What Is TrapTox? What to Know About the New Botox Trend on TikTok

Jul 27, 2023

It's also known as "Barbie Botox" and it's alllllllll the rage.

Botox…in your shoulders?

It sounds wild, but it’s just the latest in a string of social media crazes that has believers singings its praises, skeptics scratching their heads, and physicians scrambling to set the record straight.

TrapTox, as it’s known on TikTok, where the talked-about treatment’s hashtag has amassed more than 25 million views, refers to an injection of botulinum toxin type A (better known by brand names such as Botox, Xeomin, Dysport, and Daxxify) into the trapezius muscle, which runs from the back of the head to just above the lower back and outward toward the shoulders, explains Macrene Alexiades, MD, associate clinical professor of dermatology at Yale University School of Medicine and founder of Dermatology and Laser Surgery Center of New York.

Meet Our Experts: Macrene Alexiades, MD, associate clinical professor of dermatology at Yale University School of Medicine and founder of Dermatology and Laser Surgery Center of New York, Karan Lal, DO, MS, FAAD, a double board-certified adult and pediatric dermatologist with Affiliated Dermatology in Scottsdale, Arizona, Marina Peredo, MD, associate clinical professor of dermatology at Mount Sinai Hospital in New York and founder of Skinfluence NYC, Andrew Peredo, MD, a plastic surgeon at Skinfluence NYC, Sheila Farhang, MD, of Avant Dermatology & Aesthetics in Tucson, Arizona

Why, you may be wondering, would anyone want to inject a muscle relaxer here? “Overworked trapezius muscles can become tight and stiff, and neurotoxins can help relieve this tension and soreness,” says Marina Peredo, MD, associate clinical professor of dermatology at Mount Sinai Hospital in New York and founder of Skinfluence NYC. That’s reasonable—and botulinum toxin type A has been used for years to treat other medical conditions such as chronic migraines and hyperhidrosis.

But there are cosmetic implications too: TrapTox has been used to help make the neck look longer and slenderer and soften the shoulders, says plastic surgeon Andrew Peredo, MD, of Skinfluence NYC, who performs the treatment on “female patients who think their necks are too short or their shoulders are too masculine.” This swan-like lengthening effect has led some to nickname the procedure “Barbie Botox,” after the classic doll’s lithe frame (it can’t hurt the treatment’s popularity to be associated with a billion-dollar film that’s killing it at the box office right now, either). It’s another hashtag that’s seen some major action lately—12 million views and counting.

But is TrapTox or Barbie Botox or whatever you want to call it a wise idea? Or something only someone with the mental faculties of a lump of plastic would try? I turned to the experts to find out—read on, and decide for yourself.

As described above, the procedure involves using a needle to inject neurotoxin into the trapezius muscle—two common injection sites, according to Dr. Alexiades, are at the slope of the neck and just before the shoulder. The procedure is one of many off-label uses for botulinum toxin type A (Xeomin, for example, has been approved to treat cervical dystonia and blepharospasm on the medical side and moderate to severe frown lines between the eyebrows on the aesthetic side), which means the U.S. Food & Drug Administration has not conducted or reviewed any studies of its use in this area.

That doesn’t mean it’s unsafe, however: “Most cosmetic neurotoxins are indicated for the glabella, the muscle between the eyebrows that causes ‘eleven’ lines to appear,” says dermatologist Sheila Farhang, MD, of Avant Dermatology & Aesthetics in Tucson, Arizona. “It’s worth noting that many of the areas where inject toxin are off label depending on the brand.”

How much toxin is injected depends on the size and bulk of a patient’s trap muscle, says Dr. Farhang, who typically injects 20 to 25 units of toxin to each side. “A larger muscle could require up to 50 units per side.” Any of the brands of tox can be used for TrapTox, but for results that stick around longer, Drs. Peredo are turning to Daxxify, which studies indicate may have a more lasting effect.

Because botulinum toxin type A works by temporarily relaxing muscle fibers to prevent them for contracting excessively or spasming, TrapTox “is performed medically for the treatment of muscle spasms, headaches, and pain localized in this area,” says Karan Lal, DO, MS, FAAD, a double board-certified adult and pediatric dermatologist with Affiliated Dermatology in Scottsdale, Arizona.

