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Dermatologic surgeons have performed botulinum toxin type A injection to treat muscular calves, with different dosages and injection sites suggested.We investigated the use of individualized botulinum toxin type A injection protocols to treat hypertrophic calves in Asian women.A total of 294 calves were examined and their bulging areas divided into 4 units (Units 1, 2, 3, 4). The rare bulging area unit 5 was only seen in 1 case. Thirty-five cases were treated using botulinum toxin type A between September 2011 and May 2016, with the treatment protocol chosen according to the assessed bulging units. Standard photo documentation was performed at each clinical visit.The average injection dose was 187 ± 10 U per patient. The average maximum calf circumference was significantly reduced 3 months postinjection, with that of the right leg reduced from 36.48 ± 0.57 to 34.87 ± 0.44 cm, and that of the left leg from 36.26 ± 0.61 to 34.71 ± 0.53 cm (both p < .01). The overall patient satisfaction rate was 73.08%.A botulinum toxin type A injection protocol tailored to the shape of the hypertrophic calf muscle can effectively improve the contour of the lower leg.