Injection Sensation
The unexpected can be daunting and it is normal to feel nervous when having injectable treatments for the first time. It’s your face.
Patients who are new to the experience have two main concerns:
How the procedure feels / how painful it is.
Will they look different in an obvious way. (That’s a different blog but the short answer is no. Not on my watch.)
Below explains the sensation of having Botox and fillers/other injcatbles, immediate considerations and how to optimise comfort and calm.
Does it hurt?
Not really. A pinch here or pressure sensation there, but with the right care and control, there’s no cause for concern.
It is important to establish a individual’s pain threshold and if somebody has anxiety around needles. There are different ways to approach the procedure and to ensure that comfort levels are optimised.
Some people want to hear all about what’s happening, exactly when and where you are going to inject. Others want to stay focused on their happy place, eyes closed no talking. Other people find humming helps.
The protocol for a comfortable experience is:
Establishing a patient’s individual mental and physical pain parameters
Pre counselling of what to expect (unless somebody explicitly states that they don’t want to know)
Topical anaesthetic and local anaesthetic blocks where appropriate
Knowledge of anatomy and experience of injecting –facial nerves and tissue planes
Frequent needle changes to avoid a blunted needle (which hurts a lot more.)
A light and controlled touch - injecting slowly
Breathing methods
Distractions- music, a stress ball, cold packs
Tapping or pinching the skin, whereby the sensation reaches the brain before the pain. Otherwise known as The Gate Theory.
Breath work is also helpful, exhaling slowly as you are injected, helps ease the situation.
Recognition of treatment fatigue – not over doing the injecting in any one session unless expressly requested (i.e. flying visit or limited on downtime potential).
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, which works to prevent bruising also.
Filler Injections:
Fillers are more “invasive”, certainly to watch, although not necessarily 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 methods cited above, there are some other techniques, which help maintain comfort during the procedure.
Local anaesthetic
Applying topical numbing cream to the skin when injecting fillers. This takes the edge off the needle prick. Fillers contain a local anaesthetic themselves (lidocaine), so once you start injecting, there’s a flush of LA to numb the area too.
If injecting large areas, such as foreheads or hands, a local anaesthetic block is advisable to maintain optimum comfort for what is a more invasive procedure.
Injecting slowly
Expansion of the tissue (and we’re talking gentle/subtle) can be uncomfortable. I would describe it as a similar mild burning sensation. The slower the filler is injected the more comfortable it is.
Treating with a cannula
A cannula is a blunt needle that is introduced into the skin by way of one sharp entry point. Filler can be injected with both a needle and / or a cannula. A needle is best for crisp definition (such as lip borders) or injecting deep, on to bone. A cannula is indicated for sculpting, for hairlines and for safety zones (such as noses). Also, it may be employed to lessen the risk of bruising.
So again, the skin is numbed, a needle with a slightly bigger diameter than the cannula is introduced briefly just under 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 soft tissue to appreciate what plane 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 know that the unusual sensations are normal.
For skin quality, Profhilo, Polynucleotides and Skin boosters may be injected with a needle or cannula also. If injected in deposits, there will be palpable “bumps”, which then diffuse over the course of 1 – 3 days.
