University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Dr. Bartley Rust



In 2017 in the United States, over 7.2 million treatments were performed utilizing botulinum toxin type A injections. Varieties of methods are available to improve pain perception during these procedures with little information available on which is superior or preferred by patients.


A randomized controlled study was performed to evaluate if one type of topical anesthesia was superior to another to provide reduction in pain perception for those receiving botulinum toxin type A injections into the lateral canthus region. 45 patients were randomized into 1 of 3 groups. The injection area was treated with: a cold gel pack, lidocaine-prilocaine gel, or vibration. Only one side was treated with the anesthesia protocol. The non-treated side served as the control side for each subject. A Visual Analog Pain Scale was completed after each side was treated.


Statistical analysis utilizing a two-way ANOVA with a Krusal_Wallis test and a Tukey Multiple Comparison test showed statistically significant difference for treatment versus control. An Interaction Plot demonstrated that for each level of anesthesia group, the pain scale is higher for the control group versus the treatment group supporting the hypothesis that treatment with anesthesia significantly reduces pain perception during cosmetic injections.


Use of topical anesthesia can substantially lower the pain experience of patients receiving botulinum toxin type A to the lateral canthus. While individual methods were used in this study, resulting evidence suggests that combining of topical anesthesia methods during injections may allow for a minimally painful treatment that is desirable for patients.


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