admin Let’s get one thing clear up front: I absolutely do not recommend basing your aesthetic treatment plan off of what’s trending on social media. However, social media can be a useful way to learn about modalities and procedures you may not be aware of — and if you follow the right experts, you might even find helpful solutions to concerns you’d previously assumed weren’t fixable.
It was through following Dr. Shereene Idriss, a.k.a. The Pillowtalk Derm, on both Instagram and TikTok that I first became aware of “TrapTox,” a definitely buzzy — but also completely legit — practice of injecting neuromodulators like Botox into the trap (or trapezius) muscles to de-bulk and slim them. Dr. Idriss, who’s a board certified dermatologist in New York City, often posts honest explainers on the treatments her patients and followers are asking about. She has her own skin-care brand, PillowtalkDerm, but she chooses not to partner with brands in the (rather lucrative) way some other derms do as a spokesperson, allowing for more objectivity in her recommendations.
But, back to TrapTox: As Dr. Idriss puts it, “it’s basically Botox, Dysport — whichever (neuromodulator brand) you want — in your trapezius muscle.” The goal is to basically hit “pause” on the muscle, and therefore atrophy and shrink it, with the aim of eventually appearing less bulky. Plenty of people (myself very much included) carry tension in the area, and factors like TMJ and workouts (like incorrect chaturanga push-ups during yoga — again, guilty!) can cause it to build up extra bulk.
While some may want to generate such bulk, others might prefer a slimmer silhouette and neckline, especially because large trap muscles can contribute to the appearance of a hunchback and slumped posture. This is, of course, a purely personal aesthetic concern, but with my wedding rapidly approaching (and my dress’s simple, square neckline in mind), I was immediately interested to learn whether I might be a good candidate for this type of injection.
“I personally prefer Dysport, because I feel like it has a little bit more of a spread factor,” says Dr. Idriss, who reiterates that she’s “not sponsored by anyone, so I’m not getting paid (to recommend any brand).” Compared to injecting the typical wrinkle-relaxing areas on the face, when it comes to the trap muscles, you want a bit of “spread factor,” so it can distribute throughout the large muscle for maximum impact.
Because the trap muscles are larger than facial muscles, aesthetic results can also take longer to set in. “When you’re doing larger body surface areas, the muscle is big. It’s going to take a little bit more time for that muscle to sort of, for lack of a better word, ‘deflate’ or relax and for it to take effect.”
It takes about three-to-four weeks to begin to see results from TrapTox, according to Dr. Idriss. “It could take that long for that muscle to sort of acclimate and relax and not be as pumped up,” she says. “Imagine somebody who’s working out a lot: It takes them a few weeks or months to go back to flaccidity if they don’t work out. With this it’s the same concept.” Other, non-aesthetic benefits of TrapTox may be more rapid: “Now, in terms of feeling, it’s a different story. You will feel more relaxed, especially if you hold stress in this area, faster. It takes a good week to fully kick in to do its magic.”
TrapTox is certainly having a moment right now. “I do think it has sparked a curiosity, especially because people are now working from home a lot, sitting on computers hunched over and holding all of their tension in that area,” Dr. Idriss says. “But I don’t think it’s going to be like (lip filler) was in 2019 or 2018. It’s not the new lip situation, and I do wonder if it will die out relatively fast because it is expensive and not everybody’s going to be the right candidate or see those amazing results.”
The pros of TrapTox
In the right candidates, TrapTox can create a slimmer neckline silhouette and help to correct hunched posture. Those are the key aesthetic benefits of the treatment, and that’s what Dr. Idriss focuses on as a dermatologist. But there are other potential benefits as well.
“People who have chronic migraines and tension headaches can benefit from it,” she notes.
Dr. Idriss herself relied on TrapTox before her own wedding for medical purposes. “I had a really bad torticollis and I couldn’t turn my head to the right,” she remembers. She injected her trap muscles about a month ahead of her wedding, and calls it “the best thing ever did, because it really just broke that cycle of tension — your muscle contracts, it gets worse, your muscle contracts, it gets worse. If you just break that cycle, your muscle then relaxes and releases, and it’s not going to be tensed as much down the road. It’s like a reset: You hit total pause, the muscle has a chance to really relax.” She compares it to a longer-term alternative to a muscle relaxant: “It’s really allowing your muscle the time and space to relax, without having to constantly contract and make things worse and bring more inflammation into play.”
