摘要

Objectives: The primary objective of this study is to demonstrate the efficacy and safety of a multimodal shoulder contouring protocol combining botulinum toxin (BoNT-A) and hyaluronic acid (HA) fillers. I aim to establish a standardized injection technique that targets the deep subcutaneous and periosteal planes. This approach seeks to overcome the limitations of monotherapy by addressing both muscular hypertrophy and skeletal volume deficits, ultimately defining a safe, reproducible method for enhancing the clavicle-acromion silhouette while minimizing neurovascular risks. Introduction: A defined shoulder line is a key aesthetic goal, yet relying solely on BoNT-A often yields suboptimal results due to unaddressed structural deficiencies. While BoNT-A effectively reduces muscle bulk, it cannot simulate skeletal projection. Conversely, improper filler placement poses significant vascular risks. Therefore, a precise anatomical understanding is crucial. This study introduces a comprehensive strategy that integrates muscle reduction with structural volumization. By strictly utilizing safe anatomical planes, this protocol offers a solution for refined upper-body contouring. Materials / method: I applied a multimodal protocol to 3 females. Volumization: 5–10cc HA filler/side via 16–18G, 70mm cannula. 4 entry points (acromion, glenohumeral joints, deltoid) utilized. Injection strictly confined to deep subcutaneous (acromion/deltoid) and supraperiosteal (clavicle) planes to avoid neurovascular injury. Tough deltoid fascia aids safe cannula placement. Neuromodulation: 20–30 IU BoNT-A to trapezius (4–6 points, nerve arborization zones) and 20 IU to deltoid (5 points, max bulging) per side. Results: All patients achieved visible aesthetic improvements immediately post-procedure, with peak definition observed at 4 weeks. Contour: The clavicular projection was sharpened, and the deltoid-acromion curve became smoother and more defined, achieving a streamlined, 90-degree shoulder silhouette. Volume & Tone: A significant reduction in trapezius and deltoid bulk, combined with strategic volumization, corrected the sloping appearance. Safety: No vascular occlusion, nerve injury, or migration was reported. Adverse events were limited to mild, transient edema. Conclusion: The synergy of BoNT-A and HA fillers offers a comprehensive solution for shoulder contouring. By adhering to a precise protocol—specifically using a 16–18G cannula in the deep subcutaneous/periosteal planes and landmark-based toxin injections—practitioners can achieve reproducible, high-satisfaction outcomes with a minimal risk profile. This multimodal technique serves as a safe and effective standard for upper-body aesthetic enhancement.