Ultrasound-guided injection of ankle contouring with botulinum neurotoxin

Abstract

Background: A slim ankle is considered a hallmark of beauty in modern aesthetics. Excessive muscular hypertrophy, particularly of the deep calf muscle (soleus), can lead to a thick ankle appearance that detracts from an overall refined leg contour. Although surgical approaches have been used historically, they carry risks such as scarring, contracture, and unpredictable outcomes. Objective: This study aimed to evaluate the efficacy and safety of ultrasound-guided botulinum toxin type A (JETEMA THE TOXIN, JETEMA Co., Ltd. Korea) injections for improving ankle contour in patients with thick ankles. Methods: Three adult female patients with noticeably hypertrophic calf muscles underwent ultrasound-guided injection of 20 units of botulinum toxin into the soleus muscles. Needles were inserted with ultrasound guidance to ensure precise real-time visualization and accurate injection into the soleus muscles. Ankle circumference and soleus muscle thickness were measured pre-treatment and at 8 weeks post-treatment using standardized methods. Wilcoxon signed-rank test was applied to evaluate statistical significance. The manuscript was checked against the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist (Supplemental Appendix). Results: All patients exhibited a reduction in ankle circumference (approximately 6.7-7.1 %) and soleus muscle thickness (around 14-15 %) at the 8-week follow-up. The Wilcoxon test revealed statistically significant differences ( p = 0.001) between pre-and posttreatment values. Visual assessment of photographic records further confirmed a noticeably slimmer and more refined ankle contour. Conclusion: Ultrasound-guided botulinum toxin injections appear to be a safe and effective minimally invasive approach for ankle contouring, achieving clinically meaningful reductions in muscle bulk with high patient satisfaction. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)