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J Plast Reconstr Aesthet Surg. 2010 Sep;63(9):1443-6. doi: 10.1016/j.bjps.2009.07.045. Epub 2009 Aug 27.

Botulinum toxin injection pain relief using a topical anesthetic skin refrigerant.

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  • 1Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.



This study was performed to determine if pretreatment application of a topical anesthetic skin refrigerant reduced discomfort during botulinum toxin injection.


Twenty patients were assigned to four groups determined by side of the face pretreated with skin refrigerant and side receiving the first injection. On a Visual Analog Scale of 0-10 patients rated discomfort levels after injections in the glabellar complex with and without pretreatment.


Mean discomfort rating for the pretreated side was 3.1, while the mean discomfort rating for the non-pretreated side was 4.5. Discomfort was not affected by the side sprayed (p=0.33) nor by administering the injection to the sprayed side first (p=0.37). The paired t-test revealed a significant difference between discomfort levels on the pretreated and non-pretreated sides (p=0.038) yielding a 95% confidence interval of (-2.71, -0.09).


Topical anesthetic skin refrigerant significantly reduces discomfort in a cost-effective manner for reported by patients undergoing botulinum injections.

Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

[PubMed - indexed for MEDLINE]
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