If you’re anything like most people considering the "arm bar" birth control, you’ve probably spent a late night or two scrolling through forums. You’ve seen the photos of bruised biceps. You’ve heard the horror stories about "losing" the rod in your body.
But honestly? The actual process of how is nexplanon inserted is remarkably fast. Most clinicians can get the whole thing done in under a minute once you're numb. It’s a minor surgical procedure, sure, but it’s closer to getting a deep piercing or a specialized shot than actual surgery.
The Setup: Getting Comfortable
You’ll start by sitting or lying down on the exam table. The provider—usually a doctor, PA, or nurse practitioner who has been specifically trained by Organon (the manufacturer)—will ask you to bend your non-dominant arm. You'll basically be "flexing" with your hand up near your ear.
This isn't just to show off your muscles. It helps the provider find the sweet spot: the inner side of your upper arm, roughly 8 to 10 centimeters above the "funny bone" (medial epicondyle). They’re looking for the groove between your biceps and triceps, though the goal is to stay away from the deep blood vessels and nerves that live there.
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They'll take a surgical marker and make two or three little dots. One is for the entry point, and the others help them line up the trajectory of the implant.
The Part That Actually Bites (The Numbing)
Here is the truth: the numbing is the worst part of the whole day.
Your provider will use a small needle to inject a local anesthetic, usually 1% lidocaine with epinephrine. You’ll feel a sharp pinch, followed by a stinging or burning sensation that lasts about five to ten seconds.
It’s annoying, but it’s quick.
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Once that’s in, they’ll wait a minute or two. They might poke you with a pair of tweezers or the tip of a needle to ask, "Do you feel this?" You shouldn't feel pain—just a weird pressure. If you still feel a "bite," tell them! There’s no prize for being a martyr, and they can always add a bit more numbing juice.
How Is Nexplanon Inserted Into the Skin?
Now for the main event. The Nexplanon comes in a pre-loaded, sterile applicator that looks a bit like a high-tech white and purple stapler.
- The Puncture: The provider stretches your skin tight. They insert the tip of the needle at about a 30-degree angle. This is just to get through the top layer of skin.
- The Tenting: This is the "expert" part. Once the needle tip is under the skin, the provider lowers the applicator so it's parallel to your arm. They "tent" the skin—lifting the skin up with the needle—to make sure the implant stays subdermal (just under the surface) rather than going too deep into the muscle.
- The Slide: They slide the needle in to its full length. You might feel a lot of pressure here, almost like someone is pushing a pen against your arm, but you shouldn't feel "sharp" pain.
- The Release: The provider unlocks a purple slider on the top of the device and pulls it back. This retracts the needle into the device, leaving the 4cm flexible plastic rod exactly where it needs to be.
That’s it. No stitches. No scalpels. Just a tiny hole that looks like a slightly large vaccination mark.
Verification: The Finger Test
Immediately after the applicator is out, your provider will do something very important: they will feel your arm.
They’ll use their fingers to palpate both ends of the rod to make sure it’s actually there. Then, they’ll guide your hand to your arm so you can feel it too. It feels like a small, firm matchstick or a piece of spaghetti under your skin.
Pro tip: If you can't feel it right then and there, don't let them send you home. If it’s not palpable, it’s either not in there or it’s too deep, and they might need to use an ultrasound to find it.
The Aftercare (And the Bruising)
They’ll clean the area and usually put on two things:
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- Small adhesive strips (Steri-Strips): These keep the tiny puncture wound closed.
- A pressure bandage: This is a wrap that goes around your whole arm.
Keep that pressure bandage on for at least 24 hours. Honestly, keep it on as long as you can stand it within that first day; it’s the only thing that prevents the "I got hit by a truck" look. Bruising is extremely common. Don't be surprised if your arm turns a lovely shade of purple or yellow for a week.
Common Concerns and Reality Checks
People worry about the implant "traveling" to their heart or lungs. While there have been incredibly rare reports of this in medical literature, it almost always happens because the provider accidentally inserted it into a deep vein rather than the fatty tissue just under the skin. This is why the tenting technique and specialized training are so emphasized now. If you can feel the rod with your fingers, it’s not in a blood vessel.
Another big one? Weight gain.
While the FDA label mentions weight gain as a potential side effect, the clinical data is a bit of a mixed bag. Many people start the implant during life stages where weight naturally fluctuates. That said, about 1 in 10 people in studies stopped using it because of side effects like mood changes or weight. Everyone's body reacts differently to the progestin-only hormone.
Actionable Next Steps
If you’re ready to get this done, here is your checklist:
- Check your cycle: It’s best to get Nexplanon inserted within the first five days of your period. If you do that, it’s effective immediately. If you get it at any other time, you need to use a backup method (like condoms) for a full 7 days.
- Ask about the training: When you call the clinic, it’s perfectly okay to ask, "Is the provider certified for Nexplanon insertions?"
- Plan your outfit: Wear a sleeveless shirt or something with very loose sleeves. You don’t want to be struggling with a tight sleeve over a freshly wrapped, sore arm.
- Stock up on Ibuprofen: Your arm will likely ache for 48 hours once the lidocaine wears off. Having some Advil or Tylenol ready to go makes the first night much easier.
Keep the area dry for at least 24 hours. After that, you can take the wrap off, but leave the Steri-Strips until they start to peel on their own. If you see pus, feel extreme heat, or get a fever, call the office—though infections are quite rare, they're the one thing you don't want to ignore.