title: Needle preference in patients receiving cosmetic botulinum toxin type A.
abstract: BACKGROUND
  Patients often complain of pain and bruising from needle injections. Some clinicians believe smaller gauge needles cause less pain. Thirty-gauge needles are currently the standard needles employed for administering botulinum toxin type A (BTX-A).
  
  
  OBJECTIVE
  This study sought to determine whether patients receiving BTX-A have a preference for 30-gauge or 32-gauge needles based on the amount of pain and bruising experienced.
  
  
  METHODS
  Thirty-seven subjects received BTX-A on the right side of the face using a 30-gauge needle and on the left side using a 32-gauge needle. Subjects were masked to needle size. They were then asked to rate injection pain on an 11-point numerical rating scale and to note any bruising. Physician preference was also evaluated.
  
  
  RESULTS
  There were no statistically significant differences in the amount of intra-procedural pain (p=.37) or the level of post-procedural pain and discomfort (p=.76) experienced. Twenty-seven percent of subjects reported greater bruising with the 32-gauge needle, versus 29.7% with the 30-gauge needle. The physician injector did not have a preference. Lastly, 83.8% of subjects did not detect a difference in BTX-A paralysis effect.
  
  
  CONCLUSIONS
  We do not recommend using 32-gauge needles in place of 30-gauge needles for administering BTX-A.
authors.affiliation: Department of Orbital, Oculoplastic and Reconstructive Surgery, Duke Eye Center, Durham, North Carolina, USA. kpricemd@bowdeneye.com
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Price
authors.forename: Zinaria Y
authors.initials: ZY
authors.lastname: Williams
authors.forename: Julie A
authors.initials: JA
authors.lastname: Woodward
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D009339:Needles / Q000009:adverse effects*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D016037:Single-Blind Method
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A