By LIV Clinic · Medically reviewed by Dr. Narathai Vichienkalayarut, M.D. · Published October 16, 2026

Most first-timers describe it as a series of tiny pinches — over before the sentence they were mid-way through.

Does Botox hurt? Only briefly and mildly for most people. The needles used are very fine and each injection takes about a second, so the usual description is a quick pinch or sting rather than pain. The whole treatment typically takes five to ten minutes, and numbing cream or ice can be used for sensitive areas such as the lips or underarms.

What the injections actually feel like

A pinch, then nothing

The needle used for botulinum toxin is very fine and the volume injected is tiny. Most people describe a brief sting or pinch at each point, sometimes with a faint pressure sensation as the product goes in.

How long it lasts

Each injection takes about a second. A standard upper-face treatment involves a handful of points and is usually finished within five to ten minutes, including mapping.

Which areas are more uncomfortable

The easier areas

Forehead, frown lines and crow’s feet are generally well tolerated, partly because the skin there is less densely supplied with nerve endings than the lips or nose.

The more sensitive areas

Lips, the base of the nose, the chin and the underarms tend to be more sensitive. The Cleveland Clinic notes that discomfort is generally brief and that numbing options can be used where needed.

Comfort by treatment area

Illustrative only — pain perception differs considerably between individuals.

What makes it hurt more than it should

Discomfort is usually avoidable rather than inherent. Common aggravating factors:

• A rushed injector who does not stabilise the skin
• Reusing a blunted needle across many points
• Treatment during the few days before a period, when sensitivity is often higher
• Caffeine beforehand, which can heighten the startle response
• Tensing the muscle instead of relaxing it
• Anxiety, which measurably lowers pain threshold

Options for reducing discomfort

Topical numbing

A lidocaine cream applied 20–30 minutes beforehand is standard for lips and underarms, and available on request elsewhere.

Ice and distraction

Brief cooling just before each point dulls the sting and also reduces the chance of bruising. Simple breathing or conversation genuinely helps.

Afterwards: soreness versus pain

What is normal

Mild tenderness, pinpoint redness and occasionally a small bruise for a day or two. Some people get a short-lived headache after forehead treatment.

What is not

Severe or increasing pain, spreading redness or significant swelling after the first day is not expected and warrants contacting your clinic. The MedlinePlus entry lists the symptoms that should prompt medical attention.

Step-by-step: making your treatment more comfortable

Practical preparation that genuinely reduces discomfort:

1. Tell your doctor at consultation if you are needle-anxious or have had a painful experience before.
2. Request numbing cream in advance for lips, nose, chin or underarms.
3. Skip caffeine for a few hours beforehand.
4. Avoid alcohol and blood-thinning supplements for 24–48 hours, where appropriate, to reduce bruising.
5. Arrive with clean, make-up-free skin so no extra wiping is needed.
6. Let your face relax rather than tensing the muscle being treated.
7. Apply cool compresses briefly afterwards if the area feels tender.

A comfortable first treatment at LIV Clinic

Doctor-led, unhurried

At LIV Clinic on Koh Samui and Koh Phangan, treatment is carried out by Dr. Narathai rather than rushed through, and numbing is offered rather than something you have to ask for.

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See our Botox and wrinkle programme, compare with dermal filler, or book a consultation.

Frequently asked questions

Safety and consultation

Botox is a prescription medical treatment and, like any injectable, carries some risk — common temporary effects can include redness, swelling, bruising, mild headache or a short-lived heaviness, and less common reactions such as temporary eyelid or brow droop are possible. Results vary from person to person, and no specific outcome can be promised. This article is general information, not medical advice.

At LIV Clinic, every treatment begins with an in-person assessment by Dr. Narathai Vichienkalayarut, M.D., who reviews your skin, medical history and goals before recommending a personalized plan. Book a consultation to find out whether this treatment suits you.