Is it standard practice these days to mix the anesthetic in with the product?

My doc has started mixing the anesthetic with the restylane. It thins the product and it seeps out at the injection sites temporarily. Im wondering if this is normal?

Doctor Answers 9

Anesthetic and Fillers

Most every filler (except belotero and sculptra) come with anesthetic mixed.  However, some doctors try to change the property of the filler by mixing in larger amounts of anesthetic to be able to limit complications, provide more numbing, or use the filler in other areas or for a different intended purpose.  If you are concerned please speak to your physician.  Best, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

Filler dilution with anesthetic

Dear cypress107:

Thanks for this question! Historically, since the time of collagen, silicone and other materials for injections, anesthetic was pre-injected or not injected at all for the use of improved facial creases and lines. 

Since the advent of Hyaluronic Acid (HA) gels and the growth of the cosmetic injectables market, both patients and physician injectors requested the various pharmaceutical companies to add an anesthetic to the mix for patient comfort. Nearly all fillers now have lidocaine in small amounts to improve the patient experience. 

Each filler has it's own physical properties, particularly its viscosity or ability to slide through the needle. 
There are so many injectables now that diluting a product may add more versatility for the physician who wishes to limit the number of different types of fillers he or she carries. Dilution increase the volume but not the quantity or quality of the product.The extra anesthetic is absorbed and a lesser concentration of the filler has been delivered over the area or volume of tissue. 

One subtle technique is stopping the injection prior to needle exit so gel will not "seep" out. A more dilute product may do this and with my technique, not desirable. 

You may wish to discuss the use of mixing added anesthetic with your injector.

Choose your injector carefully. Look for a Board Certified Plastic Surgeon, ENT Facial Surgeon or Dermatologist with a large injectables practice to provide for you the filler that "fits your needs" the best. 

All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 82 reviews

Dermal fillers and anesthetics

Years ago, physicians would mix anesthetic into the dermal fillers to make it more comfortable for patients.  However, nowadays, many of the dermal fillers come premixed with anesthetic at the time of manufacturing and anesthetics do not need to be mixed in.  The best recommendation is to ask your physician/injector why he/she mixes in it as there may be another reason for doing this.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Mixing anesthetics with fillers

Hello Cypress107,

Almost all of the fillers used these days have small amounts of lidocaine included to help with the discomfort of the injection.  The most notable product that does not is Sculptra which is mixed with lidocaine and saline.  I would recommend you discuss your concerns with your injector to find out why he or she is using that technique.  If you aren't happy with the reason or with your injector then I'd recommend you consult with a facial plastic surgeon, plastic surgeon, or dermatologist for different options.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Is it standard practice these days to mix the anesthetic in with the product?

I appreciate your question.

Since Restylane contains lidocaine in it, I don't mix any more in it. 

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.

Best of luck!

Dr. Schwartz

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

Is it standard practice these days to mix the anesthetic in with the product?

Restylane typically contains Lidocaine. However, you can thin the product or create a product that can be placed more superficially by adding Lidocaine to the filler. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Mixing Fillers With Lidocaine

Most of the newer fillers, with the exception of Radiesse and Belotero, already have lidocaine mixed in with them. Unless I am using those two fillers then I don't usually mix in any more lidocaine. But, i'm sure different injectors have different practices.

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 10 reviews


Most fillers on the market come with anesthetic mixed in however some practitioners prefer to mix anesthetic in. It's all preference and should not make a difference in your results. 

Payman Danielpour, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 38 reviews

Mixing Product with Lidocaine

Some doctors mix the product with lidocaine to inject it "smoother" in other areas such as the temple, hands, and other areas.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

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.