32 Gauge Needles Are No Better Than 30 Gauge for Botox

Dr Timothy C. Flynn
By Dr Timothy C. Flynn

Dr Timothy Flynn is a Consultant Dermatologist in North Carolina, USA. He is acknowledged as an expert in skin cancer and dermatologic surgery.

I frequently ask a new patient following the first injection of botulinum toxin, "Did you feel that?" They often reply, "Just a little prick." I usually cannot resist saying, "I have been called worse."
But seriously, patients do remember the pain of a cosmetic procedure, which has prompted two recent studies now published in the literature. 
Would the use of a thinner 32-gauge needle for a cosmetic botulinum toxin injection hurt less than the standard 30-gauge needle? 
The ophthalmology literature answers the question. Studies by Yomtoob, et al and Price, et al show no statistical difference in pain level between the two needle sizes. Furthermore, Price noted that there were no differences in the level of postprocedural pain and no differences in the degree of bruising. Smaller gauge needles require special ordering and have a greater cost, and are not beneficial for BOTOX injections because there is no benefit to the use of the 32-gauge needle when it comes to decreasing pain or decreasing bruising.


  1. Yomtoob DE, Dewan MA, Lee MS, Harrison AR: Comparison of pain scores with 30-gauge and 32-gauge needles for periocular botulinum toxin type a injections.  Ophthalmologic Plastic and Reconstructive Surgery. 2009; vol. 25:376.
  2. Price KM, Williams ZY, Woodward JA: Needle Preference in Patients Receiving Cosmetic Botulinum Toxin Type A.  Electronic publication ahead of print Dermatologic Surgery. 2010.

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