Why Was my Botox So Painful?

Several things could contribute to painful Botox injections.  None would indicate long term damage, but might impact your decision to try another injector next time.  If the needle strikes a cutaneous nerve this can cause a lightening like pain away from the injection site.  Hitting the underlying bone can also be quite painful and is usually associated with that 'crunching' noise.  The diluent is also an issue.   Preserved normal saline is the best to use and the least painful.(This is my preferred vehicle and most patients need no skin prep before my injections)  Nonpreserved saline is a bit more uncomfortable and usually brings comments.  What would really be painful would be the wrong diluent being grabbed off the shelf and used, such as sterile water or sodium bicarbonate.    Rest assured there is no long term injury but I would suggest you try a new injector next time.

If the Botox was reconstituted with anything other than buffered saline, yes, it does hurt. I would have asked your provider to start again, with a new unopened vial, and have them explain their reconstitution. Check out the Botox cosmetic website for Q & A...

A 30 gauge needle is small enough that it can pass between nerve receptors in many parts of the body.  If it misses the nerve receptors you will barely feel it, if at all.  If it hits a nerve receptor, OUCH.  It is a hit or miss proposition.  That is why some days you feel little pain, and other days, shooting pains from the superior orbital nerve system  seem to shoot up through the forehead with ferocity.  Ice cold Botox can also be the culprit.  The use of xylocaine with epinephrine is off-label and whether it alters the efficacy of the Botox has not been established. We plan to study this.   A well trained surgeon that knows the anatomy and its variations is your best bet for safe and effective Botox treatments.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS