Dental Block Vs. Numbing Cream - Which is Better for Cosmetic Injections?

Question

Why would the injector use a topical numbing cream verses a block, when the block is less painful for the patient? Is one better than the other?

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients to be concerned about pain and
discomfort when undergoing treatment with injectable fillers.For this reason, a variety of strategies have
been utilized to provide analgesia for these procedures.These usually include topical anesthetics and
the injection of local anesthetic agents.Each of these approaches has advantages and disadvantages when patients
undergo treatment with injectable fillers.Topical
anesthetics are relatively easy to use. These agents are simply spread over the
area before the procedure. They take approximately 10 to 15 minutes to work and
are moderately effective. The administration of these agents is pain free, but
doesn’t totally alleviate pain from the injection of dermal fillers. When
using injectable fillers, nerve blocks with local anesthetics are extremely
effective. This procedure is performed by infiltrating local anesthetic
intra-orally in the area of the infra orbital and mental nerves. This
effectively provides anesthesia of the upper and lower lips and surrounding
areas. This approach provides excellent anesthesia which is almost
instantaneous.When
this approach is utilized, patients don’t experience pain when fillers are
injected.Unfortunately, this numbness
may last for 2 to 4 hours. During this period, patients may have difficulty
with eating, speaking and may even drool.Pain
tolerance varies from patient to patient and for this reason anesthesia needs
to be individualized. Consultation with a board certified plastic surgeon who
is familiar with these anesthetic techniques is appropriate. This surgeon
should be able to provide the anesthetic methods that’s appropriate for the
problem.

David J. Levens, MD · Answer

Nerve blocks are similar to the anesthesia administered by your dentist.  Sometimes they work really well, sometimes not, sometimes too good, and last longer than desired.
An effective topical anesthetic should provide excellent anesthesia if properly compounded and properly used. 
The block can provide profound anesthesia but may be too much for a filler injection.  Therefore, I prefer topical anesthesia.

Richard W. Westreich, MD · Answer

Only certain types of filler injections have lidocaine in them, making the injection less painful. The most popular products, however, do not.
For nasolabial folds, eyelids, lip corners, and marionette lines I always use a "dental" block. These areas are well anesthetized with a small local anesthesia block. This block takes effect almost immediately. I like to ensure my patient's comfort because it is critical for precise injections.
Other areas, such as the frown line or the lip itself are not well covered by the dental blocks. In those instances I do use the topical cream, often in association with a formal block. The lips have too many nerves going to them to block completely. They are also very very sensitive. That is why I add the cream. Creams do work well, however, they have to be left on for a minimum of 30-45 minutes to be really effective, which is a lot of time for a patient to sit around and wait.

Steven Wallach, MD · Answer

It really depends upon the individual. Some patients don't require any topical. But that is the rare patient. I think it varies for different patients. I use topical for most patients. If they are very sensitive, I may perform a dental block after using an oral topical inside their mouth first. I tried to make my patients as comfortable as they want. It is always easier for both of us when the pateint is comfortable.

Michael A. Bogdan, MD, MBA, FACS · Answer

The dental blocks are more invasive than a topical cream, but are much better for pain relief.  The block is performed by injecting 1 to 2 ccs of local anesthetic right next to where a major nerve group comes out of the bones of your face.  The entire segment supplied by this nerve bundle then "falls asleep" for 1 to 4 hours.  If the block is performed through the mouth using some numbing cream or spray at the injection site, it can be painless.  There are relatively few nerve receptors inside the mouth, and those are very susceptible to the topical creams.
Topical numbing creams do work outside the mouth, but they take much longer to have effect.  The numbing cream has to "soak through" the skin to have its effect on the nerve receptor.  In areas with a high density of nerve receptors (around the lips!), this is really not sufficient, and the blocks are the only way to go.
The blocks do have some drawbacks.  First, since a long needle is used for the injection, there is a rare possibility of a visible bruise.  Second, if you numb both the upper and lower lip in the same session, all sensation will disappear from the lower eyelid to the chin for 1 to 4 hours.  This lack of proprioception will make you feel like you are drooling!  (Don't chew gum or eat a meal until the block wears off.)  In my mind, these minor drawbacks are worth the excellent pain relief.

Dental Block Vs. Numbing Cream - Which is Better for Cosmetic Injections?

Answers (5)

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