The short answer is no, not really, for most patients. Anti-wrinkle injections involve a series of small pinches with a fine needle. Most patients describe the sensation as a brief sting or pressure rather than pain, and the procedure is over in under two minutes from the first injection to the last. Numbing cream is rarely needed and usually not requested.
The longer answer depends on the area being treated, the patient's individual sensitivity, and what is meant by "hurt".
I am Shontelle, the registered nurse at Silk Clinical Aesthetics. Here is what to expect.
What the Needle Feels Like
The needles used for anti-wrinkle injections are very fine, typically 30 or 32 gauge. For comparison, the needles used for blood tests are 21 to 23 gauge, several times thicker. The puncture itself is brief and shallow.
Most patients describe each injection as one of three things:
- A small pinch, similar to plucking a hair.
- A brief sting that lasts less than a second.
- A pressure sensation as the product is delivered.
The product itself is delivered slowly into the muscle. Some patients feel a brief warm or tight sensation as the small volume of product is placed, more so in some areas than others. This sensation passes within seconds.
Area by Area
Sensitivity varies between facial areas. Most patients are mildly surprised at how comfortable the experience is.
Frown lines (glabella): Generally the most comfortable area. Three to five small injections in muscle that does not have particularly sensitive skin overlying it. Most patients rate this area as a 1 or 2 out of 10 in discomfort.
Forehead: Comfortable for most. Slightly more sensation than the glabella because the forehead skin is thinner and more vascular, but still well tolerated.
Crow's feet (around the eyes): Slightly more sensitive than the forehead because the skin is thinner. Most patients still describe it as easily manageable. The proximity to the eye area can make patients more aware of the procedure even when the actual sensation is mild.
Bunny lines (nose): Briefly sharp because the skin is tightly bound to the underlying tissue and the area is more vascular. Two to four small injections.
Lip flip and lip lines: More sensitive than other areas because the lips and surrounding skin are densely innervated. Most patients describe the lip flip as a few brief stings rather than ongoing pain.
Masseter (jawline): Different sensation because the muscle is large and deeper than upper face muscles. Most patients describe a pressure or ache rather than a sting. The injection itself is brief but the muscle reaction can leave a mild dull sensation for an hour or two afterwards.
Neck (platysma): Tolerable for most. The neck has more sensitive areas and the procedure involves more injection points, so it is a longer experience than upper face areas, but each individual injection is manageable.
Underarms (hyperhidrosis): Some patients find this area more uncomfortable because of the number of injection points required. We sometimes apply ice or topical numbing for hyperhidrosis treatment, particularly in patients who are sensitive to the area.
What Helps
A few practical points that reduce discomfort.
Eat before your appointment. Patients who arrive hungry are more likely to feel lightheaded or anxious, which makes the experience seem more uncomfortable than it is. A normal meal in the hour or two before treatment is fine.
Avoid alcohol and blood thinners for 24 hours before. This reduces bruising rather than pain, but bruising is what most patients are concerned about.
Tell the practitioner if you have low pain tolerance. We can apply ice to numb the area before each injection, slow the injection rate, and pace the procedure to suit you.
Ask for ice or topical numbing if you want it. Most patients do not need it, but it is available, and there is no clinical reason not to use it if you would prefer.
Breathe. Patients who hold their breath during injections tend to find the experience more uncomfortable. A normal, slow breathing pattern through the procedure makes a real difference.
What it Feels Like Afterwards
The injection sites usually have small red marks for 30 minutes to an hour after treatment, occasionally longer. These usually fade quickly and are easily covered with light makeup if needed. Mild tenderness at the injection sites for a few hours is normal.
A small percentage of patients develop small bruises at the injection sites, particularly in the crow's feet area where the skin is thin and vascular. Bruising is more common in patients on blood-thinning medications or supplements (aspirin, fish oil, vitamin E) and after alcohol consumption in the previous 24 hours. Bruises typically resolve within a week.
Mild headache for the first 24 hours is reported by some patients, particularly with forehead treatment. This usually resolves with paracetamol if needed.
The treatment itself does not cause ongoing pain. If you experience escalating pain or significant discomfort hours after the procedure, that is not a normal recovery and warrants a call to the clinic.
What "Hurt" Actually Means
Some of what patients describe as pain is actually the anticipation of pain. The first appointment is often where patients are most anxious. By the second or third treatment, patients usually report that the procedure is much more comfortable than they expected.
This is not patients building tolerance. It is the experience matching the expectation more accurately. The anticipation tends to be worse than the actual sensation.
When to Use Numbing
Topical numbing creams (such as those containing lidocaine) are available at most clinics including ours. They take 20 to 30 minutes to take effect and are most useful for:
- Lip filler and lip flip in patients particularly sensitive to that area.
- Larger treatment areas like the underarms for hyperhidrosis.
- Patients with significant anxiety about needles.
- Children or younger patients receiving clinically-indicated treatment.
For most upper face anti-wrinkle treatment, topical numbing is not necessary and adds time to the appointment without significant benefit.
Ice is faster and free. A clean ice pack applied to the area for 30 seconds before each injection numbs the surface enough to take the edge off. We use ice in patients who are particularly sensitive to specific areas.
Comparing Anti-Wrinkle to Filler
Patients often ask how anti-wrinkle injections compare to filler in terms of discomfort.
Filler treatments tend to be more uncomfortable because the volume of product is larger, the gel is denser, and the placement is in or under the skin where there are more nerve endings. Lip filler in particular is more sensitive than upper face anti-wrinkle injections.
Most filler products contain local anaesthetic mixed in, which reduces the discomfort once the first small amount has been delivered. We also use topical numbing for filler appointments and sometimes dental-style nerve blocks for lip work.
If you are comfortable with anti-wrinkle injections, you will likely be comfortable with filler treatments. The first lip filler appointment is the one most patients describe as more sensitive than they expected; subsequent appointments are usually easier.
For broader detail on what the procedure feels like, see What to Expect at Your First Cosmetic Appointment at Silk Clinical.
Frequently Asked Questions
Will I cry during the procedure?
Possibly, in the eye area. Treatment near the crow's feet sometimes triggers a tear reflex even when the sensation is mild. This is a normal response and not a sign of significant pain.
Can I take a painkiller before my appointment?
Paracetamol is fine. Avoid ibuprofen, aspirin, and other blood-thinning medications for 24 to 48 hours before treatment if you can, because they increase the risk of bruising. If you are on prescribed blood thinners, do not stop without consulting your prescriber.
What if I have needle phobia?
Tell us in advance. We can apply numbing cream, use ice, position you so you cannot see the needle, and slow the procedure to suit you. We have treated many patients with needle anxiety and the standard accommodations work well for most. In severe cases, we will sometimes recommend addressing the anxiety separately before pursuing treatment.
Does Botox hurt more than Dysport?
The two products feel essentially identical during injection. The needle and technique are the same. The product itself does not cause distinct sensation differences in most patients.
Why do my injection sites feel slightly tight afterwards?
The product needs to spread through the muscle and integrate. A mild tightness or fullness at the injection sites for a few hours after treatment is normal and resolves on its own.
How long until I am back to normal after the appointment?
Immediately, in most cases. You can drive, return to work, and resume normal activities. Avoid intense exercise, saunas, lying flat, and rubbing the treated areas for the first four hours after treatment, but otherwise the recovery is straightforward.
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