I don't respond/numb to topical anesthetics- can I get local nerve blocks instead?
Doctor Answers 1
Nerve blocks are possible for laser treatment, but specific lasers have other pain relief, or need heat feedback from patients
Thank you for your question. You submitted a question without a photo, stating you don’t respond to topical anesthetic, so ask if it is possible to get nerve blocks for laser treatment.
I can give you some guidance with this question as we have several lasers in our practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been performing laser treatment in my practice for over 20 years in Manhattan and Long Island. The basic answer to your question you’re asking is yes, but you didn’t specify what type of laser treatment are you getting, so I need to explain a little about that.
When it comes to topical anesthetics, there are many different choices. We actually get topical anesthetic that’s custom formulated by a compound pharmacy to work a little more effectively than what is generally commercially available. That said, that topical anesthetic can really be very helpful, but depending on the kind of laser treatment, it may not be adequate.
Let’s say for example you’re having some type of resurfacing, or the most limited level which is a micropeel, where you might be more sensitive than someone who tolerates this with topical. After the CO2 laser, the early Erbium lasers came out at the mid to late 90s, and it was commonplace for colleagues to say the patient can tolerate it. I remember just putting a few spots of that laser and my patient was uncomfortable. I decided then to treat this like any other procedure and give local anesthetic. For a physician, performing local anesthetic is perfectly fine.
There’s a more modern example we have in our practice which is the Q-Switch laser that we use for tattoo removal. It is routine and standard practice to use topical anesthetic for that laser. Since tattoo pigment is so deep in the skin, when the laser hits the tattoo pigment, it literally explodes, which can be pretty uncomfortable, so I routinely give local anesthetic for that treatment.
There are other examples such as laser hair removal, which in our practice is done with the Nd:YAG laser. For laser hair removal treatment, we use a device that blows cool air onto the skin so it cools the top layers of the skin with an anesthetic effect, which makes the heat energy of the laser less significant.
For pulsed light treatment, you could use a cold roller on the skin to make the skin cold before you apply the pulsed light.
Again, the answer to your question is r can use a local block. There’s only one situation where we don’t use a local block, but it is not indicated when we do non-surgical skin tightening and fat reduction using long pulsed Nd:YAG laser. This is a kind of situation where we want to hit a target temperature, so we want the patient to be able to tell us if the skin is getting too warm. The same applies to a device like Pellevé when you’re using radiofrequency to heat the skin where you actually don’t want the person to be numb because you want the feedback. If you go above a certain temperature, it’s kind of an intrinsic safety, but because it’s long pulse, the heating is more gradual, which is more tolerated.
I think that if you’re uncomfortable where you are currently going for the laser, and if you are going to a place where laser treatment is done by an aesthetician or someone not licensed to do injections, they may be trying to dissuade from doing that. I think you’re better off finding a physician and figuring out that maybe there’s an alternative laser or other treatments. If you need local anesthetic, by all means, get the local anesthetic. I hope that was helpful, I wish you the best of luck, and thank you for your question.