Why Was my Botox So Painful?

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

I have been injecting Botox for cosmetic reasons for over twenty-two years. Since its ground-breaking entrance onto the nonsurgical aesthetic stage at that time, much has been learned about storing,  mixing and injecting Botox (as well as the other more recent neuromodulators, Dysport and Xeomin). We now know that rigidly refrigerating these materials immediately before injection is not necessary for keeping them stable and effective, nor is it necessary to reconstitute them with preservative-free saline solution. Injecting with conventional sized needles, refrigerated solutions, and those containing preservative-free saline simply hurt more. Naturally hitting bone, striking sensitive nerves and nicking underlying blood vessels with hematoma formation from poor technique or lack of a good appreciation of the anatomy of the regions being injected are other potential causes of pain or discomfort.

To reduce the discomfort of the injections we can use especially small, narrow-gauge needles, we can allow the reconstituted material to come to room temperature, and we can reconstitute it with preservative-containing saline mixed with a small amount of local anesthetic and epinephriine (the latter being included to diminish the likelihood of bruising).

Of course, it goes without saying, that treatment should only be obtained from a board certified aesthetic physician experienced in the proper preparation and injection techniques for these materials. 

Botox can be mixed with sterile water or bacteriostatic saline.  Both methods are acceptable and are equally effective but sterile water stings when injected.  Ask for bacteriostatic saline next time.

A few different factors can cause the discomfort you are experiencing this time around; a large gauge needle hitting a nerve receptor and/or poorly or wrongly mixed Botox can both cause more discomfort than normal.  We have noticed at my practice that applying a small ice pack to the area before treatment gives our patients a bit of more comfort that way if for some reason a nerve receptor was hit, it would be numb, therefore lowering the discomfort level. “Dr. D”