What can cause pain during an aesthetic injection ?
Potential pain during an injection depends on several combined factors, which the doctor must assess and control :
- The nature of the product injected : some products are more viscous or require greater injection pressure, which can cause temporary discomfort. This is particularly true of highly cross-linked hyaluronic acids or tissue stimulators injected deeply.
- The anatomical area concerned : some regions are more sensitive than others. The lips, area around the eyes and nose have a high density of nerves and are therefore more likely to produce a painful sensation if the anaesthesia is unsuitable.
- The technique used : injecting too quickly, poorly controlled depth, or excessive skin manipulation can increase discomfort.
- The equipment used : ultra-fine needles or blunt-tipped cannulas considerably reduce local microtrauma.
How does pain vary according to the product injected ?
Not all products used for aesthetic injections cause the same degree of discomfort or pain during injection. Viscosity, gel temperature, the volume required, and whether lidocaine is incorporated all influence the patient’s perception.
- Cross-linked hyaluronic acid : the denser the product, the greater the injection pressure required, which can cause a stretching sensation. This type of product is used deeply (cheekbones, chin, facial outline), where sensitivity is lower.
- Skinboosters or very fluid gels : these products are injected superficially across the area, sometimes through multiple micro-injections. The sensation is comparable to small, well-tolerated pinpricks.
- Botulinum toxin : injected in very small volumes using extremely fine needles. The sensation is comparable to a mosquito bite. This is probably the least painful aesthetic injection.
- Tissue stimulators (Radiesse, Sculptra) : the quantity injected is greater because these products are diluted, and they can create moderate tension during and after the procedure. Adding lidocaine makes these injections well tolerated.
Which areas are most sensitive to injections ?
Not all facial regions respond to pain in the same way. Some are more sensitive than others. Here is an overview of the most frequently injected areas, presented according to their degree of sensitivity :
- Very sensitive : lips, nose, eye contour (dark circles), area around the mouth.
- Moderately sensitive : nasolabial folds, cheekbones, jawline, temples.
- Less sensitive : chin, angle of the jaw, deep areas or areas with little movement.
Cannula or needle and patient comfort
The choice between a traditional needle and a blunt-tipped cannula directly influences the sensation experienced.
The needle :
- More precise for superficial areas or where the skin is thin.
- May cause a slight pricking sensation at each injection point.
- Used for the lips, fine lines or injections in small areas.
The cannula :
- Less invasive : it slides between tissues without cutting capillaries.
- Less painful, because a single skin entry point is enough to treat a large area.
- Used for the cheekbones, tear troughs, chin or jaw.
In practice, the cannula is often better tolerated, particularly for deep injections or extensive anatomical areas.
How does pain change after several sessions ?
A frequent observation in clinical practice is that injection-related pain decreases noticeably over successive sessions. The first injection is often the most feared ; afterwards, patients approach treatment with greater confidence because they know what to expect. Their memory of the pain helps reduce perceived discomfort, and local sensitivity may also diminish over successive sessions.
This change allows the technique to be adjusted to provide maximum comfort without needing to alter the aesthetic protocol.
Injections and hormonal cycles : an impact on sensitivity ?
For female patients, it is important to note that pain sensitivity varies during the menstrual cycle. During the premenstrual phase, some women experience heightened sensitivity, making injections slightly more uncomfortable.
Where possible, it is sensible to schedule injections outside periods of hormonal tension, particularly for sensitive areas such as the lips or under-eye area. This helps optimise overall comfort and avoid an exaggerated perception of sensations.
Are there contraindications related to pain or sensitivity ?
There is no formal contraindication to aesthetic injections based solely on fear of pain. However, in certain specific cases, greater attention to patient comfort is needed :
- People with fibromyalgia, neurological hypersensitivity or neuropathy.
- Patients who are very anxious or have a needle phobia.
- People who have previously had a painful experience that was poorly managed.
For these patients, pain management involves a trusting relationship, a detailed explanation of the procedure, carefully tailored anaesthesia, and a calm, reassuring environment. Under these conditions, the injection is well tolerated in almost all cases.
Pain after aesthetic injections and lingering sensations
After an injection, slight discomfort, local tightness or tenderness to touch may occur, particularly in highly mobile areas such as the lips or nasolabial fold. These sensations are temporary and usually disappear within 24 to 48 hours, sometimes a little longer.
In some cases, slight swelling or a small bruise may make the treated area temporarily sensitive. This is not actual pain, but rather discomfort that can be relieved by applying cold locally, using arnica (as a cream or granules), and avoiding muscular effort such as chewing or intensive exercise during the first 24 to 48 hours.
What does a patient actually feel ? Is perceived pain objective ?
Pain perception is subjective by definition : it depends on individual sensitivity, emotional context, stress levels, or memories of previous pain. A very anxious patient will perceive sensations more intensely, even minor ones.
This is why the quality of the doctor-patient relationship, a clear explanation of the treatment stages, and psychological preparation play a fundamental role in injection tolerance. A reassuring approach, a calm environment, and a slow, gentle injection are sometimes enough to turn a feared experience into a comfortable, or even painless, procedure.
Can you request sedation or an anti-anxiety medicine to improve comfort ?
In very rare cases, for patients with extreme phobias or hypersensitivity, a mild anti-anxiety medicine (such as hydroxyzine or low-dose alprazolam) may be prescribed before the session. This remains exceptional, as most patients tolerate the procedure perfectly once properly informed.
However, it is important never to minimise expressed anxiety and to offer practical solutions for patient comfort : prolonged application of anaesthetic cream, a pause during injection, a semi-reclining position, relaxing music.
The importance of appropriate local anaesthesia
Several techniques can minimise the pain experienced by the patient without affecting procedural precision or the aesthetic outcome.
- Anaesthetic creams : topical lidocaine (EMLA® cream or equivalent) is applied to the skin 30 to 45 minutes before the injection. It numbs the skin surface in most cases, particularly for superficial injections or Skinboosters.
- Hyaluronic acid containing lidocaine : most latest-generation hyaluronic acids already contain an incorporated anaesthetic (generally 0,3 % lidocaine). This significantly reduces pain as the injection progresses.
- Nerve block or infiltration anaesthesia : for certain very sensitive areas, such as the lips, local anaesthesia can be administered by injection. This highly effective technique allows completely painless lip injections.
