Shoulder contouring with botulinum toxin and fillers

Interest in shoulder aesthetics has increased, with emphasis on clavicular definition and balanced shoulder contour. Minimally invasive approaches combining hyaluronic acid fillers and botulinum toxin type A (BoNT-A, Letibo, Hugel, Korea) have been proposed to address both structural and muscular components.

This technical note describes three patients who underwent combined acromial and clavicular filler injections with BoNT-A administered to the upper trapezius and deltoid regions for shoulder contour refinement. Filler volume was individualized according to baseline shoulder slope, clavicular/acromial projection deficiency, soft-tissue thickness, and the degree of asymmetry, with total volumes of 10, 12, and 15 cc. BoNT-A was administered as 25 units distributed across five anatomically defined injection points. Outcomes were assessed by standardized clinical photography, clinical follow-up, patient-reported satisfaction, and adverse-event grading using the Common Terminology Criteria for Adverse Events framework.

All three patients demonstrated visible, qualitative improvement in shoulder contour, including enhanced clavicular definition and reduced trapezius prominence. Patient-reported satisfaction was favorable in all cases. No major complications were observed. Minor adverse events, including transient swelling and discomfort, were classified as mild CTCAE grade 1 events and resolved without intervention.

This three-case technical note illustrates a feasible anatomy-guided multimodal approach for shoulder contour refinement. Because of the very small sample size, lack of a control group, and predominantly qualitative outcome assessment, these observations should not be interpreted as evidence of efficacy, safety, or generalizability. Larger controlled studies with standardized morphometric measurements, validated patient-reported outcome instruments, and longer follow-up are required.