Left/Right Pain Asymmetry With Injectable Cosmetic Treatments for the Face.

By Gennaio 15, 2018 Gennaio 24th, 2020 No Comments

Jacobus Johannes Fouché, MD Jani Adriaan Jochem Van Loghem, MD Job Thuis, MD Linda Marije De Heer, MD, PhD Martijn G H van Oijen, PhD

Aesthetic Surgery Journal, Volume 37, Issue 6, 1 June 2017, Pages 708–714

Published: 27 January 2017



Pain is processed and experienced differently on the left (L) and right (R) sides of the body; however, L/R pain asymmetry with cosmetic treatments of the face has not been evaluated.


The authors compared patient ratings of L/R facial pain during and immediately after injectable cosmetic treatments.


In this cross-sectional multicenter pragmatic study, pain Levels were evaluated for 302 patients who underwent facial treatments with botulinum toxin (BTX) and/or impermanent soft-tissue filler (STF). Patients indicated pain intensity on each side of the face with a visual analogue scale (VAS; 0, no pain; 10, worst pain).


Combined mean VAS scores for BTX and STF treatments (L, 3.79 vs R, 3.42), and individual scores for BTX (L, 3.60 vs R, 3.30) or STF (L, 4.22 vs R, 3.69) treatments were significantly different, with pain rated as worse on the L side of the face (all P < 0.01). When treatments were performed first on the L side, patients rated the overall experience as significantly less painful than when treatments were begun on the R side. BTX treatments with a 29-gauge (G) needle were significantly more painful than with a 33-G needle.


To lessen pain with injectable facial treatments, the authors recommend placing the first injection on the L side of the face and, when possible, employing a high-G needle.

Level of Evidence: 2