The impact of TrapTox on certain candidates can be major, according to Dr. Idriss.
“One of the comments I got on TikTok a lot was, ‘It’s so expensive!’ — but physical therapy is also expensive, not just in terms of financial dollars, but time, effort and energy. You’re going to need a lot of treatments there,” she says. “And I’m not saying it’s a replacement for physical therapy, absolutely not. You definitely still need PT if you’re that candidate, do not misunderstand me. But if it’s for purely cosmetic concerns, then I think there’s a huge benefit to it.”
The cons of TrapTox
It’s important to consider that not everyone is the right candidate for TrapTox.
“For anybody who’s prone to any sort of inherent hereditary muscle weakness, or with medical conditions like myasthenia gravis, I would never inject in that area,” cautions Dr. Idriss. “If someone’s a professional bodybuilder, I probably would never inject in that area. Obviously there’s going to be a little bit of muscle weakness there. So if a patient is an athlete, I would think twice.”
And for those who are mainly interested in pursuing the treatment for pain management or other health concerns, the expert suggests seeking alternative medical care. “I’m not trying to take the job of a neurologist. I’m not in pain management, that’s not my goal. I’m purely looking at aesthetics. But if somebody has had back surgeries or multiple traumas to that area, I’m not going to overstep my own boundaries as a physician and I would then refer you to a neurologist or someone else,” says Dr. Idriss.
She also urges that patients should not look at this treatment as a “preventative” one. While it may inhibit ongoing issues of tension in the trapezius muscles, not everybody is going to develop issues with the area.
It’s important to consider that while TrapTox may help in the short term, issues can still come back over time. Also, “setting expectations in terms of timeline and what you see is also important, because you’re not going to see a difference right away, the way you would on your forehead within seven-to-10 days,” Dr. Idriss says. “By the end of one month, you will see the maximum result.”
The cost of TrapTox
This type of treatment requires anywhere from 25 to 75 units of product per side, so 50 to 150 or even up to 200 units total, Dr. Idriss estimates. She guesses that, depending on where a patient is located in the U.S., they can expect to pay anywhere between $1,200 and $2,000 for TrapTox.
“But it does last anywhere from three to four or five months. And again, if you break that cycle, you might not ever need it again,” says Dr. Idriss. “There’s some sort of longevity to it, in some cases.”
My experience with TrapTox
Dr. Idriss injected both of my trap muscles with Dysport (for the spread!) about three months ahead of my wedding. I’ve always carried an inordinate amount of tension in my trap muscles — massage therapists have expressed genuine concern as to whether I’m okay — and with a job that includes excessive time spent hunched over a computer keyboard, I was beginning to fear the early signs of an oncoming hunchback.
I began to notice a release in the muscles around a week to two weeks later (but neuromdulators seem to always take a little longer to set in for me). I felt less clenched, less hunched and generally a little more upright. At the one-month mark, I did see some positive (though not drastic) aesthetic results, too — but I felt that my left trapezius muscle still sat a little higher and appeared bulkier than my right. I returned to Dr. Idriss for a touch-up on that side.
Another month of settling later, and I was pretty pleased with the overall effect: nothing too drastic that anyone else in my life would likely notice, but definitely enough that I did. My posture has never been better, and my shoulders no longer hover upward toward my ears quite as much when I’m stressed.
Before + After TrapTox
Left: My “before”; Right: My “after” Photos: Stephanie Saltzman/Fashionista
Ahead of my treatment, I’d worried that TrapTox might somehow cause even more posture issues or problematic muscle weakness that might negatively impact my workouts. (I’m not a lifter or intense exerciser by any means, but I do rely on my near-daily yoga practice to maintain some semblance of calm.) Dr. Idriss assured me that, most likely, I wouldn’t really notice much of a change in workouts, and that’s been true. I perhaps noticed a tiny bit of weakness in the area when it was first settling in, but only when I went to do my aforementioned incorrectly aligned chaturanga push-ups. Since you’re really not supposed to be using those muscles in correct form anyway, I think the treatment actually helped my yoga practice in that I can no longer compensate for my weak arms with those muscles – now, my biceps are able to get in on more of the action.
Overall, TrapTox definitely helped break the “cycle” of excessive trap tension Dr. Idriss talked about, and I wish I’d tried it sooner, for both the aesthetic and sensorial benefits.
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