Ultrasonographic analysis of the calves for efficient botulinum toxin type A injection

Contouring With Neuromodulators

BACKGROUND AND OBJECTIVE

Botulinum toxins, originally used for facial rejuvenation, have emerged as a promising tool for sculpting and refining contours for both the face and body.

METHODS

The peer-reviewed literature on neuromodulator contouring treatments was analyzed, with a particular emphasis on studies and case reports involving the use of botulinum toxin type A.

RESULTS

Modification of face, neck, shoulder, arm, and calf contour has been reported. Treatment and dosing protocols vary with the strength and depth of the target muscle. Regional effects of neuromodulator treatment begin to appear approximately 2 weeks after injection and are often most prominent at the 70- to 90-day time point. Although treatments are generally well tolerated, short-term muscle weakness and other side effects may occur.

CONCLUSION

The use of neuromodulators to enhance facial and body contours has demonstrated efficacy, but further research is needed to validate their use and explore the full potential of this intervention through larger randomized controlled trials. The application of neuromodulators as a minimally invasive tool to address the rising demand for nonsurgical body sculpting represents a promising frontier in aesthetics.

The Efficacy of Botulinum Toxin A Injection for Gastrocnemius Hypertrophy: A Prospective, Randomized, Double-blinded Controlled Trial

Background

Many individuals hold an interest in aesthetic appeal, with one aspect of physical attractiveness being the alluring contour of the lower leg. Utilizing botulinum toxin A (BTX-A) injections offers several advantages, including a short procedure time, low pain, and a speedy recovery. With a demand for high-level evidence regarding the effectiveness of BTX-A injections for correction of lower leg contour, we evaluated the safety and efficacy of BTX-A injection for improvement of gastrocnemius muscle hypertrophy.

Methods

We conducted a prospective, randomized, and controlled clinical trial to evaluate whether the injection of BTX-A into the gastrocnemius muscle could decrease muscular hypertrophy. The patients were randomized into a low-dose injection (60 units) group and a high-dose injection group (100 units) for each leg. Demographics, clinical outcome, and satisfaction score were compared between the two groups.

Results

A total of 20 patients and 40 legs were enrolled in this study. Clinical and surgical demographics were similar between the two groups. BTX-A injection showed a significant decrease in the circumference of the calf after 8 weeks (preinjection: 36.35 ± 0.63 cm versus postinjection: 35.87 ± 0.61 cm; P = 0.03). However, no significant difference was observed between the low- and the high-dose group (-0.52 ± 0.74 cm versus -0.44 ± 1.04 cm, P = 0.78).

Conclusions

BTX-A injection can be a good noninvasive method for the correction of hypertrophic gastrocnemius muscles. This study supports the use of BTX-A injections in patients unsatisfied with lower leg hypertrophy.

Botulinum Toxin Treatment for Calf Contouring Based on the Study of Combined Injection of Gastrocnemius and Soleus

BACKGROUND

Botulinum toxin is administered to paralyze the gastrocnemius muscle and reduce its size, thereby improving the calf contour and reducing the leg circumference of the calf.

OBJECTIVES

In pursuit of better efficacy, we designed a new injection protocol that targeted both the gastrocnemius and soleus. An algorithm of botulinum toxin injection for calf contouring was proposed based on the results of the study and ultrasonographic data.

METHODS

A prospective, self-controlled, double-blind study was conducted. The gastronemius muscle (GM) group (n = 17) included the patients whose gastrocnemius muscles were treated, and the GM + soleus muscle (SM) group (n = 17) included the patients who had both the gastrocnemius and soleus treated. Parameters including the maximum leg circumference and the subcutaneous fat, gastrocnemius muscle, and soleus muscle thicknesses were collected before and after injection.

RESULTS

Both GM and GM + SM injection helped improve calf contour. Although the thickness of the gastrocnemius muscle was reduced, reducing the leg circumference, the subcutaneous fat and soleus muscle had compensatory thickening after injection, especially over the long term, which may affect the efficacy. Compared with the GM group, the GM + SM group effectively reduced the tendency of the soleus muscle to thicken. Calf muscle thickness could be roughly estimated by constructing a fitting equation and measuring height, weight, and leg circumference.

CONCLUSIONS

Two injection methods achieved the effect of improving calf contour and reducing the leg circumference with equivalent patient satisfaction. The GM + SM injection group did not show any obvious extra clinical benefit when compared with the GM injection group.

LEVEL OF EVIDENCE: 2

Classification of gastrocnemius muscle hypertrophy for personalized botulinum toxin type A treatment

BACKGROUND

Owing to its safety and convenience, botulinum toxin type A (BoNtA) has become a first-choice treatment for contouring calf muscle asymmetries or deformities. Different injection methods and dosages have been discussed in the literature, but a standardized BoNtA treatment remains unclear.

AIMS

This study aimed to classify gastrocnemius muscle hypertrophy (GMH) through multiple measurements to provide a personalized BoNtA treatment protocol.

METHODS

The measurements combining of gastrocnemius muscle (GM) contour, max leg circumference and GM thickness was applied to classify different type of GMH in a normal population. Based on these findings, a personalized BoNtA treatment protocol was determined and evaluated regarding max leg circumference, GM thickness, the position of max leg circumference, patient and doctor satisfaction rate, and complications.

RESULTS

A total of 100 GMH were classified into two bulging types (bilateral-bulging type and unilateral-bulging type) and two categories (moderate GMH and severe GMH). 40 cases were treated with personalized BoNtA injection methods ("Even" or "Intense"method) and dosages (300 or 400 units). Follow-up examinations at 1, 3, and 6 months after treatment. Max leg circumference and GM thickness decreased significantly and the position of max leg circumference rose prominently during treatment (2.56± 1.93; p< 0.05). The overall patient satisfaction rate was 70%-100%. No serious complications occurred.

CONCLUSIONS

We identify four groups of GMH through several measurements and outline a personalized BoNtA treatment for each type. This recommended protocol may improve the therapeutic outcomes and patient satisfaction after treatment.

Tailored Indications for Different Neurotoxins

Background

Minimally invasive procedures have become increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. All U.S. Food and Drug Administration-approved neurotoxins are indicated for achieving similar effects, even though they are different in regard to structure, manufacturing technique, and storage requirements. It is agreed upon that each neurotoxin is unique and therefore not interchangeable. The aim of the author is to provide an approach for choosing the optimal toxin in different indications regarding the area of treatment, the age and characteristics of the patient, potential risks, and ultimate goals.

Methods

As the country that the author practices carries onabotulinum (ONA), prabotulinum (PRA), and abobotulinum (ABO) toxin type-A, one of these three toxins was preferred for each category. ABO toxins were preferred in wide areas due to the broader action halo. Typical examples include hyperhidrosis treatment, wide forehead area, and calf slimming. In areas where very precise and targeted treatment is required, PRA and ONA toxins were preferred to limit potential side effects due to wider diffusion. First-time patients were typically treated with PRA toxins for a softer trial periods where as "repeat" patients were successfully treated with ABO toxins.

Results

No toxin is superior to the other in terms of producing effects. Yet, small differences in their properties can allow the plastic surgeon to cater to each patient's needs while yielding the most optimal results.

Conclusions

This study is meant to serve as a guideline for choosing the ideal toxin in different patient settings and indications.