Nexplanon is inserted just beneath the skin of your upper arm through a quick procedure that typically takes less than five minutes. A healthcare provider uses a pre-loaded applicator that looks similar to a large pen, which slides a small, flexible rod (about the size of a matchstick) into place while retracting the needle. The whole process is done under local anesthesia, so you feel pressure but little to no pain.
Where Exactly It Goes
The implant is placed on the inner side of your non-dominant upper arm, in an area overlying the triceps muscle. The specific spot sits about 8 to 10 centimeters (roughly 3 to 4 inches) above the bony bump on the inside of your elbow, and slightly behind the natural groove between your biceps and triceps. This location was chosen because it’s generally free of major blood vessels and nerves.
During the procedure, you’ll be asked to bend your arm at the elbow and place your hand behind your head, or as close to that position as you can get. This flexion shifts a major nerve in the arm away from the insertion site, reducing the already small risk of nerve injury.
How You’re Numbed
Before anything touches your arm, the provider cleans the area and injects a local anesthetic into the skin at the insertion site. This numbing shot is the part most people say is the worst of the entire experience: a brief sting and some burning that fades within seconds. Once the area is numb, you shouldn’t feel the implant going in. You may feel some pressure or a tugging sensation, but not sharp pain.
The Insertion Step by Step
The implant comes pre-loaded inside a single-use applicator. Your provider punctures the skin at roughly a 30-degree angle with the applicator’s needle, then immediately lowers it so the needle runs nearly flat, just under the surface of the skin. As the needle advances, it “tents” the skin upward, which is how the provider confirms the implant is staying in the correct shallow layer rather than going too deep.
Once the needle is fully advanced, the provider slides a mechanism on the applicator that retracts the needle backward while the implant stays in place beneath your skin. Think of it like pushing a stick of chapstick down while pulling the tube away. The needle never goes deeper into your arm; it comes back out the same entry point, leaving just the tiny rod behind.
The entire hands-on part, from needle in to needle out, takes about 30 seconds to a minute.
Checking That It’s in Place
Immediately after insertion, your provider will press along the area to feel the implant through your skin. You’ll be asked to do the same. You should be able to feel a small, thin rod sitting just beneath the surface. If neither of you can feel it, the provider will use imaging (such as ultrasound or a specialized X-ray, since Nexplanon is designed to be visible on imaging) to confirm it’s there. Until placement is verified, you’d need to use a backup method like condoms.
After you leave, check periodically that you can still feel the implant by gently pressing the area. If you ever can’t find it, contact your provider.
When It Can Be Inserted
If you’re not currently on hormonal birth control, the recommended window is between day 1 and day 5 of your menstrual cycle. Inserted during that window, it’s effective right away. If it’s placed at any other time in your cycle, you’ll need to use backup contraception for 7 days.
If you’re switching from the pill, the implant is ideally placed the day after your last active pill. Switching from an injectable? It goes in on the day your next shot would have been due. Coming from another implant or an IUD, the new one is inserted the same day the old device is removed. After a first-trimester miscarriage or abortion, it can be placed within 5 days. For postpartum placement, the typical window is 21 to 28 days after delivery, or after the fourth week if you’re breastfeeding.
What to Expect Afterward
Your provider will apply a small adhesive strip over the insertion point and then wrap your arm with a pressure bandage. Keep the pressure bandage on for 24 hours. The smaller adhesive bandage underneath should stay on for 3 to 5 days. Avoid heavy lifting or strenuous activity with that arm for the first day or two.
Some bruising around the site is normal and can look dramatic, spreading across a few inches of your inner arm over the first week. In a study of 659 insertions, about 5.6% of patients had a documented complication, and most were minor: insertion site pain (2.6%), arm pain (less than 1%), and bruising (less than 1%). Numbness, itching, and rash were each reported in roughly half a percent of cases. Serious complications from the insertion itself are rare.
How Long It Lasts
Nexplanon is currently approved for up to 5 years of pregnancy prevention. At the end of that period, it must be removed. If you want to continue using an implant, a new one can be placed through the same small incision on the same visit. Removal involves another round of local anesthetic, a tiny cut in the skin, and the provider grasping and sliding the rod out, which typically takes just a few minutes longer than insertion did.