Recently, I was stopped in my (scrolling) tracks by a TikTok video. “The most controversial cosmetic thing I’m getting done for my wedding,” explains a woman (@stacemariep) from the driver’s seat of her parked car, “is Botox — and I’m not talking a little sprinkle… I’m talking trap Botox,” gesturing at her upper back muscles. Wedding prep videos are not usually a genre served to me on my FYP, but sometimes the algorithm knows what I’m looking for better than I do. She continues, “They inject them with units of Botox and your traps emaciate away and disappear.” And just like that, the miracles of science make you feel more confident in a strapless dress.
The 30-second video now has over 4.6 million views, meaning I’m not the only person intrigued by the phenomenon of “traptox.” While it may feel like we’ve gone from a reality without traptox to the internet instantly heralding it as a “trend,” the idea of trapezius injections in not new. “This off-label use of botulinum toxin has been available and very popular in Asian countries like South Korea for many years,” says dermatologist Dr. Y. Claire Chang, board-certified cosmetic dermatologist at Union Square Laser Dermatology. The feeling of newness comes from the increasing popularity in the US, as well as the convergence of some very specifically 2023 factors.
Board-certified plastic surgeon Lara Devgan says trapezius injections are a frequent part of her practice. “Trapezius muscles tend to get bigger and bulkier when people carry more tension in their shoulder muscles,” she explains. “Now everyone has this bulky area because the pandemic has been a uniquely stressful time.” And it’s not just that: It’s TikTok culture putting the procedure in front of new audiences. It’s desk work culture and constantly hunching over computers and phones. It’s summer and people wanting to wear exposed-shoulder clothing. It’s even injectables culture: Now more people are interested in these treatments and have more options than ever. “The Venn diagram of all that is trapezius Botox culture.”
As is common with viral videos, the quick explanation of traptox left me with more questions than answers. So, I went straight to the experts to fill me in on every answer TikTok isn’t necessarily providing.
So, what is traptox?
“Traptox” is short for trapezius botox. The procedure involves injecting a neuromodulator (Botox, Dysport, or Jeuveau, to name a few brands) directly into the trapezius muscles to relax muscle activity. “Basically, Botox or any sort of neuromodulator is going to block the release of a chemical, acetylcholine, which is responsible for transmitting that signal in your muscle to contract,” says board-certified dermatologist Shereene Idriss.
With disuse of that muscle over a few weeks or months, it atrophies. If you’ve ever seen someone get a cast taken off to reveal that the arm or leg has become notably thinner, “that is the same mechanism of action,” says Devgan. “But it’s not a physical cast, this is a chemical cast.” The result is a relief of tension, pain, and stiffness from lack of muscle contraction, and in doing so, “the muscle smooths out, appears less bulky and your neck appears elongated,” says Idriss.
Who is it for?
The people seeking out traptox are usually in one of two camps: those looking for pain relief from chronic muscle tension, and those desiring the aesthetic results of slimming enlarged shoulder muscles, like so many of our TikTok friends. Team aesthetics is the one getting all of the attention right now, as it’s the visual results creating the virality of the procedure. Trapezius injections have also been given the nickname “Barbie Botox” on the app, referring to the long-necked, sloped-shoulder look of the doll.
What is getting traptox like?
The procedure itself is similar to getting Botox anywhere else on your body. Given you’re a good candidate for traptox, your injector will mark out the area to be treated and potentially offer topical anesthetic to help with discomfort. Then, the area will be sterilized and you are injected into specific mapped-out points. As injectables are never one-size-fits-all, “the number and location of the injections will depend on each person,” says Chang.
“Typically patients will require about a hundred units on each side to have a meaningful difference in the trapezius muscle,” says Devgan. For comparison, that’s likely about four times as many units as one might get injected into their face, she says, noting that it’s within a safe and normal dosing pattern for the larger muscle.
Regular reactions also include temporary injection-related bruising and swelling, and some patients may be sore or feel a little weak in treated area for a few days after treatment.
How long does it take to feel and see results?
Starting about a week or two after injections it's going to feel “almost like you've put down a heavy backpack,” says Devgan. The visual change follows after about four weeks and progresses over the course of months. As it’s a naturally bulkier muscle, it takes more time to change appearance as it loses muscle tone.
Does it effect range of motion?
Some basic anatomy lessons can help you understand that atrophying this muscle isn’t as quite as scary as it may sound. The trapezius is the large, kite-shaped muscle that goes all the way from the back of your neck, across your shoulders, and down to your mid-back. What is actually being injected for the sake of traptox is only a very small portion of this very big muscle. “It’s just one of many muscles in the back and it's actually one of the weaker functional muscles,” says Devgan. So, “treating the tippy top superior border of the trapezius muscle does not have any functional impact on your normal activities, including sports activities, daily living activities, exercise tolerance, or anything else.”
That being said, all of the experts agree it’s of the upmost importance to select a well-trained, qualified injector. More serious issues can arise if the injections are too deep, too low, or if you’re over-injected.
How often do you have to do it to maintain results?
The short answer, as you’ve probably come to expect, is that it depends. Neurotoxins degrade gradually, and that rate varies from person to person. Different brands also have different formulations that may have a longer effect. Botox lasts typically three to four months, while Jeuveau is often five to six months.
However, there is a possible bonus to experience a residual effect on the tail end of traptox treatments, says Idriss. After a long enough period of time relaxing that muscle and changing your habits — think retraining your posture, doing stretching exercises, adjusting the position of your computer monitor, etc. — you may be able to avoid the muscle pain or extreme hypertrophy from coming back. “I’ve had a number of patients who, after about a year, have been able to successfully wean off of trapezius Botox with the help of those lifestyle changes,” notes Devgan. “I've had other patients who try to wean off of it, but they go back to their old habits, and then they have to keep doing it.”