Dermal filler injections are second only to Botox in popularity for non-surgical facial rejuvenation. There are a number of different ways to provide anesthesia during dermal filler injections. These include ice, topical anesthetic, dental blocks, and local anesthetic mixed with the filler itself. The choice of anesthetic depends on the type of filler used and the area of injection. This discussion will focus on the hyaluronic acid fillers, namely Restylane/Perlane and Juvederm Ultra/Ultra Plus.
Topical anesthetics include 2% lidocaine gel and a triple anesthetic gel composed of 20% benzocaine, 6% lidocaine, and 4% tetracaine, (BLTgel). I find the BLT gel is more effective that the lidocaine gel alone. Dental blocks with 3% Polocaine are painlessly given with a tiny 30 gauge needle to anesthetize the upper and lower lips and peri-oral region. Recently, clinicians have started mixing small amounts (0.2-0.3 cc) of 2% lidocaine with epinephrine with the hyaluronic acid gels with high patient satisfaction. Medici, the maker of Restylane/Perlane has introduced a pre-packaged mixture of 0.3% lidocaine with Restylane/Perlane in Europe. It is not available in the US, yet.
Glabellar creases, lateral sub-brow fat augmentation, nasolabial folds (laugh lines) and melolabial folds (frown lines) respond well to either pre-injection icing or topical anesthetic gel. Tear trough (depressions on the inside corners of the lower lids) injections typically require anesthetic to be mixed with the filler in addition to icing. Lip augmentation and injections to the outer corners of the mouth almost always require a dental block for adequate analgesia.