle definition and fat creates the illusion that the person is bow legged.”

Dr. Grossman informs that twenty two years ago when he began performing fat grafting procedures, most surgeons were using implants to augment the legs. Many still do today. At the time, Dr. Grossman had other ideas.

“Since fat and the fat derived stem cells can be safely injected anywhere on the face and body, it made sense that fat and its stem cells would be the perfect solution for a bow leg procedure,” he explains.

Other plastic surgeons have caught up on the trend, and are now also performing fat grafting to the lower leg. However, it pays to research their success rates. With over twenty years of experience under his belt, Dr. Grossman informs that he’s developed techniques that consistently achieve positive results. “Most doctors tell patients to expect to lose 80% of fat, whereas I tell my patients to expect to retain 80 to 100% of fat injected,” he says.

The process

In recent years, fat grafting has become increasingly popular, mainly because using your own fat is extremely safe. Furthermore, the procedure is very effective, versatile, has a short recovery time, and produces natural-looking results. Once injected, the results of fat grafting are also long lasting, if not permanent.

If you’ve been dreaming of removing a little excess fat off your buttocks, thighs, abdomen or side flanks, this procedure provides the perfect opportunity to do so.

Fat is harvested from the donor site using standard liposuction with a local anesthetic. It is then purified and transferred to syringes so that it can be reinjected into the inner portion of the lower leg area. Volume is added in the areas that are lacking in bulk, straightening out the lower portion of the leg and correcting the appearance of bow leggedness.

It’s important to understand that some patients won’t have quite enough fat available to achieve optimal results. But even then, Dr. Grossman informs, “patients are nearly always 100% satisfied with the improvement.”

The entire procedure takes between ninety minutes and two hours to complete. And best of all, there is no pain or scarring after the procedure.

Recovery time

After your bow leg correction, you won’t be required to wear clunky scaffolding, special dressings or any compression garments at all. Instead, you will be able to walk out of the surgical facility right away, and resume normal activities the very next day.

Within one week most patients can return to more intensive physical activity, such as gym workouts.

“The complications from this procedure are minimal,” says Dr. Grossman. “I’ve never had a single infection or seroma (a collection of fluid that builds up under the surface of your skin) on a patient who needed fat transfer. The only thing patients should expect with the bow leg procedure is some prolonged swelling of the ankles and feet.”


Dr. Grossman informs that the procedure is priced at $8,500. However, the cost can be higher if liposuction and harvesting must be preformed in more than one area.

Alternatives to fat grafting

Another possible solution is calf implant surgery. However, implants aren’t likely to produce satisfactory results on patients with bow legs. And compared to fat grafting, implants can come at a much higher expense.

“With implants, patient must realize they will be left with a large incision behind the knee (about 3 inches). Plus, the implant can only extend as far as the muscle goes, not into the ankles, if that’s what’s required to achieve a straighter appearance,” says Dr. Grossman. “Compared with fat grafting, the level of incapacitation is also huge. Patients hardly walk after three weeks with a submuscular placement of implants. On top of this, infections and seromas are much more common.”

“The ideal thing about fat is it can be placed into any area of a hollow, or in fact, anywhere on the body to create symmetry. If patients have no donor sites suitable to harvest fat, they have the option of using Macrolane or Sculptra (synthetic body-contour fillers). But unlike fat grafting, which is long lasting and often permanent, these are temporary solutions,” Dr. Grossman concludes.

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