Mixing Juvederm Ultra Plus with 0.1% lidocaine and 1: 10,000 epinephrine. Pros and cons?

Juvederm can be modified with either Lidocaine or Saline.  Some injectors like epinephrine in certain areas as it can decrease acute swelling.  Each injector will have nuances which he or she will use to create the best results based on patient area and patient's individual anatomy.

There is no harm in mixing a small amount of lidocaine into Juvederm Ultra Plus. Juvederm Ultra Plus XC and Juvederm Ultra XC which are the newer formulations of the product already have lidocaine mixed into it so adding additional lidocaine to these products is pointless. Juvederm Voluma also comes pre-mixed with lidocaine.

Fillers can be modified for certain facial areas by thinning them, typically with a local anesthetic. Most fillers purchases today already have a small amount of lidocaine in them to provide pain relief during the treatment. Thus, the local and adrenaline do not provide any numbing or bruising benefit typically but they do thin the filler, as you mentioned, creating more subtle results. A better option than thinning Ultra Plus would be to use Ultra which is a naturally more thin and softer filler. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Hello,I don't see any logic in doing this.  The lidocaine won't make it hurt less since it is so dilute and can't take effect until after you were injected (and felt the pain).  Perhaps if you keep doing multiple need sticks into the same area, it might help a bit with pain on the subsequent injections.  The epinephrine causes vaso-constriction, but that requires 5 to 10 minutes to take affect.  If the needle hit a blood vessel, then you already have leaked the blood out into the tissue well before the vaso-constriction took affect.  Lidocaine and epinephrine are valuable when injected 10 minutes before a procedure, not simultaneous to the procedure.  Furthermore, the act of mixing the Juvederm wastes some of it and risks contaminating it.  And lastly, it really doesn't make it any easier to mold.