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Does Position Matter For Botox Injection?

asked 11 months ago by anon
Latest answer by Ronald Shelton, MD
Question viewed 1,605 times
Tags: between eyebrows, cheeks, eyebrows, eyes, face, forehead, lips, smile, bottom lip, injection, skin

I've seen it advertised to have patients lie in the Trendelenburg position while administering Botox. Supposedly the blood flowing to the face which makes veins more prominent, in turn makes it easier for the surgeon to avoid them.

Do you think this position really makes any difference?

15 answers to Does Position Matter For Botox Injection?

Proper Position for Botox Treatments

It's far more important for both patient and injector to be in a comfortable position. Also, a sitting position allows for the patient to naturally animate for the injector to assess muscle function, anatomy, and how to design a natural treatment plan.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon

www.celibre.com

Position for Botox

We were always taught to have patients sitting up. Even if you hit a vein, this should not be a big issue. All I can say, is go to a professional!!

Tracy Kuykendall, MD
Tulsa Dermatologist

Botox treatment position is Physician Preference

Bruising is not a major issue with botox injections. It is more important to have accurate placement of the drug and this is more difficult when someone is placed in the trendelenberg position. In people who are taking aspirin or who bruise easily, it helps to apply a cold compress to temporarily constrict vessels in the area prior to injections. Most physicians inject with patients sitting upright so we can best assess natural facial anatomy and expression. Cool packs and pressure can also... more

Doris Day, MD
New York Dermatologic Surgeon

Patient position during the administration of Botox

The positioning of the patient is upto the physician's discretion. I haven't heard of any advantages in treating patients in this position and don't see any great rationale for doing so. In fact, it used to be of general practice to instruct patient to not assume a reclining position for several hours after having Botox injections. In addtition, I would imagine it would be uncomfortable for both the physican and patien to do sot. I... more

Ted Brezel, MD
Long Island Dermatologist

Botox injected in the sitting vs. lying flat or trendelenberg position

I have not seen that bruising from botox occurs often and I would rather not use the reclined Trendelenberg position to avoid veins. I use good lighting and magnification if necessary while my patient is in the sitting position.

Ronald Shelton, MD
Manhattan Dermatologist

Patient Position in Botox Injection

I can see how this might make sense, but it just seems a little ridiculous. In my practice we have people sitting up, but slightly reclined to make it comfortable for them. There is always the risk of hitting a blood vessel and bruising, but rarely do we see bruising in the glabellar area. Occasionally, there will be bruising around the eyes, because the number of blood vessels are more numerous and superficial there. Physician experience is the most important thing to look for when... more

Timothy Jochen, MD
Palm Springs Dermatologic Surgeon

Botox Positioning

My impression is similar to that of previous posts. Injection of Botox requires knowledge of facial muscular anatomy. Putting patients in the Trendelenburg position is absolutely unnecessary and probably the best way to shrink a Botox practice.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

Does Position Matter For Botox Injection?

It does not matter if you achieve the results desired. The Trendelenburg position is just a head done position to cause the venous system to engorge, it may help in avoiding these veins but no guarantee.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Botox injection

The only position that matters in botox injection is the position of the needle. You want the needle inside or just under the muscle before you inject because the botox acts on nerve signal input into the muscle and the nerves enter the facial muscles of expression from their undersurface for the most part. We usually tell the patient not to lie down for a few hours after the injection to decrease the risk of migration of the injected botox to areas where we do not want it like the upper... more

Aaron Stone, MD
Los Angeles Plastic Surgeon

Positioning for Botox is not important

It is very strange to hear it being advertised that patients should lay in the Trendelenberg position (head down) for Botox injections. I have never heard of this, nor do I know of any studies to suggest this makes a difference. Unfortunately, there is no marketing police to check the validity of things said in advertisements. You were wise to question it and ask your question on RealSelf!

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon

facialplasticsurgerymd.com

Botox position

Not at all. Your doctor should be familiar with the muscle anatomy and be feeling the muscles when he injects to get the best results. Most patients receive this treatment sitting or mildly reclining.

Michael L. Schwartz, MD
West Palm Beach Plastic Surgeon

My botox patients sit up

I think that this is a gimmick. I treat my patients sitting up and tell them not to lie down for 4 hours. My husband treats headaches and was taught to treat lying flat. Most large vessels can be seen without standing patient on their head

Jo Herzog, MD
Birmingham Dermatologist

www.brookwooddermatology.com

This is psychotic IMHO.

No you don't need to be upside down when you are treated with BOTOX. Doctors are always looking for new angles to differentiate themselves from the competition. This will be a very uncomfortable way to be treated with absolutely no advantages. Please try not to be taken in by nonsense.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Does position matters

Yes, position matters but not so much for this. I would not put my patients into Trendelenberg (meaning the feet are higher than the head) to make the veins more prominent unless the person has a history of repeated bruising. Patients tend to be more comfortable in a seated position and I like to inject them while they are comfortable. I dont have a lot of bruising with injections of Botox or Dysport and this is mostly because we use small needles and are careful with placement. more

Kenneth Beer, MD
Palm Beach Dermatologic Surgeon

www.palmbeachcosmetic.com

Botox positioning

The position preferred for treatment may vary by surgeon preference. I treat all my Botox patients sitting upright and have done this successfully for the last decade.