] described two fat compartments: lateral and medial. He specified that the upper limit of the fat compartment to be aspirated is the lower edge of the gastrocnemius muscle. The patient should go on tiptoe to determine the lower edge of the muscles. However, performing liposuction caudal to the lower edge of the muscles, even by a gradient, assumes that the inner and outer edges of the legs and ankles are symmetrical.
] described the ankle and the distal leg as a rhomboid prism with a major anteroposterior axis, four sides, and four edges. This description is correct and helps in identifying the four fat compartments on the ankle. However, it does not describe the distribution of curves of the legs from knee to ankle.
In his trek toward the “ideal beautiful normal,” Howard [4
] applied the “divine proportion,” as described by Ricketts [5
], to the lower extremity. However, it was applied only to the medial aspect of the calves in order to determine what he called the medial “peak.” No mention was made to the medial concavity or to the subtle lateral convex–concave curves. The lateral sweep was described as a long, easy curve that should mimic the lateral gastrocnemius muscle. One should note that the lateral easy curve does not run from the head of the peroneus to the lateral malleolus; the lateral easy convex curve turns into a slight concavity at the lower third to end up on the lateral malleolus.
Cuenca-Gerra et al. [6
] have proposed a model for calf augmentation. They suggested that the two most attractive feature variables are the anteroposterior (AP) and laterolateral (LL) projections. They correctly identified the junction of the upper and middle thirds of the leg as the point of the highest AP and LL projections. They used Fibonacci’s numerical sequence to identify the ideal projection of the calf. They stated that in the posterior view, the leg has the shape of an inverted “pointed gothic arc” and that the relationship with the ankle is 1.618:1 (the divine proportion = phi) (Fig. ). This would suggest that the lateral and medial convexities are alike, i.e., symmetrical. A quick posterior view examination of the leg clearly shows that the medial and the lateral convexities of the legs are fundamentally not symmetrical. The authors also suggested that from the lateral perspective, the leg has the shape of a half-inverted pointed arc with the convexity to the posterior side. Once again, examining the leg from the side perspective shows that the convexity in the upper two thirds inverts into a concavity in the lower third (Fig. ). Finally, the leg used as a model in their study did not have enough convexity in its medial aspect to balance the lateral curve. In my view, the medial upper convexity followed by the lower pronounced concavity is one of the most attractive features that defines leg beauty.
Fig. 21 The leg taken as a model in the study by Cuenca Guerra et al.  does not have the form of an inverted “gothic” arc as stated in their article (reprinted with permission from )
Most plastic surgeons who studied leg aesthetics reference Ricketts’ article “The Biologic Significance of the Divine Proportion and Fibonacci Series” [5
]. However, the article focused on facial and dental proportions but no mention was made to the legs. Moreover, the drawing used by Ricketts does not portray (illustrate) the application of the golden ratio to the lateral aspect of the legs.
Art historians as well as theorists of the Divine Numbers agree that the Golden Ratio is inherent in every work of art considered beautiful. This ratio ultimately describes the absolute and unique beauty. To understand and interpret beauty, one must return to the basics: the Pythagoras-Platonic heritage contained in the works of Euclid [7
We are not completely sure if Pythagoras practiced geometry! In fact, all of the works attributed to him are apocryphal, though he is considered by some the inventor of Greek mathematics [8
]. This is another myth that may have been perpetuated until the end of the fourth century BC to explain the origins.
The Pythagoreans formed a heterogeneous group, few of whom actually practiced mathematics, except for one: Archytas of Tarentum (around 430–348 BC). The Pythagoreans were especially interested in the philosophy and mysticism of mathematics. In fact, the “number” was for them a fundamental concept that could explain the world as a whole. The expression “everything is number” offers mainly a metaphysic, and the numbers are integers, whole numbers, equal to or >2. Respected art historians think that “it is simply impossible to speak of shared numbers, percentages or averages (the relation between two parts, either quantitative or qualitative) in Pythagorean or Euclidian theorems” [7