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Nerve Block for Juvederm in Nose Crease or Smile Lines?

Asked 37 months ago by td031487 in ft myers florda
Sort 22 expert answers by:
+4

Nerve block not necessary

I used to do this but now I use a strong topical local anesthetic ointment and ice and the patients do just great without the nerve block injections.
Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
+3

I never use nerve blocks for those areas

I use nerve blocks only for lip augmentation. Quite simply, topical anesthetic, or mixing lidocaine with the Restylane, ice, vibration therapy, and injecting slowly are all better options. Nerve blocks increase the duration of swelling and the numbing prevents good assesment of the correction. It is also a while before you can talk right and eat because of the mouth weakness. Most of my patients like to go straight to lunch or to work after this procedure.
Mary Lupo, MD
New Orleans Dermatologist
+3

Nerve blocks are not required but frequently recommended

I appreciate that some patients do not like the odd sensation of nerve blocks. Injection of fillers into the areas you mentioned can be associated with considerable discomfort, depending on your individual pain tolerance. Alternatives to nerve blocks include pre-applying ice to the injection sites, topical anesthetic creams, and mixing the filler material with local anesthetic. You and your doctor should be able to develop a strategy that works for you. Good luck.
Bryan K. Chen, MD
San Diego Dermatologist
+3

Nerve Blocks for Juvederm?... or "No pain, no gain?"

Hi TD, Whether or not you receive a nerve block for Juvederm injections depends on your pain tolerance, as well as the "lightness of your physician's technique". Dr. Placik has thoroughly answered this question below, I would just add that Allergan will soon release Juvederm with local anesthetic already mixed into the syringe. Fortunately the old saying "No pain, no gain" is gradually changing to "No little discomfort, no gain". Be well and enjoy the Super... more
Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
+3

Many choices for diminishing Juvederm injection pain

There are several forms of diminishing the pain of Juvederm injections: 1) Distraction acupressure: using small ultrasonic or massage type devices over nerve points 2) Topical anesthetic creams 3) Ice compress to area immediately before injection 4) Topical ethyl choride sprays 5) Nerve blocks - injections at a distance from folds typically inside the mouth and similar to dental techniques 6) Direct injection of anesthetic to the area prior to Juvederm injection 7) Mixing of the Juvederm... more
Otto Joseph Placik, MD
Chicago Plastic Surgeon
+3

Multiple techniques

No, you don't need to have a nerve block. There are multiple techniques to anesthetize that area prior to injection. As with everything in medicine there are pluses and minuses. The most low tech would be icing. Pros - provides a brief anesthesia (seconds), doesn't distort the anatomy, short acting. Con - short acting, it will hurt soon after. The next method is being experimented with - vibration. This provides brief anesthesia by confusing your pain and vibration receptors in order to... more
Edward S. Lee, MD
Englewood Plastic Surgeon
+2

Nerve block depends on the patient, but not always a requirement

I find that many patients prefer a nerve block prior to filler injections into the nasolabial folds, but it is not a requirement. Many patients do very well simply with topical anesthetics only-- speak with your surgeon and he or she will provide you with several options and the advantages and disadvantages of each.
Shahram Salemy, MD
Seattle Plastic Surgeon
+2

Nerve blocks with injectables

While we offer nerve blocks for patients who prefer this, by far most patients get acceptable pain relief (and no local anesthesia hangover) with triple anesthetic cream applied to the areas before injection. Slow injection technique also helps. Nerve blocks can cause slight distortion of the tissues and numbness that persists after the injection period for about an hour. So most patients don't request nerve blocks and they certainly aren't necessary in all patients.
Brent Moelleken, MD
Beverly Hills Plastic Surgeon
+1

Nerve Block for Juvederm?

Hi, Now that we have anesthetic added to Juvederm, we rarely do blocks any more. We usually use a strong topical anesthetic along with ice to prevent bruising. Since the Juvederm numbs as it's being injected most of my patients don't want a nerve block anymore. Best, Dr. Liu
Grace Liu, MD
Newport Beach Dermatologic Surgeon
+1

Nerve block for juvederm in nose crease or smile lines?

 Hello, Yes, you can have a nerve block.  However, injection of the local anesthetic is also painful.  So, most patients with a plan to inject only a limited area will choose not to have local anesthesia / nerve blocks.  If a large area is to be treated then nerve blocks may make sense.
Michael Kulick, MD
San Francisco Plastic Surgeon
+1

Nerve block for juvederm in nose crease or smile lines is a good thing.

