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Updated: Jun 20, 2026

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
Published on: November 9, 2016
Botulinum toxin injection pain relief using a topical anesthetic skin refrigerant
Scott J Engel1, Ahmed M Afifi, James E Zins
1Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Background:
This study was performed to determine if pretreatment application of a topical anesthetic skin refrigerant reduced discomfort during botulinum toxin injection.
Methods:
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.
Results:
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).
Conclusions:
Topical anesthetic skin refrigerant significantly reduces discomfort in a cost-effective manner for reported by patients undergoing botulinum injections.
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