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Dr. Barry Eppley

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Botox Injections Using Ultra Small Needles

Botox Injections Dr Barry Eppley IndianapolisBotox injections into various areas of the face are tremendously effective at reducing specific wrinkle areas, particularly around the eyes and forehead. While effective they are not necessarily pain-free. Despite using a very small 30 gauge size needle, some discomfort still exists with Botox injections. This has led to a variety of pain management strategies from ice to topical anesthetics to help make the injections as comfortable as possible.

In the September 2015 issue of the JAMA Dermatology journal, an article appeared entitled ‘Pain Perception with Botulinum Toxin Type A Injections’. In this study the authors compared differences in the perception of pain with Botox injections using 30 vs 32 gauge needles. Twenty (20) patients were studied using a blinded randomized clinical trial approach for their glabellar and forehead wrinkles with one side of the forehead injected with a 30-gauge needle and the other side with a 32 gauge needle. Similar injections were also done in the arms. For facial injections, more pain was seen with the  30-gauge needles which were associated with more pain in 8 patients (40%) compared with the 32-gauge needles, which were associated with more pain in 3 patients (15%) Mean injection pain scores for the face were somewhat lower with the 32-gauge needle (3.4/10) than with the 30-gauge needle (4.15/10). The mean pain scores were lower for the arm injections (1.2 with the 32-gauge needle and 1.66 with the 30-gauge needle).

The study found that significant pain was almost 4X times more likely with facial injections with 30-gauge needles than with 32-gauge needles. This was different in the arms where there was very little if any differences in pain associated with the two needle sizes.

small needles for injectionWhile this study is far from conclusive, it is logical to assume that the smaller the injection needle the less pain that may likely result from its use. While no injection can be absolutely pain free, use of 32-gauge needles may be as close as one can get. Because they are more expensive, however, many practices are likely to not routinuely use them and save them for the most pain-sensitive injection patients.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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