How to reduce skin botox pain: three methods and the Potenza skin botox we use now

In skin botox consultations, people who have heard all about the effects almost always end with the same question: "But doctor, doesn't that hurt a lot?"

Personally, I find skin botox a really appealing treatment. Spread in tiny amounts across the facial skin, it can bring all of these changes at once.

• Oil production drops, so skin looks less shiny
• Pores that looked enlarged look tidier
• Fine lines soften and texture becomes smoother

But there is a problem. It hurts a lot. Muscle Botox goes into just a few points. Skin botox is spread over the whole face in dozens of small injections. So it keeps stinging. So I tried several methods myself to reduce this pain.

One thing I thought of early on was sodium bicarbonate. It is the same compound as baking soda, but what we used was a product made for injection. When an injection is close to acidic, it irritates the nerves more as it goes in and stings more. Botulinum toxin often turns mildly acidic when dissolved in saline. So I thought that mixing in a very small amount of sodium bicarbonate to bring it close to neutral might make it hurt less.

I tried it myself, and patients clearly seemed to feel less pain. A study that split the face in half in 30 people injected in the forehead and between the brows also found that with it mixed in, pain was about 1 point lower on a 10-point scale.

Then a problem I had not expected came up. The effect did not seem to go as far as I hoped. I could not tell for certain whether the weaker effect came from the drug itself losing strength or from the mixing order or storage. Even so, the chance of a weaker effect weighed more with me than the benefit of less pain. So I no longer use this method.

Second, I tried giving skin botox together with PN (polynucleotide). I thought giving them together might make the sting a little less, and since PN is an injection used to improve skin texture and elasticity, it could take care of texture as well.

With the two together, both skin condition and overall results were satisfying. In fact, a study that placed PN around the eyes found elasticity, hydration and pores improved more than with hyaluronic acid.

But as a way to reduce pain, it was not enough. There is no evidence yet that having PN alongside reduces pain, and skin botox was still many injections placed by hand all over the face, so the sting stayed the same. So I still give PN alongside for people who also want better texture and elasticity, and I decided to deal with the pain by changing the way the drug goes in.

So the method I finally found is Potenza skin botox. Potenza is a device that places very fine needles into the skin and releases radiofrequency heat from the needle tips. We had already been using it for texture, scars and pores. When these needles make fine channels in the skin and the drug is applied, it gets in much more easily. The dozens of hand pricks were replaced with these channels.

When you come in, I first look at your face with a magnifier. I mark separately the areas where pores cluster, such as beside the nose or the inner cheeks, the oily areas such as the forehead, and the areas where redness comes up easily. Then numbing cream goes on, and while it takes effect we put on relaxing videos or music on the screen in the treatment room.

Once the preparation that helps absorption is done, I deliver the skin botox while making dense channels with Potenza. I do not use one setting for the whole face. Where the skin is thin or red I go lower and gentler, a standard I have built up over more than 10,000 Potenza treatments. Finally, soothing care is done and you can go home.

What I hear most often from people who have had Potenza skin botox is "It hurts less than I expected." It is not only because the device changed. Even with the same Potenza, I keep the settings low and gentle. That is a standard I built up over more than 10,000 Potenza treatments.

You may worry that lower settings mean less effect. So I use the magnifier to look separately at oily areas, areas where pores cluster and areas where redness comes up, and I set a different strength for each area. No pain, maximum effect. That is the principle I always keep.

For reference, I minored in aesthetics at Seoul National University, so in my practice I place weight on looking at the beauty and balance of the whole face together, not just the skin. I also check whether a face looks wide from the side because of the jaw muscle or because of the parotid and submandibular glands, and if needed I suggest jaw Botox or salivary gland Botox as well. Including wrinkle Botox, I design and inject all facial Botox myself.

People who have had skin botox by hand injection notice the difference while it is still going on and ask, "Is that it?" I kept the drug as it was and changed only the way it goes in, and these are the differences that came out of it.

• Less stingingThere is no pricking the face dozens of times by hand.
• No injection bumpsThe drug is not pushed into one spot. Only light redness remains.
• Even spreadThe drug goes in along dense channels. It reaches areas hand injection tends to miss.
• Skin texture care tooMaking the channels helps the skin regenerate. Texture and elasticity improve together.

As we went, many people noticed changes in texture, pores or oil. There is also a study that compared the two halves of the face in 30 people with enlarged pores. One month later, the pore effect was similar when the drug was applied after fine needles made channels and when it was injected.

Which skin and which settings give the best results is something I am still refining as results come in.

"Is it all right to go to work the next day?" I get this question a lot too. After treatment only mild redness remains, and in most cases it settles the same day or the next. While the fine channels close, it is better to keep irritation down. Start make-up from the next day, and on the day itself just avoid saunas, hard exercise and alcohol.

The effect does not show right away. Over 1 to 2 weeks the shine lessens and pores feel tidier. The skin renewal that started when the channels were made carries on for a few more weeks. So people feel their texture become noticeably smoother.

If pain is your biggest worry, Potenza skin botox is what I recommend now. If you also want to look after texture and elasticity on top of oil and pores, there is the option of having PN with it. Hand injection stings, but it is the method we have used the longest, so when a set amount has to go precisely into set spots, hand injection is still the better choice.

I do not think anyone should simply have to put up with pain just because a treatment works well. That is how I ended up going from sodium bicarbonate through PN to the Potenza method I use now. Which method suits your skin now can be decided together at the consultation.

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