I don’t trust a painless procedure. For it to work, it has to hurt—at least a little. Facials without the kind of high-pressure extractions that make your eyes water? Fat-melting devices that really, truly just feel “pleasantly warm” and not like a hot iron is branding your flank? A waste of time and money, in my mind.
It makes sense then that filler, the treatment that delivers my favorite results, is also the one I most dread getting. Whereas Botox, to me, feels like a quick, sharp, prickly pinch (a sensation I almost enjoy), filler feels like a heavy sludge, slowly forcing its way through tough layer after layer, making p-p-popping sounds along the way. It’s not even painful so much as uniquely strange, yet it never fails to blur my vision and break me out in a sweat. I have been responsible for dwindling the juicebox supply at many doctors’ offices in the Manhattan area.
Recently, I saw Dr. Jessie Cheung, a dermatologic surgeon with offices in Chicago and New York City, for a filler touch-up. I warned her that I tend to feel faint but I’m used to it by now and said she should feel free to keep working even as my skin drains of color and the crunchy paper under me starts to disintegrate. Instead of just handing me a useless stress ball, she suggested a nerve block. A few easy shots in my gums (“a lot less painful than injecting through the skin,” she says), and less than 30 minutes later, my face was entirely numb.
Dr. Cheung spent an hour injecting me with more filler than I’d ever gotten before—building out my chin, strengthening my jawline and cheekbones, correcting hollowness in my temples—and I barely felt a thing. I couldn’t believe no one had let me in on the secret before; but I’d also never had a doctor take such a thorough, whole-face approach. “Instead of treating just one area, performing a nerve block gives me more freedom,” she says. “Oftentimes, a wrinkle or depression needs to be treated by injecting not directly into it but around it.”
Once the intense swelling went down, I saw that she did for my chin what I thought only an implant could and made everything else look noticeably more symmetrical and structured. My best friend says I have a “little plum face” now, whatever that means. The lesson here? It doesn’t have to hurt to work, so long as your provider has your back in terms of pain management.
I asked doctors to share their other go-to techniques for lessening the sting/burn/forceful-sludge feeling. Don’t be a hero; ask about them at your next appointment.
Related: Off-Label Is the New Black: The Weird New Ways Doctors Are Using Filler
1) Talkesthesia
Granted, chitchat won’t physically shut off your nerves’ impulses, but there is plenty of anecdotal evidence that talkesthesia—when a provider speaks in a calm, steady cadence and distracts the patient with conversation unrelated to the treatment—works. “The experience of pain is often due to anxiety about the procedure more than actual pain,” says Dr. Ava Shamban, a dermatologic surgeon in Beverly Hills, California. “I find that talking to the patient throughout the procedure is quite effective at reducing anxiety and, therefore, pain. [With talkesthesia,] everyone feels great— without a hangover or aching—when the procedure is over.”
2) Numbing cream
Dr. Joshua Zeichner, a dermatologist in New York City, swears that numbing cream “absolutely works” and cuts the pain from the initial injection in half. For laser resurfacing, which he says is the most uncomfortable procedure he performs, he has patients arrive 90 minutes before their appointment time, to allow time for the high-potency cream’s effects take hold; for injectables, he lets it sit for 30 minutes. “All the fillers I currently use also contain lidocaine, so the injection itself has a numbing effect,” he says.
3) Vibrating facial massager
Your doctor’s version of a vibrator likely resembles a metal razor (some have a light for guidance) and works according to the gate control theory of pain. “The vibration confuses your nerve fibers that sense pain and shuts the gate on pain signals going to your brain. Your brain is overwhelmed and turns down the perception of pain,” says Dr. Cheung. “You can actually hold the vibrating tool anywhere on the body, to distract the brain—but I hold it right next to my injection site because it has a light and to stabilize the skin.”
Dr. Zeichner urges patients to ask about sterilization of these tools first, however, since some doctors may not properly clean them between uses. He prefers to tap the targeted area with his fingers, which serves “to distract the skin from the discomfort of the needle.”
Related: Sarah Hyland’s Latest In-Office Procedure Looked Super Painful—But It Still Might Be Worth It
4) Nitrous oxide
Both Dr. Cheung and Dr. Shamban say that Ultherapy is one of the more painful devices they work with and they use laughing gas to mitigate the discomfort and produce a calm, euphoric high that is out of the body’s system in minutes. Scalp injections, fat transfer, and the Y lift are other procedures that may require it, says Dr. Cheung.
5) NuCalm
NuCalm is a unique relaxation system for everyday meditation and cosmetic procedures alike. It uses a sleep mask to block natural light, electromagnetic frequencies that claim to interrupt adrenaline and cortisol release, and auditory hypnosis. “It puts you into parasympathetic nervous system dominance,” says Dr. Cheung, which is the “rest and digest” system that slows functions. The brand also makes a natural oral supplement that “creates deep relaxation without controlled substances, causes no side effects, and requires no recuperative time or supervision,” says Hinsdale, Illinois, dermatologist Dr. Christina Steil in a RealSelf Q&A, who adds that it’s a great option for patients who don’t have someone to drive them home after treatment.