It seems almost to be a tailor-made treatment for our times, when poor posture seems to be at almost epidemic levels and desk work has many of us hunching over, putting undue stress on our trapezius muscle. “Many of us also hold stress in our traps, which is why I had recently had the procedure,” admits Dr. Farhang. “It’s become really popular for working millennials.”

And because the trapezius muscle is being relaxed, its size and bulk is eventually reduced, says Dr. Alexiades—the same thing that would happen to any muscle over time that is significantly underused. “As a result, the muscle extends less away from the neck and shoulder, restoring a more contoured look to the area,” she says. This is what creates the “Barbie-like” effect and why it’s also being done for purely cosmetic purposes.

It can be, says Dr. Farhang. “In my experience, because we use a slightly larger 27-gauge half-inch needle instead of a syringe and have to inject deeper to reach the trap muscle, it can be slightly more uncomfortable than getting injections in the face only,” she explains. Of course, most dermatologists will happily numb the area if you have a low tolerance for pain, so you can ask your physician about that during your appointment.

If you’ve ever received botulinum toxin injections in your face, the appointment shouldn’t be too much of a surprise: Your physician will consult with you beforehand, numb the area, and then inject the tox into the area. Dr. Farhang notes that some dermatology offices may not have disposable gowns available so it may be a good idea to wear a button-front shirt so that the traps can be easily accessed.

Afterward, Dr. Peredo recommends avoid alcohol and NSAID pain relievers for a few days to minimize bleeding and bruising. It may also be wise to steer clear of rigorous physical activity for a day or two post-procedure as well, notes Dr. Alexiades.

You may notice the effects of TrapTox for up to six months, Dr. Farhang says, depending on which toxin is used and how much is injected.

That depends on many factors, including your location and how much toxin is used to effectively relax your trapezius. Our experts generally estimate the cost to be between $500 to $3,000 per treatment. The procedure is not covered by insurance for cosmetic purposes (botulinum toxin injections are typically only covered for approved medical uses such as chronic migraines and hyperhidrosis) so expect to pay out of pocket for TrapTox.

Like any medical procedure—and botulinum toxin injections are a medical procedure—there is some risk involved, though those risks are significantly mediated by seeing a fully-trained professional. These include injection-site pain swelling or bruising as well as muscle weakness in areas not intended to be treated. See a medical professional immediately if you experience any of them. And note that botulinum toxin injections are not recommended for women who are pregnant or breastfeeding.

Additionally, Dr. Lal advises using caution if you’re considering TrapTox for purely cosmetic purposes: “My concern is that it could hinder appropriate posture, resulting in the recruitment of other muscles to sustain posture which can further exacerbate back pain,” he notes. “It’s also not helpful for women with larger breasts as it is even harder to maintain posture in those patients.” So maybe not worth it if the doll look is your only end goal.

That’s a judgement call only you and your doctor can make. Physicians across the country, including the ones I interviewed for this story, are safely performing TrapTox for both medical and cosmetic purposes, but you should discuss the risks and benefits with your health care provider. “It’s truly appropriate if a person has tight upper back muscles, headaches, or are experiencing spasms of this muscle,” says Dr. Lal. Anything else—that’s on you.

If you are going to try TrapTox, Dr. Farhang stresses that you should only see a board-certified dermatologist or plastic surgeon who is a skilled injector for the procedure. “You need a doctor who will truly understand if you’re a good candidate and can analyze your anatomy to make sure of that,” she says.

Brian Underwood is the beauty director at Women’s Health. He is an award-winning journalist with more than 15 years of experience covering beauty and lifestyle for several national media outlets and previously served as beauty and wellness director at Oprah Daily. His work has appeared in Woman’s Day, Life & Style Weekly, Good Housekeeping, and many more. He also serves as a member of the Skin Cancer Foundation’s gala committee and lives in New York City with his daughter.

The 13 Best Keratosis Pilaris Treatments

The Benefits Of Protein Treatments For Hair

23 Best-Smelling Body Lotions To Gift Yourself

18 Best Dandruff Shampoos Of 2023, Per Derms

The Best Zinc Oxide Sunscreens

We Rounded Up Every Jennifer Garner Product Rec

18 Eye Creams For Dark Circles, Per Dermatologists

The 16 Best Face Scrubs For Glowing Skin

How To Use Rosemary Oil For Hair Growth

Natural Hair Dyes Are Rare, But Here Are A Few

14 Best Laser Hair Removal Devices Of 2023

Pamela Anderson Flaunts Freckles In No-Makeup Pic