Many patients say:

• “I had shoulder Botox, but my shoulders didn’t go down.”
• “My neck still looks short.”
• “There was no visible change at all.”

The most common reason why shoulder Botox fails is misdiagnosis of the true anatomical cause of shoulder prominence.

Not all elevated or wide shoulders are caused by the trapezius muscle.

Correct diagnosis is the key to successful contouring.

When Shoulder Botox Works Well: Trapezius-Dominant Shoulders

Standard shoulder Botox targets the trapezius muscle, which is responsible for:

• Shoulder elevation (shrugging)
• A short-looking neck
• A bulky neck–shoulder junction

Patients who tend to respond best are those with:

• Vertical shoulder elevation
• A rounded or unclear neck–shoulder border

With proper trapezius Botox:

• Shoulders drop naturally
• The neck appears longer
• The collarbone and shoulder line become softer and more feminine

When the Scapula Is the Problem: Trapezius Botox Alone Is Not Enough

If the scapula itself protrudes upward, the main cause is often the:

• Supraspinatus muscle
• Other deep muscles that elevate the scapula

In these cases, Botox injected into the trapezius alone produces almost no visible improvement, regardless of dosage.

Ultrasound-Guided Supraspinatus Botox at AVAN TOKYO

At AVAN TOKYO GINZA LIPOSUCTION CLINIC, we always perform real-time ultrasound evaluation of shoulder musculature before injection.

Based on this assessment, we determine whether to treat:

• Only the trapezius
• Only the supraspinatus
• Or a combined trapezius + supraspinatus approach

Because the supraspinatus is located deep, blind injection carries risks of nerve and vascular injury.

Therefore, ultrasound-guided injection is essential for both safety and accuracy.

Wide Shoulders Are Often Caused by Fat — Not Muscle

If the shoulder appears wide horizontally, the main cause is usually:

• Axillary fat
• Upper arm root fat
• Posterior upper arm fat

In such cases, Botox is ineffective, regardless of how much is injected.

The correct treatment is:

👉 360-degree full-circumference upper arm liposuction

Correct Treatment Depends on the Root Cause

Incorrect diagnosis = expensive treatment with poor results.

Why “Upper Arm Liposuction + Trapezius Botox” Is the Most Photogenic Combination

• Liposuction → Physically reduces shoulder and arm width
• Botox → Lowers shoulder height

This combination:

• Softens the shoulder contour
• Narrows the shoulder frame
• Creates a smooth, continuous neck–shoulder–arm line

From a body-contouring perspective, it is one of the most effective upper-body shaping protocols for photography and daily appearance.

Conclusion

Shoulder Botox is not a universal solution. Its success depends entirely on:

• Accurate muscle diagnosis
• Proper evaluation of scapular position
• Precise assessment of fat distribution

At AVAN TOKYO GINZA LIPOSUCTION CLINIC, we emphasize:

• Ultrasound-based diagnosis
• A layered evaluation of muscle × fat × bone
• Combined liposuction when structurally required

Our goal is not merely to “slim the shoulders,” but to design a beautiful, anatomically balanced upper-body silhouette from a medical perspective.