Providing adequate anaesthesia is an important part of performing dermal filler procedures. Providing a better and more comfortable procedure for your client. 

Anaesthesia methods for dermal filler 

● Injectable

o Local infiltration 

o Ring blocks 

● Topical 

● Ice and other coolants 

The anesthetic method used is largely dependent on the sensitivity of the treatment area and the pain tolerance of the client as well as the need to preserve the baseline anatomy. Clients who have never had injectable cosmetic treatments previously may have higher anxiety levels and a lower pain tolerance and may require injectable anesthetics for a more comfortable procedure. Clients with high pain thresholds can be made more comfortable with the use of topical anaesthetics or topical coolants, especially when lidocaine-based dermal fillers are used which have less treatment discomfort. Sensitive areas such as the lips, almost always require injectable anesthesia regardless of the client’s pain threshold. 

Before using anesthetic: 

● Confirm that the client has no previous allergies to anesthetics or adverse responses with injectable procedures. 

● Confirm that the client has eaten in the last 3-4 hours to reduce the risk of hypoglycemia. 

● Address anxiety symptoms and defer the procedure if the client is particularly apprehensive. 

● Obtain informed consent 

Injectable anesthetics 

Lidocaine is the most commonly used injectable anesthetic used for dermal filler treatments. It has a fast onset of effect for pain reduction within a few minutes of being injected. Pressure, temperature and touch sensations are also reduced. 

Complications with injectable anesthetic 

● Vasovagal episode 

● Hypoglycemia 

● Anxiety 

● Bruising 

● Infection 

● Nerve injury 

● Allergic reaction 

● Anaphylaxis 

● Lidocaine toxicity of the central nervous system o Dizziness 

o Tongue numbness 

o Tinnitus 

o Diplopia 

o Nystagmus 

o Slurred speech 

o Seizures 

o Respiratory distress 

● Lidocaine toxicity of the cardiovascular system

  1. Arrhythmias 
  2. Hypotension 
  3. o Cardiac Arrest 

● Epinephrine adverse response 

  1. Tachycardia 
  2. Tremor 
  3. Anxiety 
  4. Local hypoperfus

Topical anesthetics 

 Topical anaesthetics are often used with dermal filler treatments due to their ease of use. With the incorporation of lidocaine into dermal filler products, discomfort is greatly reduced. Those clients with high pain thresholds can tolerate treatments with a topical anesthetic and a dermal filler product with lidocaine.

Topical anesthetics have the same mechanism of action as injectable anesthetics by blocking sensory nerves through neuronal impulse inhibition and they reduce discomfort associated with the insertion of the needle.

Commonly used topical anaesthetics

  • L-M-X (lidocaine 4%-5%)
  • EMLA (lidocaine 2.5%. prilocaine 2.5%) Complicationsoftopicalanesthetics
  • Allergic reactions
  • Lidocaine toxicity of the central nervous system
    • Dizziness
    • Tongue numbness
    • Tinnitus
    • Diplopia
    • Nystagmus
    • Slurred speech
    • Seizures
    • Respiratory distress
  • Lidocaine toxicity of the cardiovascular system
    • Arrhythmias
    • Hypotension
    • Cardiac Arrest

Ice and other coolants 

Ice may be applied to the skin immediately before injection for approximately 1-2 minutes, until the skin is erythematous but not blanched