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Individualized Treatment of Botulinum Toxin Type A for Hypertrophic Muscular Calves With Different Bulging Units in Asian Women

Xu, Fawei MS*; Ma, Hongfang MD; Li, Yirun BS; Cai, Jiaqin MD; Gu, Zi-chun MS

doi: 10.1097/DSS.0000000000001261
Original Article

BACKGROUND Dermatologic surgeons have performed botulinum toxin type A injection to treat muscular calves, with different dosages and injection sites suggested.

OBJECTIVE We investigated the use of individualized botulinum toxin type A injection protocols to treat hypertrophic calves in Asian women.

MATERIALS AND METHODS A total of 294 calves were examined and their bulging areas divided into 4 units (Units 1, 2, 3, 4). The rare bulging area unit 5 was only seen in 1 case. Thirty-five cases were treated using botulinum toxin type A between September 2011 and May 2016, with the treatment protocol chosen according to the assessed bulging units. Standard photo documentation was performed at each clinical visit.

RESULTS The average injection dose was 187 ± 10 U per patient. The average maximum calf circumference was significantly reduced 3 months postinjection, with that of the right leg reduced from 36.48 ± 0.57 to 34.87 ± 0.44 cm, and that of the left leg from 36.26 ± 0.61 to 34.71 ± 0.53 cm (both p < .01). The overall patient satisfaction rate was 73.08%.

CONCLUSION A botulinum toxin type A injection protocol tailored to the shape of the hypertrophic calf muscle can effectively improve the contour of the lower leg.

*Department of Plastic Surgery, Xiasha Campus, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China;

Department of Plastic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

Address correspondence and reprint requests to: Zi-chun Gu, MS, Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, Zhejiang Province 310016, China, e-mail:

Supported by the grants from Medical and Health Technology Development program of Zhejiang Province (2017RC020, 2017KY090, and 2017KY423), and Natural Science Foundation of Zhejiang Province (LY14H150001) (to Hua Li).

The authors have indicated no significant interest with commercial supporters.

© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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