Trap Tox, Ballerina Neck, Barbie Tox, Swan Neck, whatever it is you choose to call it; treating the trapezius muscles with Botox is by no means a new treatment. It has however gained momentum over the past year most notably because of Kim Kardashian's Facetune flop, and the release of the Barbie movie this summer. For years, injectors and doctors have been safely injecting the trapezius muscle for both aesthetic and therapeutic purposes - to elongate the neck and shoulder line sculpting and as an injection site for migraine protocols. Due to the sudden spike in popularity, I wanted to give it a try and share my experience with you, but as always, first a little background education and treatment overview.
"Trap"Talking
The trapezius muscles are a large triangular shaped pair of muscles that extend from the lower neck, laterally inserting in to the shoulders, and into the upper back. The function of the trapezius muscle is to assist in shrugging or lifting of the shoulders and act as a stabilizing muscle between surrounding muscle groups. The upper portion of the trapezius muscles play a role in the aesthetic appearance of the neck and shoulder line, and its shape/size may make a person look more masculine or feminine. When examining sexual dimorphism of the neck and shoulder line, a long, slim neck and shoulder line is associated and most often an anatomical feminine feature.
Conversely, a well-developed muscular neck line is associated to the male anatomy, with a thicker and shorter neck in many cases.
What Does Botox Do When It's Injected Into The Trap
With many of us bent over for much of our day, whether it be looking at a computer screen or down at our phones, stiffness, tension and chronic pain in the trapezius muscle is a very common complaint in modern society. Stiff trapezius muscles can cause chronic neck, upper back and shoulder pain and aches, occasionally leading to persistent migraines.
The injection of Botulinum toxin into the upper portion of the muscle relaxes the localized muscle fibres. When muscle fibres are not functionally used they start to weaken and slim down from decreased flexing and movement. As a result, there is less tension held in the area, and the area also physically becomes smaller and slimmer over a period of 1-2 months. Dosage depends on indication and muscle size, however average dosage ranges between 50-80 - units per side with the longevity of the treatment often lasting 4-8 months. Trap tox that we talk about today is the evolution of a treatment that was first used for a physical indication and has now has gained popularity due to its aesthetic outcomes.
Why I Chose To Try Out Trap Tox
I am someone who already has a long and feminine neck and shoulder line. In the past year, I have been working out more vigorously and lifting heavier weights, and I have noticed a slight enlargement of these muscles. While I never felt the need to slim the muscles down for purely aesthetic reasons, the work I do alternates between having my arms lifted, and shrugged (to deliver facial aesthetic treatments) and sitting at a desk typing. The combination of the two daily tasks has increased the tension and knots in my trapezius muscles. I've found temporary relief in stretching, massage and the occasional anti-inflammatory medications.
The increased attention to this treatment has raised what I would consider "a toxic tension" and "egotistical activation" amongst practitioners in the aesthetic industry. Not everyone agrees on this treatment, and almost everyone wants to prove they are right on the topic. Some assert that trap tox doesn’t help aesthetic improvement enough to validate the large amount of units required, some believe this treatment may cause more harm than good to a large stabling muscle of the upper body, and others stand behind the studies of muscular relaxation to this area, the role this muscle plays in migraines, and understand that it can achieve aesthetic outcomes that patents may be seeking.
Its important to note that as practitioners we play a large role in the influence and education of our patients. However we also understand that everyone's beauty and physical goals are different and informed consent is a must and our ethical responsibility. Before I took a definitive stance like some of my peers, I felt the need to try it myself and see what type of relief it offers my physical tension, and what the aesthetics outcome would be.
Tox My Traps - The Treatment
July 7, 2023 -
Dosage: 40 units per side of Botox at a 2:1 dilution to maximize spread throughout the large muscle. *this is considered a low/starter dose for this area
Technique: 4 point linear injection at the most superior part of the muscle
*there are other injection techniques depending on need
Observations: overall comfortable, quick, with 1-2 point per side that pinched more, otherwise it felt like a light pressure.
Next 48-72 hours post treatment: Traps were a little tender to touch or with movement. The next morning the feeling was similar to that of a flu shot in the arm. I usually take the weekends off from working out, so I can’t comment on how workouts felt in the first 72 hours, however my activities of daily living seems to be unaffected by the treatment.
Tuesday July 11 ( 4 days post): I did a big/heavy weights workout with kettle bells and didn’t notice any change in my work out abilities as of this time.
Wednesday July 12 - Noticeably sore in the traps and below the area of injection . The rest of this week I continued to alternate between cardio and weight exercise days with a soreness to the traps that resolved by the Monday.
Week 2: No impact at the gym, no noticeable sensations, or change physically or aesthetically.
Week 3: I couldn’t help but notice a huge physical relaxation to the trap area. It felt as if my shoulders relaxed down and I had this overwhelming sensation of pulling my shoulders back, and to stand up straight. It was really eye opening to recognize how hunched my posture was, and how high I carried my shoulders prior to treatment. My tension in the traps is softening and they physically feel softer to the touch. My husband even noticed how much softer they feel with less knots. I notice the same with palpation.
Weeks 4-6: I don’t notice any change during my aerobic workouts, however on my upper body weights days I do notice that my deltoids (shoulders) seem to carry a bit more of the load now resulting in an increased soreness post workout. Now some can argue we did more exercises that activate the deltoid, however I did notice over the past two week how my upper body felt different to months past. During this time I’m also starting to see a slight aesthetic change. As mentioned earlier, my goal in doing this treatment wasn’t for aesthetic improvement, but for muscular tension. I can see the convexity to this muscle flattening, and most of all the softening of my previous shrugged state and appearance.
The Trap Tox Verdict - Do I Need Trap Tox?
I am two months into the treatment and physically this is where I feel the most improvement. I have noticed a huge relief in tension to the trap muscles; the knots in them created a lot of shooting pain into my neck as a result of the massages I did in order to try and relax them. Due to the lighter dose, I don’t see a very impactful aesthetic change.
So I guess the question is, Would I do this treatment again, do I think its worth it - do I need trap tox?
I would have to say yes! I will likely allow this treatment to wear off, assess the status of my muscles and see if the tension returns. If relying on an anti-inflammatory becomes a need again, then 100% I would prefer a longer term solution. It is absolutely worth getting Trap Tox twice a year compared to the physical discomfort that I was often distracted by. I might not look like I have the neckline of a ballerina, but I certainly feel like I have the posture of one.