Dangers of Barbie Botox: should Trap Tox be done for aesthetics?

A new trend is causing controversy in medical aesthetics – Trap Tox or Barbie Botox – aimed at making the female neck and shoulders appear more feminine. Although this treatment – injecting the trapezius muscles with botulinum toxin – has been carried out as a medical procedure for many years to treat tension and migraines, there are significant concerns when it comes to doing this procedure solely for aesthetic purposes.

In this blog, Dr Tim Pearce explores why women are asking for Trap Tox to achieve a longer-looking neck, whether it has become a trend and been dubbed ‘Barbie Botox’ thanks to the box-office-record-smashing Barbie movie, what medical conditions are usually treated by injecting botulinum toxin into the trapezii, and why it could be dangerous to consider offering this treatment.

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Why do patients want ‘Trap Tox’ treatment?

The concept behind the so-called ‘Barbie Botox’ trend – pushed front and centre by the release of the recent Barbie movie – is that Barbie does not have trapezius muscles and has a long neck. Women want to look like Barbie; hence, they seek to relax their trapezius muscles with botulinum toxin, or Botox, to mimic a Barbie neckline.

If you look at the shape of a Barbie doll, she has no trapezius muscles and lacks any elevation from the shoulders to the neck; the doll is cast with complete right angles, flat shoulders, and a long neck, unlike any human where these muscles are required to support the head. This look is, however, associated with a desire for a certain type of femininity – non-typical female, slender, young, doll-like shapes – and women are trying to achieve it by shrinking their trapezius muscles to elongate the neck; a look that is perceived as more elegant.

What medical conditions are helped by relaxing the trapezius muscles with botulinum toxin?

This procedure has its origins in medical interventions for treating conditions like torticollis (stiff or wry neck) and as part of the injection protocol for treating migraines with botulinum toxin where the trapezius is injected during a series of injections across the back of the head and neck.

The medical practice has therefore been in use for some time, but what has changed is the indication – from tension in the muscles causing neck pain which may trigger migraines as a medical intervention, to simply wanting to reduce the size of the muscles for cosmetic reasons.

However, it is not a new idea to want to shrink a muscle with the help of botulinum toxin. Aesthetic medical clinicians also treat and reduce the masseter muscles, often in patients with bruxism (teeth grinding) for both medical and cosmetic effects including jaw slimming.

Similarly, some practitioners also treat the muscles in the calves with botulinum toxin to achieve a thinner, more slender lower leg which is regarded as more attractive. Although, Dr Tim is unsure of its merits and notes that he does not find a very narrow, tapering lower leg any more attractive than a leg with a curvature to it, he acknowledges that such ideals are often influenced by different cultures.

Why might Trap Tox be dangerous?

The biggest downside to the so-called Trap Tox treatment is that to achieve a significant difference in the neckline, you will have to create a weaker muscle, but this is one of the locations in the body where the muscle needs to be at its strongest. If you consider the forces that are imposed upon the head and neck, the point with maximum leverage on the neck is right where you are planning to cause atrophy, which is a concern for Dr Tim.

Although there is no clinical evidence to suggest that such a treatment is likely to cause a problem, it makes intuitive sense to avoid it because there will be a small number of patients who will experience a negative outcome from the treatment of the trapezius muscles.

Dr Tim explains that he has noticed some similar adverse feedback in patients who have undergone treatment of their platysmal bands with botulinum toxin. There are patients who notice that their head feels heavier and complain that it is harder to perform certain tasks, for example, sitting up straight, or doing sit-up exercises which require the use of the platysmal muscles as a contributory muscle for lifting the head. This would potentially be worse and more noticeable in those where you have treated the trapezii, one of the largest muscles that support the neck and head. Doctors are already urging caution when it comes to Barbie Botox.

Should aesthetic clinicians be quick to jump to providing trends like Barbie Botox?

Dr Tim warns that if there is one important lesson that he has taken on board after a decade and a half of practising in Medical Aesthetics, it is not to be the first to rush in when new treatments or products are announced or launched.

His reticence is vindicated when he notes that, even in the last year, there have been three different complications that have emerged from the use of new procedures. These ‘new things’ often enter the aesthetic sector with a big fanfare and with everyone talking about them, only for practitioners to discover six months or so later that they are resulting in adverse side effects which cause misery for a small number of patients. Sadly, this is not discussed until the complications start to occur.

Of course, aesthetic clinicians do not want to be somewhat ‘left behind’, especially if patient enquiries increase, but Dr Tim would advise that you become quite comfortable with the FOMO (fear of missing out) when it comes to new, untested procedures. Observe what happens, learn from it, and then if you decide it is the right thing to do, you can train and incorporate it into your services.

Check out more blogs on following social media and celebrity trends, including:

• TikTok lip filler trend: Should you offer lip taping for butterfly lips?
• Managing patient expectations: “I want to look like a celeb”

Is the Barbie movie responsible for the Trap Tox trend?

There is a certain amount of irony when it comes to the increased popularity of Trap Tox treatment and its rebranding as Barbie Botox. The messaging in the Barbie movie is about ‘sticking it to the patriarchy’ but what we have ended up doing is using the attention that Barbie is getting to sell more treatments, making women feel a bit less comfortable in their skin because now they are told there is a problem with a trapezius muscle that they did not know existed beforehand.

This is always the conflict in medical aesthetics, explains Dr Tim. We want to empower people (women and men) to feel better, but by coincidence or accident, we first make them feel worse about something that they would never have noticed, to create a new way to compete with other aesthetic treatment providers.

Barbie is a caricature; if you met a real person who looked like Barbie, it would be quite frightening because her proportions are more alien than human. For decades, Barbie has been criticised for promoting unrealistic beauty ideals; yet here we are with a new trend extolling the virtues of an unrealistically long neck and proposing a muscle-weakening procedure to achieve it. Have we not learned anything from past debates? Perhaps, as aesthetic clinicians, we can help to reframe beauty aspirations based on women having healthy trapezius muscles, being strong and working out at the gym to achieve ‘trap definition’ instead? Empowering strong, more muscular women as a beauty ideal?

Aesthetic clinicians must conduct proper and full medical consultations with their patients, guide them, and make them aware of both the pros and the cons of treatments like Trap Tox. There will be patients who have an aesthetic concern that is holding them back, which you could improve with this procedure, but Dr Tim does not believe that we should be aiming to erase the appearance of the trapezius muscle to achieve the Barbie doll look.

Dr Tim is always keen to hear about the experiences of his followers; have you been asked for Barbie Botox, are you carrying out Trap Tox procedures? You can find Dr Tim Pearce on Instagram if you have any comments or questions.

Botox® is a registered trademark of Allergan Aesthetics plc.

Aesthetics Mastery Show

‘Barbie’ Botox can be dangerous! Should ‘trap tox’ be done for aesthetic purposes?

Dr Tim says:

“I want to get to the bottom of whether the ‘no traps’ look is more attractive. Which image do you find more attractive at the end of this video? 1 or 2?

“This new trend is causing controversy in the aesthetics industry. ‘Barbie’ Botox or ‘trap tox’ is a growing trend amongst women to make their neck/shoulders appear more feminine. Whilst this procedure has been done for years to treat medical conditions such as migraines and tension, there are downsides to this procedure when done for aesthetic purposes alone…”

Watch the full Aesthetics Mastery Show here.

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