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Extremely Painful Botox Injections

I had my first ever botox injections yesterday and the injections were extremely painful! Is this normal? I read in different fora that they are not supposed to be very painful. The pain I had while getting the injections was penetrating and sometimes even extended to the head. Is it possible that the young doctor who did it was not experienced enough or injected the botox too fast? Please enlighten me. Thank you.

Doctor Answers 13

This should not happen

Botox injections should not be painful.  Depending on the area and technique, the feelings should range from imperceptible to mild discomfort.  It should never be very painful.  If you experienced severe pain with multiple injections, my first suspicion is that the injector mixed sterile water with the Botox instead of saline with the Botox.  This does indeed cause significant pain with injection.  Other than that, unless they used a large gauge needle (I use 31 gauge), there really isn't any reason for it to be that painful in multiple areas.  There are several other techniques to minimize the discomfort including numbing the area with a spray or ice, gating techniques, superficial injections, etc.  I would strongly recommend seeing a different injector for hopefully a different experience.


San Diego Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Botox should not be very painful

Several factors may have caused your pain.  Since it was your first time, you may have been anxious.  Women are more sensitive to pain during their menstrual cycle.  Methods your doctor can use to relieve discomfort include:

using preserved saline for reconstitution of Botox

using a very small, sharp needle

slow, more superficial rather than deep injections

pre-treating the areas with ice

applying an anesthetic cream a few minutes before the treatment

Hopefully your next treatment session will be more comfortable.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 20 reviews

Prevent painful Botox injection

If you consider having another Botox treatment, you may ask your doctor to rub an ice cube on the injection site for a few seconds to briefly numb it up.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 28 reviews

Botox and "Beauty" Pain

Overall Botox injections are not very painful.  A very small needle is used and most patient tolerate the procedure extremely well.  There is a very small percentage of patients that do not  tolerate any pain well.  For these patients pretreatment with a topical anesthetic might be necessary.  It is very uncommon, but a few people require it even for the most minor procedures.

Lisa Kates, MD
Annapolis Dermatologist
5.0 out of 5 stars 1 review

Should Botox Hurt?

Hello 19103.  Generally speaking our patients do not have trouble with pain from Botox injections.  As has been suggested by another practitioner, it may have something to do with the gauge (size) of the needle, normally very small needles are used for Botox.  We also periodically have a patient that uses a cold pack for a few seconds at the injection sites and this helps numb the area temporarily before the injection.

A steady and gentle hand can also help minimize any discomfort.  Hope this helps and good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox and pain

Everyone repsonds differently to botox injections. Most patients tolerate it very well without topical anesthetic.  Still some require topical and still feel uncomfortable. But I would say in the majority they do not complain that it was painful.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 19 reviews

Botox injections should cause minimal discomfort

Botox injections should not be painful. Pain during the injections may be due to cold temperature, improper technique (injecting too deep or a rapid injection), or a large needle. I use a 31 gauge needle, and my patients never experience any discomfort with Botox injections. Delivering a pain-free treatment is part of the 'art' of Botox injections.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Botox not very painful if done gently

Several factors will lead to a fairly comfortable experience. First the needle should be very small. Injections should be slow and NOT deep onto the bone.

In addition - botox is refrigerated, and the syringe should be brought closer to body temperature immediately prior to its use.

Having said that, pain tolerance is very subjective and there is some degree of uncertainty.

Christopher J. Peers, MD
South Bend Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Painful injections of botox

Botox injections can be painful due to several reasons: large needles (the ones to use are 30G needles), too deep of injections (Botox injections should be injected in the upper part of the muscles not against the bone), too rapid of an injections (slow injections of a small volumes are less painful than large volumes of Botox), and finally if the needle did hit a small nerve the pain can radiate to the top of the head. Your doctor should know the path of such nerves to avoid hitting them. In the future you can use ice prior to the injection to minimize the pain. 

Henri P. Gaboriau, MD FACS

Henri P. Gaboriau, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox injections typically are not very painful

slow injections, small needles and not too deep an injection should make botox injections not very painful.  If the bone were touched by the needle deeply, or the injection very quick or the needle larger than necessary then the injections might be more painful. botox should be diluted prior to use and if the diluent used was not the water that should be but some other solution, then maybe it hurt more for that reason.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.