Botox EXTREMELY Painful Injection?

I've had botox a few times. No problems. Minimal pain... if any. I just got back from my appt. The injections were excruciating. To the point that I cried. And I have a high tolerance. The dr eventually injected himself in the forearm. He found it extremely painful. Yet he told me there's nothing to worry about. Have you heard of this? Do I need to be worried? The dr gave me his cell. He sounded confident it would be fine. But at the same time, it had never happened to him before.

Doctor Answers 21

Painful Botox

This is very unusual to have painful injections. This pain can be caused by what the particles are mixed with in the office. Sterile water and non peservative saline can be uncomfortable. These  will not cause a problem with your health or treatment.

However, if the Botox was accidentally mixed with hypertonic saline this can cause an ulceration. It will sting a lot going into the skin. This could happen if the office also does sclerotherapy for spider veins and uses this for the treatment.

For these reasons I am a bit old fashioned. I mix all of my own Botox and draw it up myself. Also my supplies for Botox are no where near the hypertonic saline. I actually have a Botox station near my patient rooms so I am the only one that touches it.

Also, some injectors are a bit heavy handed and possibly go to close to the bone causing pain on injection.

Was this the first time you used this injector?

I hope you are doing well with your treatment.

Houston Dermatologic Surgeon
5.0 out of 5 stars 29 reviews

Painful Injections with Botox

This is very uncommon as Botox is typically injected with a extremely small gauge needle and rarely results in any significant discomfort.  As others have stated, it may be possible that the Botox was reconstituted with an incorrect solution.  


Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews


A agree with the others. The pain of Botox injections should be minimal, especially if pre-treated with a topical anesthetic. Most likely the Botox was reconstituted with bacteriostatic water rather than saline. Preserved saline has benzyl alcohol, besides being a preservative, has a mild numbing effect. The difference between preserved saline and bacteriostatic water can be substantial. While the package insert states that we should be using non-predserved saline, very few offices use this. In fact, I have a patient who is allergic to benzyl alcohol and it is very difficult for me to even find unpreserved saline. 

There is a possibility that hypertonic saline was used. While Dr. Herzog is correct that this can cause an ulcer at full strength, diluted hypertonic saline also might have been inadvertently used and would not cause an ulcer. Hypertonic saline is used to induce abortions and  though it is true that some Ob-Gyns have infiltrated into our speciality, it is very unlikely that this would be sitting on their shelves for that purpose. More likely, hypertonic saline might be available for its use in sclerotherapy. 



Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

Botox injections should not be painful

Botox injections might be a little uncomfortable but should not be PAINFUL. I agree with the others and think that the problem was with what the Botox was reconstituted with.  Bacteriostatic saline makes the injection the most comfortable. The worst scenario would be if someone used hypertonic saline by mistake. If this was the case you would already know as this could cause ulceration. It is most likely  that they used sterile water and that does hurt more. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

It sounds odd and the thought of injecting himself sounds even odder!

While I am sure this is a great way to check it out, the thought of injecting himself seems over the top!  Botox pain can be due to the way it is reconstituted (how the powder that Botox comes as is made into a liquid).  It is possible that his office staff changed their fluid and there is a possibility that the wrong fluid was used this time.  Generally, this won't cause major issues, but it is somewhat concerning if major pain is noted.

I have also noted that women who are premenstrual tend to have more pain, so that may be a reason.  Good luck with it!

Joel Schlessinger, MD
Omaha Dermatologic Surgeon
4.8 out of 5 stars 40 reviews

Painful Botox injection

Botox injections should not be painful, and should cause only minimal discomfort. I don't think the pain you experienced was due to poor technique; rather, it was probably related to the solution that was used to reconstitute the Botox.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews


botox is very NOT painful.  If it is painful, it can be due to a small nerve that is there

Bivik Shah, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 26 reviews

Pain post botox

Yes this is unusual but can happen.the pain should subside and putting ice on the area will help eleiminate the pain but you should do well.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

Painful Botox

Hi.  I agree that you should only have minimal discomfort with Botox injections.  If the pain is persistent I would recommend seeking evaluation and staying in close communication with your physician. 

Richard W. Maack, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Botox Injections Painful

It is very unusual for Botox injections to cause great discomfort. Just keep in contact with your physician should you notice any issues. 

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 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.