If you spent any time on TikTok over the summer, you likely saw an endless stream of videos extolling the virtues of #TrapTox. The alliterative hashtag refers to the injection of a neurotoxin into the trapezius muscles to slim and relax the area for both aesthetic and functional benefits.
While it seems like the ‘trap Botox’ trend came out of nowhere, it’s actually been an established – albeit under-the-radar – off-label use of botulinum toxin type-A injections for some time. So, what are the benefits of injecting Botox® and the like into the trapezius muscles and who is a candidate for treatment? Top injectors break it down.
Anatomy 101: The Trapezius Muscle
Before we dive into trap Botox, let’s start with a quick anatomy lesson. The trapezius is a large, superficial back muscle that gets its name from its shape – it resembles a trapezoid. It starts at the base of the neck and extends across the shoulders and down the middle of the back.
The main function of the trapezius (a.k.a. ‘the traps’) is stabilizing the scapula (read: shoulder blades) and controlling it during movements of the shoulders and arms (think: throwing, shrugging, raising your hand, sitting up straight, etc.). “Many of us hold tension in our shoulders,” says Kiran Mian, DO, a board certified dermatologist at Hudson Dermatology & Laser Surgery in New York City. “We also hold postures in our day to day that require our shoulders to be hunched over, like working at a computer, sitting at a desk, or even on our phones.”
The overuse of the trapezius causes hypertrophy or enlargement, Dr. Mian notes, which can lead to both functional (think: physical discomfort) and aesthetic concerns. “Most people have a bulge where the neck meets the shoulder,” says Nigar N. Ahmedli, MD, a board certified otolaryngologist and director of facial plastic and reconstructive surgery at Montefiore Medical Center in NYC. “It can interrupt the flow of the neck, thus shortening the appearance of the neck.” This is where trap tox comes in.
What Is ‘Trap Tox’?
Whether you call it ‘Trap Tox’ or ‘Barbie Botox’ (yes, the movie mania infiltrated aesthetic medicine, too), the treatment is the same. Neurotoxins like Botox®, Dysport®, Jeuveau®, and Xeomin® are injected into the trapezius muscle to address physical and/or cosmetic concerns. “Physically, Botox injections into the trapezius muscle can make the two sides more even, less bulky, and/or more proportional to the client’s overall frame,” says Kristina Kitsos, RN, a registered aesthetic nurse in Beverly Hills. “It can also make the neck appear longer and shoulders thinner, which is why many people call it ‘Barbie Botox.’”
Much like any other botulinum toxin type-A injection, the treatment is entirely customizable. “Injections of Botox into the trapezius muscle are targeted toward specific regions within the muscle to create the desired effect – ranging from enhancing the shape of the muscle, promoting symmetry, and refining proportions or slimming the muscle,” Kitsos says. “Based on the patient’s individual goals, placement and dosage is modified.”
Aesthetic Benefits of Trap Tox
Much like Botox is injected into the jaw to slim the lower face, it can be injected into the trapezius to improve the contour of upper body. “Neurotoxin injections in the trapezius can have a slimming effect on the neck,” says Margarita Lolis, MD, a board certified dermatologist and Mohs surgeon in New Jersey. “This is because the neurotoxin itself lowers the trapezius muscle, making the neck appear longer.”
The injections “elongate the neck, creating a more feminine contour between the neck and shoulders,” Dr. Mian explains. The swan-like effect creates the appearance of a more delicate upper body that is likened to a Barbie doll.
Functional Benefits of Trap Tox
We may associate Botox with wrinkle reduction, but BoNT-A injections are also used to treat muscle spasms associated with TMJ, lazy eye, vaginismus, hyperhidrosis (read: excessive sweating), and, yes, neck and shoulder pain. “Trap tox can relax tension or spasm in the trapezius muscle,” says Jennifer Levine, MD, a double board certified facial plastic and reconstructive surgeon in NYC.
At their core, neuromodulators like Botox®, Dysport®, Jeuveau®, and Xeomin® relax muscles. In the forehead, for example, that improves the appearance of wrinkles. In the upper back, that can ease stress and discomfort. “The muscles of this region – including the paired trapezius muscles – can tighten and spasm, leading to neck and shoulder pain as well as tension headaches,” Dr. Ahmedli explains. “Injecting the trapezius muscles with neurotoxin relaxes the muscles, allowing the tightness to improve and, therefore, helping decrease pain and headaches.”
The Ideal Candidate for Trap Tox
A candidate for trap tox could be someone looking to relieve tension in the neck and shoulders, someone looking to slim the area, or someone looking for a bit of both. “The ideal patient is someone with stiffness or pain in the trapezius muscles, people with overdeveloped trapezius muscles, and anyone who has neck and shoulder pain from overuse of their trapezius muscles,” Kitsos shares. “A good candidate would be anyone who would like to create a more svelte, longer-looking neck and less bulky shoulders.”
