Does Position Matter For Botox Injection?

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?

Doctor Answers 16

Positioning During Botox Injections

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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. 

New York Dermatologic Surgeon

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

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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 Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Proper Position for Botox Treatments

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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
4.4 out of 5 stars 7 reviews

Patient Position in Botox Injection

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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.

Timothy Jochen, MD
Palm Springs Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Position for Botox

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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 Positioning

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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
4.9 out of 5 stars 103 reviews

Does Position Matter For Botox Injection?

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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

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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.

Doris Day, MD
New York Dermatologic Surgeon

Botox injection

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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.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Positioning for Botox is not important

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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
5.0 out of 5 stars 42 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.