Positioning During Botox Injections
Though some physicians may prefer to use the Trendelenberg position during injection, most do not. This is because the facial skin and muscles lie differently in this position, and therefore injecting based on the way the face looks in this position can leave results that weren't tailored to the way the face normally looks. I prefer to have patients slightly reclined with their legs up and lots of adequate lighting. The exact angle of the lighting can help me not only make out facial shadows and structures, but sometimes to see vasculature. The fact of the matter is, there are hundreds of vessels big and small in the face, and avoiding them is not always possible. Nicking a vessel and causing a bruise happens despite any and all precautions and anatomical knowledge because everyones anatomy is different.
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.
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.
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 considering Botox or other cosmetic treatment.
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!!
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.
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.
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 be applied post-procedure as needed to avoid or minimize bruising.
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 eyelid lifting muscle. Injecting it with the patient in Trendelenburg is complete nonsense. Why not do it then with the patient standing on their head?
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
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!