Different practitioners may vary on this point. We tend to make it as nice an experience as possible. We routinely do a nerve block. We also apply topical numbing medicine. We also have the patient apply a cold pack after the injections. In our experience, this tends to work out the best with the least anxiety and discomfort.
Jeffrey Roth, MD
Las Vegas Plastic Surgeon
+1

Painless Facial Fillers: Anesthetic Prior to Juvederm Injections

Nerve blocks are important in minimizing pain during injections of the lip and cheek area. In the area near the nose, there are several overlapping nerves that supply the anatomic area, and a single nerve block may not completely block the pain during injections. In these areas, I would recommend topical anesthetic creams prior to injection.
Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon
+1

Not necessarily

Patients differ in their tolerances to injectables. Some patients need no anesthesia, some use ice to cool the area, others want topical anesthesia, and some want nerve blocks. I usually start with the topical, and if the patient is uncomfortable, I use a nerve block. If I see I patient who required a nerve block with a previous injectable, then of course, I go straight to the nerve block the next time.
Leonard Lu, MD
Chicago Plastic Surgeon
+1

No, but it may be more comfortable

No. This is a sensitive area and you could have your doctor inject local anesthetic first, but you can have it done with just a topical anesthetic. It does hurt, but many patients tolerate it without the injection of anesthetic.
Ronald Shelton, MD
Manhattan Dermatologist
+1

Anesthesia for Juvederm

Good anesthesia allows for better, more even placement of fillers in the naso-labial folds. The two most common techniques that I use for anesthesia in this area: 1. Nerve block or lidocaine injection into the superior sulcus along the naso-labial folds. 2. Small injections of lidocaine directly into the skin along the folds.
Daniel Reichner, MD
Newport Beach Plastic Surgeon
+1

Nerve block not required for Juvederm injections, but you might prefer it

As you can tell form the many responses, doctors vary on this point.  In my experience, there are patients who have regular filler injections with or without nerve blocks. They choose, typically after experiencing the alternatives with me or prior physicians. You can have it your way.
Sutton Graham II, MD
Greenville Plastic Surgeon
+1

No need to have a nerve block for Juvederm

You do not need to have a nerve block to receive Juvederm or any dermal filler. In most cases I use an anesthetic ointment which helps considerably. You need to apply it about 20 to 30 minutes before your injection and it will numb up the skin. Some places prefer nerve blocks because they are faster. However, the nerve block can distort the area due to swelling. Additionally, the block can last several hours, which is not good if you have plans for the rest of the day....
David Shafer, MD
New York Plastic Surgeon
+1

The block is not necessary

Level of anesthesia is very much patient dependent, but it also depends on the injector. For nasolabial folds with a gentle injection, most patients do well with a numbing cream. Some patients like a nerve block, and some actually prefer not to have it.
Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon
+1

Yes, nerve blocks are the way to go

Nerve blocks are painless to do for the patient, quick acting, and makes the whole Juvederm experience pain-free. My patients love it when I do nerve blocks for them, especially for injections around the lips. Topical anesthetic creams are not helpful because the actual needle stick does not cause much pain, but rather it's the filling agent that hurts as it enters the dermis. Also, with topical anesthetic creams, the patient has to wait 30 - 45 minutes for the topical cream to start... more
Felix Kuo, MD
Long Island Dermatologist
+1

Nerve blocks are not necessary

When receiving injectible fillers there is a certain degree of discomfort involved. Numbing creams help a little, but mostly they help with the discomfort from the injection point. Patients will still feel discomfort as the filler is injected. Some patients prefer to have a nerve block because they are very sensitive to pain and do not want to feel anything. However, a nerve block can last for an hour or two and sometimes the swelling from the block can make it look like you need less... more
Jordana Gilman, MD
New York Dermatologic Surgeon
+1

Most patients don't need nerve block for Juvederm injections

The short answer is that most patients do not require it. Topical cream works very well if you wait enough time before injection. Adding ice helps a lot. I only do the block for patients who really like to have it based on previous injections. Nasolabial folds are not that painful but the lip lines could be a little more tender so i tend to be better prepared or this specific injection.
Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon
+1

Nerve blocks and fillers

Every patient differs in their need to have local anesthetic for facial fillers. Some patients just have the fillers injected, others have topical anesthetics, and still others require nerve blocks.
Steven Wallach, MD
Manhattan Plastic Surgeon
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