Injectors will study a prospective patient a few ways to determine candidacy. “The ideal patient for trap tox has palpable trapezius muscles – the provider can feel the muscle with their hands – with a noticeable bulge,” Dr. Ahmedli says. “The neurotoxin injection will diminish the bulge and create a sleek neckline.” Body language can also be a sign. “The ideal patient for trap tox is someone who subconsciously hunches their shoulders, causing increased tension in the muscle that builds over time as well as hypertrophy,” Dr. Mian adds.
The treatment, however, is not for everyone. Generally speaking, neurotoxins are not recommended for those under 18, women who are pregnant or nursing, anyone with an allergy to the components of the injectables, or those with certain chronic medical conditions. When it comes to trap tox specifically, “one should avoid this treatment if they have neuromuscular conditions, nerve damage in that area, or any injury or generally weak musculature in that area,” Dr. Mian cautions.
What to Expect from a Trap Tox Treatment
If you’ve ever had neurotoxin injections on the face, Dr. Levine says you can expect pretty much the same experience when it comes to trap tox preparation, in-office experience, and recovery. “Much like facial Botox injections, trapezius muscle injections have little to no pain and take just a couple of minutes to administer,” Kitsos notes.
On the pain point, facial Botox injections rarely feel like more than a pinprick. Trap tox can have a slightly stronger – though still manageable – sensation. “A longer needle is used to get to the muscle, as the trapezius lies deeper than facial muscles,” Dr. Mian shares. “It can cause a little bit more discomfort during the procedure.” If pain is a concern, Dr. Lolis says patients may choose to numb for 15 to 30 minutes prior to treatment.
What is different between trap tox and facial Botox is the amount of product needed. “We are talking about much higher doses of toxin for the trapezius because it is a much more dynamic and stronger muscle compared to your facial muscles,” Dr. Lolis notes. While the actual dosage will depend on the patient and product, there are some general rules of thumb. “Because the trapezius muscles are much larger than the muscles in the face, the dosage in the trapezius is often two to three times that of popular areas like crow’s feet and frown lines,” Kitsos says.
Each brand of neurotoxin requires slightly different dosing, but Dr. Ahmedli shares that if you are used to getting 20 to 35 units of Botox® in the forehead, the trapezius may need 40 to 75 “depending on the muscle size and tightness.” Dr. Levine offers a similar guesstimate. “The trapezius is a very large muscle, so it takes many units to get an effect,” she shares. “If it is 10 to 20 units for the forehead, the trapezius may need 50 or more per side.” Neurotoxins tend to be priced per unit based on the provider and location, but you can expect to pay around $1,000 for a trap tox treatment.
For the best experience, Dr. Lolis recommends avoiding exercising and lifting heavy weights on the day of the injection to ensure the traps are “as relaxed and tension free as possible.” Post-injection, avoid alcohol, strenuous activity, and massaging the treated area for the first 24 hours. “Patients mainly need to be careful not to apply any pressure on the shoulders/trapezius muscles for a few hours after injections,” Dr. Lolis adds.
When to Expect Results from Trap Tox
If you’ve ever had a neurotoxin treatment, you know the results are not instant. In the case of trap tox, the results are often staggered. “Patients will start to notice a difference a few days after injection as the muscle begins to feel less tight,” Dr. Ahmedli says. “Maximal effect is seen at the two-week mark.”
Depending on the product used and the patient’s lifestyle and metabolism, the effect can last anywhere from two to six months. In some cases, more than one treatment may be needed to enjoy the full aesthetic and functional benefits. “Some patients will see results after the first treatment, while others may take more sessions,” Dr. Mian notes.
While “the physical relief of tension will be felt after the first treatment,” she says, the aesthetic results “of elongated neck-shoulder curvature” may take a second treatment because “alleviated hypertrophy of the muscle can take some time.” In other words, “the muscle needs time to shrink now that it’s not being recruited constantly,” Dr. Mian adds.
A Note About Muscle Movement
Neuromodulators temporarily paralyze the muscles they are injected into until the toxin wears off, so are you basically opting for partial neck paralysis when you get trap tox? Not exactly. “Ideally you want to obtain the effects of tension release and aesthetic results without affecting functional movement,” Dr. Mian shares. “The ideal dosing lies in that balance between relaxing the muscle enough to achieve those results, while still being able to have movement like shrugging your shoulders.”
That’s not to say you won’t notice a difference. “At first, the muscle may be a bit weaker than normal,” Kitsos says. “After the neurotoxin wears off, patients will find that their trapezius muscles will go back to normal movement and they will once again be able to easily shrug their shoulders.” In Dr. Ahmedli’s experience, it’s mostly about tension. “The main difference patients notice is a decrease in the tightness in the shoulders,” she says. “As the neurotoxin wears off, the tightness will return.”
These are all things to talk to your injector about prior to treatment. “There is definitely a potential for muscle weakness in the treated area, which can affect muscle function,” Dr. Lolis shares. “You can potentially lose muscle since it is not being worked, and the other potential downside is that the two sides might be asymmetric.”
Yes, trap tox can give you a longer neck and more contoured upper body. But it is really a game changer for those who experience chronic neck and shoulder pain as a result of stress or tension. Consulting with an expert injector can help you determine if you are a candidate for this under-the-radar neurotoxin treatment.
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