Even if the masseter muscle is reached, the lack of deep enough injection can cause the lower parts of the muscle to move normally while the upper part is relaxed, creating a “squirrel” appearance. Doctors should try to inject at the site where the muscle attaches to the bone, using a ½ longer needle for best results. A 32-gauge half-inch needle (Air-Tite products) minimizes injection discomfort. In the periorbital areas, it is injected obliquely into the skin to reduce the possibility of deep injections or even injuries in case the patient moves suddenly.
Pinching up or gently rubbing the adjacent skin during injection minimizes patient discomfort by distracting the patient during injection and “confusing the sensory sensation of the injection” (Figure 95,. We recommend pre-marking the areas to be injected and use bright lighting and magnification to avoid injury to the vessels of the eyelid. We rarely use topical anesthetics, and some suggest a reduced duration of effect in patients treated with topical anesthetic prior to injection. 1 We inject into the planes of the subcutaneous tissue to avoid the underlying muscular and neurovascular structures.
This reduces patient discomfort and decreases the risks of bruising and deep spread. In general, injections can be given obliquely or perpendicular to the skin, but in the orbicular areas it is essential to inject at as flat an angle as possible due to the thinness of the eyelid skin and pointing away from the eye. It is also useful when injected into the lower orbicular areas to stretch the skin, which helps place the Botox in the subcutaneous plane. Botox should be avoided in the upper central eyelid to prevent ptosis and over the lower oblique in the lower eyelid to prevent diplopia.
A 30-32 gauge is an appropriate Botox needle size, and they vary little in terms of pain or application. Injections are almost always going to be at least a little painful for your patients, even when you use small needles. And although I am personally still sad as to whether to go under the needle, at least I can effectively argue with my husband that Botox is safe for his body. Any injection can be painful, but the discomfort is usually less due to the small Botox injections that Botox injections use.
BOTOX injections usually do not require the use of an anesthetic (it comes in the form of a cream, which is applied to the area of the skin to be injected), as the needles are very small and the injections are given very quickly. Ask about the cost of therapy, how many doses of Botox you will need, what size of Botox needle you will need, and how often you have been injecting Botox. These ultra-thin needles ensure expert accuracy and ensure that pain and bruising are minimized in the injection process. Physicians and other qualified professionals administer Botox using any 30 gauge and 32 gauge Botox needle.
Researchers have found that there is not much difference in the results of the pain scale for patients with injections with 30 and 32 gauge needles. But being the science fanatic that I am, I thought a little selfish journalism could do my husband and me good and maybe end the discussion of whether to go under the needle or not. They will use this knowledge to judge the location of the muscle where the Botox injection will go and the depth to which the needle should be inserted. For example, the smallest recommended gauge for Botox injections is 32, which has a needle wall thickness of 0.064 mm, while 30 gauge has a thickness of 0.076.The IAPAM recommends using a short single-use needle, such as a 31, 32 gauge insulin needle when possible.
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