PurposeTo determine if skin cooling decreases the pain associated with periocular botulinum toxin A injections.MethodsIn this prospective study, 14 patients given bilateral periocular injections for blepharospasm or wrinkle reduction were included. Prior to the injections, one side received a skin cooling agent and the other side served as the control. Relative pain scores were recorded to assess the effects of treatment.ResultsThe range of pain scores on the noncooled side was 3 to 10 (average, 6.5); scores for the cooled side ranged from 0.5 to 7 (average, 3.6), which represents a 45% reduction in pain score.ConclusionsIn most patients, skin cooling decreases the pain associated with periocular botulinum toxin A injection.