Botox does so much more than smooth the skin’s surface, essentially erasing fine lines and wrinkles. It also has the power to prevent migraines, stop excessive underarm sweating, and even reduce pain in your neck and shoulders. Trapezius Botox, or “TrapTox” as it’s called, involves injecting Botox into the trapezius (trap) muscles to create a longer, leaner neck and better-defined shoulders.

Targeting these large muscles—which run from the base of the neck across the shoulders and down the upper part of the back–with Botox helps them to relax and, in turn, improve posture, neck and shoulder stiffness, and pain. It also creates more of a contoured and elongated neck. So, is shoulder Botox right for you? Ahead, three dermatologists break down everything you need to know about TrapTox.

What Is Trapezius Botox?

Trapezius Botox is when Botox is injected into the upper back, shoulder, and neck muscles to alleviate pain. The trapezius muscles, essential for daily movement, also stabilize the neck and shoulders for good posture. But they can become inflamed and enlarged from certain weightlifting exercises, reaching overhead, poor sleeping positions and posture, sitting hunched over, and stress. The procedure may be trending, but dermatologists say Botox has been used for years to relax overused muscles.

“The trapezius is a large muscle that extends from the neck, down the neck, and along the shoulders. Many people have tension and overactive contractions of this muscle, leading to tension headaches, neck pain, and back pain,” says dermatologist, Rachel Nazarian, MD. By injecting Botox into the trapezius muscle, the muscle is unable to spasm or contract as intensely, leading to relaxation of the muscle for several months, and ultimately, pain relief and improved quality of life.”

The Benefits of Trapezius Botox

• Relaxes the trapezius muscles
• Reduces frequency of tension headaches and chronic migraines.
• Reduces pain and stiffness
• Alleviates excessive muscle contraction
• Makes the neck and shoulder look elongated and lean

Dermatologist, Amy Wechsler, MD, says pain relief from the partial relaxation of overused muscles is the most significant benefit of the treatment. Many people hold tension in the trapezius muscles, which causes shoulder pain and stiffness. Injecting the large trapezius muscle group with Botox, or any other neuromodulator, releases tension in the area and recurring tension headaches and tech neck.

From an aesthetic standpoint, TrapTox can create an elongated neck and leaner-looking shoulders. “Treating the trap muscles with Botox can create a longer-looking neck if it is overworked and looks shortened,” says Dr. Wechsler.

Dermatologist, Macrene Alexiades, MD, adds that Botox relaxes and partially inactivates the injected muscles, causing them to lose size and volume. “Injecting the trap muscles with Botox can also alleviate excessive muscle contraction, releasing them so that the front and back of the upper body are more balanced to improve posture,” she says. “Botox has been clinically proven with a statistically significant difference in thicknesses to reduce trapezius hypertrophy.”

The Best Candidate for Trapezius Botox

According to Dr. Nazarian, anyone who has been dealing with “chronic issues of neck and back pain,” and who can identify “the source of muscle spasm and tension to the trapezius muscle portion of the mid or upper back,” is a candidate for trapezius Botox.

From a cosmetic standpoint, those who are looking for the procedure to offer an elongated neck and slim, tall upper body, will need repeated injections.

“True shoulder slimming requires repeated sessions over a longer period of time to experience muscle atrophy or thinning,” says Dr. Nazarian. “It may not be seen after one session, although some people find the shoulders tend to look less bulky more quickly.”

Does Trapezius Botox Hurt?

Injecting Botox into the trap muscles hurts no more than injecting Botox into the face or elsewhere on the body. There will be a slight pricking sensation with each injection as the needle pierces the skin. But other than that, there’s little discomfort or pain during the treatment or afterward. Your dermatologist can apply topical numbing cream before the injections to make the treatment more comfortable.

How to Prepare for Trapezius Botox

Preparation for trapezius Botox follows the same protocol as any other Botox treatment. While there’s no major prepping, there are a few do’s and don’ts to follow in the days leading up to the injections to make the treatment more effective. For starters, try and relax the muscles as much as possible to reduce stress and tension in the area. Dr. Alexiades says to avoid exercising for at least two hours before TrapTox and refrain from workouts for the rest of the day.

Additionally, our experts recommend avoiding drinking alcohol for up to one week before the injections since it can cause the area to bruise and swell. You’ll also want to avoid taking blood thinners for a week and aspirin or other anti-inflammatory medications a few days before your Botox appointment since they can increase the risk of bleeding.

What to Expect

Even though different types of neuromodulators are available at your dermatologist’s office, including Botox, Dysport, Jeuveau, Xeomin, and Daxiffy, Dr. Wechsler says one specific brand doesn’t necessarily work better for treating the trapezius muscles than another, so stick with the one you feel most comfortable with.

Trapezius Botox is a quick and easy procedure that takes 10 to 20 minutes. On average, 40 to 50 units of Botox are injected into the left and right trapezius muscles, but some people need more depending on their muscles’ size. “Every person should be evaluated on a case-by-case basis to ensure they have a curated treatment approach,” Dr. Alexiades suggests.

First, your dermatologist will mark the areas to inject along the shoulder. Then, they will quickly inject the Botox into each area. The nice thing about TrapTox is that there’s no downtime, but the results take time to develop. Dr. Wechsler says they can usually be seen two to three days after the injections and kick in over two weeks. Once the Botox starts to weaken the muscle, you’ll feel less tightness and pain in the shoulders, neck, and back and have a greater range of motion.

Potential Side Effects

Trapezius Botox is a relatively uncomplicated treatment, and the potential side effects are rare yet the same as what you could experience with Botox injections for wrinkles and lines. Post-injection, redness, mild swelling, and bruising are common. Additionally, if the toxin is injected inappropriately, there may be a diffusion effect, which can cause flu-like symptoms and muscle weakness. “That’s why your injector must be skilled and experienced in injecting those muscles to reduce the potential for unwanted side effects,” Dr. Wechsler says.

It can also be difficult and take far more effort to extend the neck and shrug the shoulders due to muscle weakness, but this movement will slowly be regained when the Botox starts to wear off.

The Cost

You can expect to pay anywhere from $10 to $25 per unit, which comes out to somewhere between $500 to $1000 per session, or more, depending on how many units of Botox you’ll need. Unless your doctor deems your Botox treatment medically necessary, which you’ll have to prove through examination and diagnosis, chances are your health insurance won’t cover the cost.

Aftercare

Your dermatologist will have you follow the same post-Botox protocol for your trap muscles as you do for your face, which includes no working out—especially anything strenuous—or laying down for eight hours. Dr. Alexiades says to lay off drinking any alcohol for the first 24 hours and avoid hot baths and saunas post-treatment, which might cause a spike in body temperature and impede the results.

Mild redness and soreness are typical after a TrapTox session. If that happens, icing the area can help dull any discomfort. It’s also worth noting that sitting up without slouching and walking straight without hunching over is important. Failing to practice good posture can cause the trap muscles to bulk back up fast.

The Final Takeaway

Dermatologists are seeing an uptick in patients requesting trapezius Botox, and for a good reason: it helps reduce tension-related pain while creating a more contoured look around your neck and shoulders. Like Botox injections for the face, the results of TrapTox take a few days to a few weeks to fully take hold, but they don’t last forever. If you want to ensure the effects hold up, Dr. Nazarian says that you’ll need to visit your dermatologist about three times a year for the cosmetic benefit, but if being done for pain or muscle spasm, only as needed.