Searing heat and pain during routine botox injection. What happened?

During a routine botox administration (forehead, bunny nose area, eye area) I experienced extreme searing sensations when the product was introduced. I have had botox several times in the past - in the same areas with no sort of pain, searing heat, post injection lumps/swelling... I had to ask my doctor to stop at each area of treatment. Plus, as a Type 1 diabetic, I thought perhaps my blood sugar was extremely high or ?

Doctor Answers 11

Pain during Botox treatment

Thank you for your question Mikkisrs1. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. In my experience patient do not experience significant pain with Botox treatments. However, I use a painless technique. I agree with my colleagues that what is used to reconstitute the Botox can affect a patient's comfort. In our office we use preserved saline to maximize our patients' comfort. Please follow up with your doctor for specific recommendations. Good luck!


Encino Physician
5.0 out of 5 stars 1 review

Uncomfortable Botox injection

I suspect the burning sensation may have been related to  how the Botox was reconstituted. If non-preserved saline was used to reconstitute the Botox rather than preserved saline, this would explain your symptoms. I would also make sure that you are going to a reputable injector who is using authentic Botox. 

Painful Botox

Most likely and highly probable, this is  due to the mixing of the Botox with unpreserved Saline. We did a test in our office one day to try and feel the difference. It is incredible the difference in the burning and the pain when reconstituted with preserved vs unpreserved saline!  I couldn't believe it myself ! It wont change the outcome of the product injected, however, it will highly change the experience.

Cynthia Stolovitz, MD
Montreal Physician
5.0 out of 5 stars 1 review

Botox pain

Causes of botox pain include 1. blunt needle, 2. incorrectly reconstituted, 3. injecting a sensory nerve, 4. incorrect product, 5. inappropriate prep

Ask you doctor which of these they think is the problem and try to correct

Burning sensation with Botox injections

Given your prior experience, I would suspect that the Botox may not have been buffered or mixed properly. Check with your treating doctor.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Pain with botox injection

Pain can vary from patient to patient. Sometimes topical can be helpful. I may also be related to using preservative free sodium chloride to mix the botox.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Pain with Botox injection

The pain is most likely related to nonpreserved saline used for the reconstitution of the Botox. This is more painful than using saline with preservative. If this was not the case, a change in the needles is possible or it might not be genuine Botox. Ask your injector. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Searing heat and pain during routine Botox injection. What happened?

Thank you for sharing your question and I am sorry to hear of your poor Botox experience.  Pain with botox administration is most likely related to the fluid used to reconstitute Botox.  I would inform your injector of your symptoms so that they can investigate their Botox lot number and what solution was used.  The silver lining in this is that your Botox results will not be affected.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Pain during botox injection

Pain of this sort during Botox injection is rare. It is impossible to tell what happened without being there. Was your injector the same one as in the past? Perhaps the Botox was reconstituted in normal saline rather than bacteriostatic saline which has anesthetic properties due to the benzyl alcohol component. I would ask your injector if they have changed techniques or products.

Matthew Brace, MD
Ontario Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Pain with Botox

If the pain was sudden and localized it may be that a nerve was hit since this is a blind procedure. If water was used to mix the Botox then the pain would be constant and everywhere the injection occurred.  It makes no difference if preserved or nonpreserved saline was used

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 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.