It doesn’t have to be. From patient to patient, there is a wide range of tolerance for discomfort. Because of that, I always err on the side of “chicken.” Seriously, my philosophy is that comfort during the procedure is as important as a great result. By using a variety of topical and oral medications my patients feel very little if any pain. I recently trained an office and it never occurred to them to use numbing for injectables–so that might be the majority. I may go above and beyond, but I consider it my role to make things as comfortable as possible. I find numbing and then injecting very slowly is less traumatic. I also mix lidocaine with epinephrine and sodium bicarbonate with some dermal fillers. This closely mimics the PH in our bodies and lessens the discomfort. My sessions last longer because of the prep, but it is well worth it for those who anticipate having to suffer.