Aesthetic Plastic Surgery

, Volume 43, Issue 6, pp 1588–1594 | Cite as

Classification of Hypertrophic Gastrocnemius Muscle and Its Treatment with Botulinum Toxin A

  • Wenjun Shi
  • Lian ZhuEmail author
  • Tingliang Wang
  • Guoyou Zhang
  • Jie Lian
Original Article Body Contouring



Treatments including selective neurectomy, muscle resections and botulinum toxin A (BTX) injections have been used to improve the stocky appearance of calves. BTX injection has the advantages of high efficiency and is almost noninvasive. However, criterion standards of injection are still missing.


We aimed to establish a method to classify the hypertrophic calf for a personalized treatment and set up an injection protocol based on the findings.


Three-dimensional CT reconstruction was used to measure the thickness and cross-sectional area of the triceps surae. B-mode ultrasound and palpation were used to evaluate the muscle thickness and determine the dosage. Patients were followed 3 and 6 months after the treatment.


A total of 112 legs were classified into three degrees of thickness (< 15 mm, 15–25 mm and > 25 mm). Twenty-seven subjects were treated with an individualized BTX (100–300 U). Maximal circumference decreased 0.33 ± 0.00 cm after 3 month (p < 0.05) and 0.67 ± 0.11 cm after 6 months (p < 0.01). The angulated calf contour was improved. No severe side effects were reported.


Localizing and dosage are the key points when applying BTX. Dosage should be decided by muscle thickness instead of circumference. BTX treatment improves the prominent contour of the calf rather than reducing the volume.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Calf contouring Botox Location Dosage 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

The ethical principles outlined in the Declaration of Helsinki were followed.

Informed Consent

Written informed consent was signed for all the patients.

Supplementary material

266_2019_1455_MOESM1_ESM.wmv (15.8 mb)
Supplementary file1 (WMV 16195 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Wenjun Shi
    • 1
  • Lian Zhu
    • 1
    Email author
  • Tingliang Wang
    • 1
  • Guoyou Zhang
    • 1
  • Jie Lian
    • 1
  1. 1.Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s HospitalShanghai Jiaotong University School of MedicineShanghaiChina

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