{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:31:40Z","timestamp":1787232700292,"version":"build-2736575974"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"15","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100019791","name":"Istanbul Medipol University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019791","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Botulinum toxin type A (BoNT-A) is widely used in aesthetic medicine to treat dynamic facial rhytides. Despite its well-established safety and efficacy, BoNT-A injections often induce discomfort and anxiety owing to injection-related pain, especially in sensitive facial areas. Although topical anesthetic creams are commonly employed to alleviate pain, they have limitations, such as delayed onset and local side effects. Mechanical analgesic devices, based on the gate control theory of pain, have emerged as promising non-pharmacological alternatives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective, single-center, split-face study, 80 adult patients undergoing upper-facial BoNT-A injections between May 2024 and August 2025 were enrolled. Each participant received a topical anesthetic cream on one side of the face and a Shot Blocker-like mechanical analgesic device on the contralateral side. All injections were administered by a single experienced physician. Pain levels were assessed immediately post-injection using a visual analog scale (VAS, 0\u201310) by a blinded evaluator. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, Spearman correlation, and Mann\u2013Whitney U tests. Effect sizes were reported using Cohen\u2019s\n                      <jats:italic>dz<\/jats:italic>\n                      and Cliff\u2019s \u0394.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean VAS scores were significantly lower with the mechanical device (3.19\u202f\u00b1\u202f1.08) than with the topical cream (4.14\u202f\u00b1\u202f1.30) (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u202f0.001). The intra-individual mean difference (0.95\u202f\u00b1\u202f1.41) favored the mechanical device. Spearman\u2019s correlation indicated that higher pain scores with the cream correlated with greater relative benefit from the device (\u03c1\u202f=\u202f0.664,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u202f0.001). Patients with higher baseline pain (VAS \u2265 4 on the cream side) experienced significantly greater pain reduction (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A shot blocker-like mechanical analgesic device is more effective than a topical anesthetic cream in minimizing pain during BoNT-A injection into the upper face. Its immediate analgesic effect, absence of pharmacologic side effects, and ease of use make it a valuable adjunct in aesthetic practice, particularly for patients with pain sensitivity. Further studies are warranted to validate these findings in broader populations and different anatomical regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence II<\/jats:title>\n                    <jats:p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-05884-2","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:13:45Z","timestamp":1778685225000},"page":"6218-6223","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing Patient Comfort in Aesthetic BoNT-A Injections: Mechanical Versus Topical Analgesia"],"prefix":"10.1007","volume":"50","author":[{"given":"Emre","family":"G\u00fcvercin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nil\u00fcfer","family":"Bahad\u0131rl\u0131","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak Erg\u00fcn","family":"Tatar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"issue":"2","key":"5884_CR1","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.clindermatol.2007.09.008","volume":"26","author":"G Salti","year":"2008","unstructured":"Salti G, Ghersetich I. Advanced botulinum toxin techniques against wrinkles in the upper face. Clin Dermatol. 2008;26(2):182\u201391.","journal-title":"Clin Dermatol"},{"issue":"2","key":"5884_CR2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/00002341-199903000-00017","volume":"15","author":"VH Yuen","year":"1999","unstructured":"Yuen VH, Dolman PJ. Comparison of the three modified lidocaine solutions used in eyelid anesthesia. Ophthalmic Plast Reconstr Surg. 1999;15(2):143.","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"5884_CR3","unstructured":"Willey A, Lee PK. Cutaneous anesthesia. In: Roenigk RK, Roenigk HH, editors. Roenigk's dermatologic surgery: current techniques in procedural dermatology. 3rd ed. CRC Press; 2007. pp. 55\u201359."},{"issue":"5","key":"5884_CR4","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.ajem.2008.04.011","volume":"27","author":"LA Drago","year":"2009","unstructured":"Drago LA, Singh SB, Douglass-Bright A, Yiadom MY, Baumann BM. Efficacy of ShotBlocker in reducing pediatric pain associated with intramuscular injections. Am J Emerg Med. 2009;27(5):536\u201343.","journal-title":"Am J Emerg Med"},{"issue":"5","key":"5884_CR5","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/HNP.0000000000000105","volume":"29","author":"N Celik","year":"2015","unstructured":"Celik N, Khorshid L. The use of ShotBlocker for reducing pain and anxiety associated with intramuscular injection: a randomized, placebo-controlled study. Holist Nurs Pract. 2015;29(5):261\u201371.","journal-title":"Holist Nurs Pract"},{"issue":"2","key":"5884_CR6","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1097\/JPN.0000000000000256","volume":"31","author":"S Caglar","year":"2017","unstructured":"Caglar S, B\u00fcy\u00fcky\u0131lmaz F, Co\u015fansu G, \u00c7a\u011flayan S. Effectiveness of ShotBlocker for immunization pain in full-term neonates: a randomized controlled trial. J Perinat Neonatal Nurs. 2017;31(2):166\u201371.","journal-title":"J Perinat Neonatal Nurs"},{"issue":"2","key":"5884_CR7","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1097\/00132586-196704000-00002","volume":"11","author":"R Melzack","year":"1967","unstructured":"Melzack R, Wall PD. Pain mechanisms: a new theory. Surv Anesthesiol. 1967;11(2):89\u201390.","journal-title":"Surv Anesthesiol"},{"key":"5884_CR8","volume":"16","author":"H Kuwahara","year":"2016","unstructured":"Kuwahara H, Ogawa R. Using a vibration device to ease pain during facial needling and injection. Eplasty. 2016;16:e9.","journal-title":"Eplasty"},{"issue":"1","key":"5884_CR9","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12871-023-02088-y","volume":"23","author":"J Yu","year":"2023","unstructured":"Yu J, Chen W, Liu Q, Mi J. Investigating 3D-printed disk compressing against skin for pain relief in intradermal infiltration anesthesia: a randomized controlled trial. BMC Anesthesiol. 2023;23(1):144.","journal-title":"BMC Anesthesiol"},{"issue":"3","key":"5884_CR10","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1001\/jamafacial.2013.2458","volume":"16","author":"EA Gordin","year":"2014","unstructured":"Gordin EA, Luginbuhl AL, Ortlip T, Heffelfinger RN, Krein H. Subcutaneous vs intramuscular botulinum toxin: split-face randomized study. JAMA Facial Plast Surg. 2014;16(3):193\u20138.","journal-title":"JAMA Facial Plast Surg"},{"key":"5884_CR11","first-page":"63","volume":"4","author":"L Uman","year":"2006","unstructured":"Uman L. Psychological interventions for needle\u2010related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2006;4:63.","journal-title":"Cochrane Database Syst Rev"},{"issue":"12","key":"5884_CR12","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1097\/PEC.0b013e318237ace4","volume":"27","author":"AL Baxter","year":"2011","unstructured":"Baxter AL, Cohen LL, McElvery HL, Lawson ML, Von Baeyer CL. Integration of vibration and cold therapy relieves venipuncture pain in a pediatric emergency department. Pediatr Emerg Care. 2011;27(12):1151\u20136.","journal-title":"Pediatr Emerg Care"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-05884-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-05884-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-05884-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:16:42Z","timestamp":1787231802000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-026-05884-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":12,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["5884"],"URL":"https:\/\/doi.org\/10.1007\/s00266-026-05884-2","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"21 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures were performed as part of routine clinical aesthetic practice. Written informed consent was obtained from all participants prior to treatment, including consent for the use of anonymized clinical data for research purposes. This study was conducted in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants included in the study.","order":3,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}