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Objective To evaluate the effect of Chinese botulinum toxin type A on gastrocnemius hypertrophy by B-mode ultrasound combined with calf circumference measurement. Methods From August 2020 to October 2021, twenty-one female who were diagnosed as gastrocnemius hypertrophy were enrolled in this study. All the patients were treated with botulinum toxin type A at Plastic Surgery Hospital of Peking Union Medical College, CAMS. Twenty-one female were enrolled in this study. Each side of gastrocnemius muscle was injected with 100 U each case. Calf circumference of the thickest part of both legs was measured before and at 4, 12, and 24 weeks after injection and the thickness of the medial and lateral head of bilateral gastrocnemius muscles at contracted status was measured preoperatively, 12 weeks and 24 weeks postoperatively using B-ultrasound. Results The 21 patients were followed up for 6 months. The thickness of gastrocnemius muscles is (14.06±2.41) mm (the medial head) and (12.46±1.43) mm (the lateral head) at 12 weeks and the mean reduction of gastrocnemius muscles thickness were (19.44±11.46)% in the medial head and (25.71±8.57)% in the lateral head. At 24 weeks, the thickness of the muscle has a slight growth compared to 12 weeks, which is (16.46±1.78) mm (the medial head) and (15.86±1.14) mm (the lateral head). The reduction in calf circumference was (0.98±0.8)% at 4 weeks, (3.86±1.55)% at 12 weeks, and (1.63±0.94)% at 24 weeks. Conclusion Botulinum toxin type A is effective in treating hypertrophy of the gastrocnemius muscle. B-ultrasound combined with calf circumference measurement could effectively reflect the reduction of muscle thickness after domestic botulinum toxin type A injection. [ABSTRACT FROM AUTHOR]