The Surprising Reason Women Are Getting Neurotoxins Injected in Their Legs

We’ve heard of women (and men) doing crazy things in the name of beauty, but injecting neurotoxins into their calves so they can fit their legs into boots takes the cake. Yes, it is happening.

Calf-grazing and knee-high boots are a winter staple, yet they aren’t always comfortable to wear. Muscular and bulkier calves can find it challenging to wear tight-fitting boots, which can feel constricting to the legs. And that’s where calf injections come in. Believe it or not, this off-label procedure can temporarily shrink and slim the back part of the leg. Strange but true, more and more women are opting for the treatment, and here’s why.

Details on the Trend

The off-label use of botulinum toxin injections is nothing new. Campbell, CA dermatologist Amelia K. Hausauer, MD says neuromodulators can treat overactive or enlarged muscles in patients with movement disorders or aesthetic applications such as slimming the lower face (masseter injections). And now, they are being used to contour the lower leg, aka “calf Botox.” The procedure, which slims the lower leg and makes the legs look longer, became popular in Asia, where the look of a “thicker” leg is often considered undesirable.

How it Works

Nanuet, NY dermatologist Heidi Waldorf, MD explains that all botulinum toxins work by relaxing muscles. “With repeated treatments and time, hypertrophic muscles—ones that have become bulky with overuse or are genetically larger—can shrink.”

Miami dermatologist Anna H. Chacon, MD explains that women who can’t comfortably fit into their favorite boots may treat the problem with neuromodulators. Similar to injecting muscle contraction–weakening neuromodulators into the muscles that run along the jaw to “de-bulk” it, the same concept applies to the calves. “Preventing the muscles from tensing up in response to nerve impulses helps them to relax.”

Typically, the neurotoxin is injected into the bulky part of the calf (the gastrocnemius muscle), creating visible and measurable shrinking. Dr. Chacon says the product can be injected into the muscles from the back or side to relax the muscles for a softer-looking shape.

Like all neuromodulator treatments, your dermatologist must tailor the dose to your needs. According to Dr. Hausauer, the calf muscles require a higher dose to see an impact because the muscles are larger. “Many studies use around 100 units of Botox legs and 360 units of Dysport per leg. Some have gone as low as 32 to 40 units, which gives subtle results and a shorter duration. Higher doses will cause dramatic, longer-lasting muscle shrinkage, but it can lead to difficulty walking, raising onto the toes or other movements.”

The Results

No matter where a neuromodulator is injected, its results are never permanent, and using one to slenderize the calves provides a temporary effect. “It’s a blessing and a curse as the medication wears off,” Dr. Hausauer says. “Depending on the treatment specifics, studies suggest the effects appear at one to four weeks, strength returns about three months out and there’s a gradual return of muscle bulk over six to 12 months. So the legs will appear slimmer for half a year while others show a return to original by that time.”

You may reap the benefits of slimmer, more feminine-looking legs for a few months, but don’t expect more than a few millimeters to one inch at most of shrinkage. For some patients, that’s all the improvement needed to make a noticeable difference. “Calf-reduction results vary depending on the size of the calf muscle,” Dr. Chacon says. “After treatment, the calves will become progressively smoother and slimmer over the following weeks.”

Of course, a few neuromodulator injections are far less invasive than surgery to achieve slimmer-looking calves. Still, the injectable approach comes with the need to repeat the process.

Now that the calves are thinner and thinner, creating more uniform-looking legs may be next on your list. If that’s the case, consider treating the neighboring knees and thighs. Popular treatments that can improve the look of the legs include sclerotherapy to erase prominent red, purple or blue veins on the legs and off-label use of Kybella and CoolSculpting to target stubborn fat pockets on the thighs and around the knees. “Radiofrequency microneedling devices, like Profound and Morpheus8, and bio-stimulatory fillers including Sculptra or dilute Radiesse can help with skin quality, too,” Dr. Hausauer says. “I often use these injectables and a new innovative device called Aveli for cellulite treatment. Together, these all help improve the overall appearance of the legs.”

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