Is this going to hurt? Is Botox and filler painful?

What does it feel like to have Botox and fillers and how to optimise comfort?

The unexpected can be daunting and it is normal to feel nervous when having Botox and fillers for the first time.

Patients who are new to the experience have two main concerns:

  • How the procedure feels and how painful it is.
  • Looking weird / different in an obvious way.

In this article I’m going to look at how it feels to have Botox and fillers, and how to optimise comfort and calm.

So, does having Botox and Fillers hurt?

Well, a wee bit, yes. A pinch here or pressure sensation there, but with the right care and control, it is entirely tolerable. If fact “that was far better than I was expecting” is a regular reaction of first time injectees.

Everybody is different and it is important to establish if somebody is needle phobic, be it mild or major, and what their pain threshold is. You can then maintain optimum levels of comfort, literally and physiologically.

Some people want to hear all about the procedure, exactly when and where you are going to inject. Others want to stay in their happy place, eyes closed (their’s not mine!) no talking, with a squeezy ball, rhythmically squished to my playlist.

My countdown for comfortable injecting is:

  • Establishing a patient’s mental and physical pain parameters (we’re all different)
  • Pre counselling of what to expect (unless somebody explicitly states that they don’t want to know and just want you to do your thing)
  • A light and controlled touch
  • Knowledge of anatomy and experience of injecting – e.g. facial nerves and appropriate depths of tissue (what are the features of each layer)
  • Frequent needle change to so that you are not using a blunted needle (which hurts a lot more.)
  • Injecting slowly
  • Topical anaesthetic and local anaesthetic blocks where appropriate
  • Breathing methods
  • Comfort aids: Squeezy ball, cold packs
  • Music
  • The Gate Theory (appropriate pinching and tapping so that the brain receives that signal over a pain signal)
  • Recognition of treatment fatigue – not over doing the injecting in any one session unless expressly requested (i.e. flying visit or limited with any potential downtime).

What is the difference between having Botox injections and having filler injections?

Botox injections:

Botox comes in a vial and is in powder form.

To make it injectable, i.e. into liquid form, your injector mixes it with Bacteriostatic saline. Bacteriostatic saline is not painful to have injected (whereas normal saline would sting).

This means that the only element of pain with Botox, is the injections themselves. We have nerve endings all over, so occasionally you may feel the odd pinch.

Using the finest needle you can get (FMS Insulin needles in my experience) and frequent needle change is vital. It hurts when the needle blunts, usually over a maximum of three injections.

The use of cold packs is helpful, especially around the eyes, as is distracting the brain with other signals by tapping or pinching the skin, in an appropriate manner! Otherwise known as The Gate Theory.

Another wonderful distractor is music and having an engaging playlist is an essential part of my practice.

Encouraging your patient to concentrate on breathing deeply, often breathing out in one big breath, as you inject is also a winner.

Filler Injections

Fillers are a tad more “invasive”, certainly to watch, although funnily enough not to experience.  Although the needles tend to be a bit bigger the injections are predominantly deeper, bypassing our nerve endings, as these are on the surface of the skin (so we know if we’re burning our hand, for example.)

There are two elements with filler injections.

  • The sensation of the needle or cannula
  • The sensation of tissue expansion on injection of the filler.

In addition to the distraction methods as with Botox, there are some other techniques, which help maintain comfort during the procedure.

Local anaesthetic (LA)

I apply strong, topical numbing cream to the skin when injecting fillers. This takes the edge off the needle prick. Fillers also contain a local anaesthetic (lidocaine), so once you start injecting, there’s a flush of LA to numb the area too.

If I’m injecting large areas, such as foreheads or hands, I will give a local anaesthetic block to maintain optimum comfort for what is a more invasive procedure.

Injecting slowly

Expansion of the tissue (and we’re talking gentle/subtle not puffer fish style) can be uncomfortable. I would describe it as a similar sensation to a “Chinese Burn”, the delightful prank children play whereby “placing both hands on a person’s arm and then twisting it to produce a burning sensation.” The slower the filler is injected the more comfortable it is.

Treating with a cannula

Filler can be injected with both a needle and / or a cannula.

A cannula is a blunt needle (that totally flummoxed me the first time I heard it) that is introduced into the skin by way of one sharp entry point.

So again, the skin is numbed, a needle with a slightly bigger diameter than the cannula is introduced into, and then removed from, the skin to form a point of entry. The cannula is then gently introduced where the injector can perceive feedback from the different layers of the skin to understand what layer they are in.

Depending on what you are trying to achieve, dictates which layer of soft tissue you are targeting. For example, tear trough filler must be placed under the muscle, mid cheek filler in a female may be in a superficial fat compartment.

It’s important to move the cannula in a controlled and considered way. The sensation here is more of a pressure, with the occasional popping sensation. Not painful, just unusual if you haven’t experienced it before. Again, pre-counsel is essential, so you know what to expect and that the unusual sensations are normal.

Believe it or not, there are a good amount of patients who finish treatment and say, “I actually enjoyed that. Is that weird?”