Shoulder contouring with botulinum toxin and fillers.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.