There is no doubt that TikTok is changing the way we navigate beauty. With more than 5.7 billion views on the app, it’s safe to say #TrapTox has gone viral. The trend involves injecting a neuromodulator like Botox or Dysport into the trapezius muscles, located beside the base of the neck. Considering its unanticipated uses everywhere from the armpits (to reduce sweating) to the jawline (for slimming), it should come as no surprise, really. But when I first heard about it, I frankly did not understand the allure. Then, upon learning that it’s used to help make the neck appear longer, reduce muscle tension, and potentially improve posture, my interest piqued.
It’s not that I have an anatomically short neck, but I’ve always wondered what it would look like with a longer, swan-like elegance — particularly when I wear certain blazers or any top with built-in shoulder pads. I also tend to have a pretty stiff neck and upper back (which is not helped by the fact that I love to write from bed) and would love improved posture, so I decided to give the “trap tox” trend a try.
“The ‘trap’ stands for the trapezius muscle, and the ‘tox’ stands for Botox, or any other wrinkle relaxer,” says Carolyn Treasure, MD, cofounder of Peachy Botox Studio. “It is gaining popularity because there was a small study that showed it may be useful for shoulder contouring, or slimming the neck and shoulders.”
In the study, 11 patients between the ages of 18 and 50 received 50 units of Botox into trapezius muscles to see if it would help slim their appearance. The results were promising, but before getting too excited, Dr. Treasure points out that the study’s small size is a major limitation to its credit. Plus, this is an off-label use of the FDA-approved drug (Botox is only approved for moderate-to-severe forehead lines, frown lines, and crow’s feet). Basically, anecdotal reports are the best we have to go by for now. There are patients who swear by it, but the data is minimal.
SkinSpirit‘s aesthetic nurse practitioner Elizabeth Jessica Ranelli confirms that with proper dosing, “patients can expect to see a reduction in the trapezius size, a slimmer neck, and collarbones that are better defined.” She adds that it is effective, in her experience, and a popular treatment — particularly in the last year, with many patients mentioning they learned about it on TikTok.
“Patients who have received [trap tox] express a decrease in muscle tightness to the neck and shoulders and a reduction in neck pain. They also notice their posture is better when their traps are relaxed, as they are no longer slouching.”
Because the trapezius muscle is larger than the typical Botox treatment area, it takes longer to take effect and requires more of the neurotoxin than you would inject in the face. As for how long it lasts? That also depends. “It can last anywhere from two to six months, but everyone metabolizes it slightly differently,” Dr. Treasure says.
I arrived at SkinSpirit in Beverly Hills for an appointment with aesthetic nurse practitioner Samantha Pang. I showed up with a stiff neck and some upper-back pain, exacerbated by stress from a home renovation and upcoming move (and too busy of a schedule to meet with my chiropractor). I knew this stress-induced somatic state could potentially be improved by the injections, but I was also eager to see if my swan-like aspirations could actually come to life.
I intentionally wore a top that could easily have the straps pulled down to expose my shoulders and traps but was snug enough to stay up to avoid flashing anyone. Even if you don’t plan ahead, they will have a strapless robe for you, just like the one you wear during a facial. I put my hair up in a ponytail to keep it out of the way, and we got started. The appointment began by taking “before” photos, then I got settled in the treatment chair.
Pang drew out where she planned to make the injections and explained to me that because it was my first time, she was starting me with a small dose of roughly 30 units. (Some treatments go up to the hundreds.) I was a little bit nervous that because the muscle was larger, it might hurt more (five people in the study reported some pain). Plus, the needle used is larger than the one for the face. Yet when she started the injections, it was as painless as getting acupuncture. Beginning with the right side, she injected Botox into the specific points she’d already mapped out.
When she moved to the left side, I was a little bit more tender, but Pang explained that this is almost always the case that the left side of the body is more sensitive. (The leading hypothesis is that the left side of the body is more sensitive because of the closer proximity to the heart.)
The entire appointment lasted less than half an hour. We scheduled my follow-up in five weeks, at which point we would determine whether I needed more and be able to compare my results with my before photos. Ranelli confirms that due to the size of the muscle, it is quite common to require multiple appointments to find your best dose. Then, I was sent on my way and basically forgot all about it.
After your appointment, the waiting game begins. If you are accustomed to getting neurotoxin injected in your face, you know there is a delayed onset — taking days or up to a week to take effect. Because the trapezius muscle is larger than our facial muscles, Pang says it will likely take several weeks for the neurotoxin to take effect visibly for the slimming and elongating effect. However, relief from pain and stress comes quicker — in about a week or two — as it begins reducing your muscle tension. (I still have a couple of days to go, but my back pain and neck tension are acute, so I will have a pretty good indication of its efficacy.)
As always, there are risks that come with injections, and it is important that you go to a board-certified doctor or trained injector such as a nurse practitioner or physician’s associate. “Like all cosmetic treatments that involve injections, trap tox can result in bruising and sometimes soreness to the area treated,” Ranelli says. “Also, the injections may cause a brief period of muscle weakness in the area, reducing upper-arm mobility and lifting capability.”
I experienced no bruising or discomfort but will be interested to see if I feel my strength is impacted. Because my dose was so small, I doubt I will — at least not from my first treatment. I am definitely curious to see if the appearance of neck elongation takes place and increasingly more excited to learn whether the reduction in muscle tension will help with back pain or neck tension. My stress levels have been higher than usual this year, and it would be ideal to have some added support in between sessions with my chiropractor.
The last thing to note is that once the results you’re seeking are achieved, you will actually require fewer treatments in time. Pang told me this is likely because after a few rounds of getting trap tox, some atrophy to the muscle itself takes place, thus reducing its size in support of the desired effect, even without maintaining the same treatment frequency.
Still, keep in mind that this is an off-label use of the class of drug and one that has only recently gone viral, with increases in the last year or so. “There really is not great data surrounding this trend,” Dr. Treasure reiterates. “Wrinkle relaxers in the trapezius muscles have not been well-studied, and more data are needed to be able to [confirm these claims] conclusively.” Until then, we can keep following along with the feedback from fans and practitioners.
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