Nerve Block for Juvederm in Nose Crease or Smile Lines?

Doctor Answers 24

Nerve block not necessary

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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.

I never use nerve blocks for those areas

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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 P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Nerve blocks are not required but frequently recommended

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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

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

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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 Bowl down there in the Sunshine State.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Many choices for diminishing Juvederm injection pain

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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 with anesthetic (off-label)

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Multiple techniques

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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 decrease the sensation of pain.

  • Same Pros and Cons as ice.

Topical anesthetic

  • Pros - anesthesia will last longer than with icing, will not affect underlying muscles, doesn't distort anatomy.
  • Cons - not always 100% numb, takes 20-30 minutes to set after being applied, may cause allergic/skin reactions

Local anesthetic - in the area

  • Pros - provides good anesthesia for a sufficient duration, can be mixed with fillers (off label for some, pre-mixed with others).
  • Con - distorts the anatomy.

Nerve block

  • Pros - excellent anesthesia usually 100% numb.
  • Cons - may distort local anatomy as the muscles may be paralyzed making the fold shallower than it normally is, takes hours to wear off, involves additional injections. Hope that helps

Edward S. Lee, MD
Englewood Plastic Surgeon

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

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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, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Nerve blocks with injectables

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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
4.9 out of 5 stars 194 reviews

Numbing Cream enough

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Generally, only a numbing cream or icing is necessary before the treatment to reduce discomfort. Nerve block is not necessary. Juvederm comes with lidocaine as well, which helps to ease the pain associated with the injection process.

I agree with Dr. Rand

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I apply topical anesthetic, if the patient desires. Also ice, if the patient desires. However, most patients do fine without any anesthesia.

Christine Glavey, MD (retired)
Alpharetta Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.