Anesthesia for Cosmetic Procedures
The American Society of Plastic Surgeons reports that of the over 15 million cosmetic procedures performed in the U.S. each year, 13.4 million (89%) were nonsurgical.(1) While there are many types of anesthesia used for cosmetic procedures, the most commonly used are EMLA cream, BLT cream, and infraorbital nerve blocks with 2% lidocaine with epinephrine.(2) Examples of nonsurgical procedures include Botox® injections, chemical peels, dermabrasion, facial fillers, laser hair removal, and microneedling.(3)
Microneedling is a new treatment which is gaining popularity for the treatment of scars and for facial rejuvenation. The treatment can be performed by a dermatologist and is an office-based procedure.(4)
For the treatment, the patient’s skin is cleansed and then a topical anesthetic (numbing cream) is applied to the area being treated. A cream, composed of benzocaine, lidocaine, and tetracaine, is the topical anesthetic widely used for cosmetic procedures, including microneedling, and has been shown to provide adequate anesthesia for laser resurfacing as well.(5) An article in the Journal of Clinical and Aesthetic Dermatology reinforces the importance of pain control. “Patient discomfort is an important consideration in aesthetic procedures, as is fear of needles, because it may cause anxiety in patients undergoing these treatments.”(6)
With microneedling, a dermatologist uses a dermaroller, a device with fine surgical needles, and rolls it over the skin, creating microinjuries. According to a major clinic’s newsletter, “as the injuries heal, the body produces capillaries, collagen and elastin that reduce fine lines, wrinkles and acne scars.” The procedure is also called collagen induction therapy (CIT) or percutaneous collagen induction (PCI).(3)
Laser Hair Removal (LHR) and electrolysis are two nonsurgical methods to remove unwanted hair. With LHR, the use of light creates heat which destroys the hair follicle. Electrolysis uses an electric current to destroy the root of individual hair follicles. Both procedures result in some pain.(7) In terms of pain control, “the combination of benzocaine 20%, lidocaine 8% and tetracaine 4% (BLT) is a common and effective combination. This preparation should only be applied by a licensed medical provider or nurse, as application of excessive amounts can result in toxicity.”(7)
Eyebrow microblading is gaining popularity as a way to thicken, shape and replace the appearance of eyebrows. For this procedure, the skin is numbed with a topical anesthetic, and thin cuts are made in the eyebrow area, before pigment is applied.(8)
(1) Jack, M. MD, Pozner, J. MD, Plastic and Reconstructive Surgery Journal, Putting it All Together: Recommendations for Pain Management in Nonsurgical Facial Rejuvenation, https://pubmed.ncbi.nlm.nih.gov.
(2) Zdybski, J. MD, Dermatology Online, Topical Anesthesia in Cosmetic Dermatological Procedures, http://www.odermatol.com.
(3) Mayo Clinic, Cosmetic Surgery, https://www.mayoclinic.org.
(4) Doddaballapur, Satish, Journal of Cutaneous and Aesthetic Surgery, online article, Microneedling with Dermaroller https://www.ncbi.nlm.nih.gov.
(5) Hashim, P.MD, Nia, J. MD, et. al., Dermatology News, online article, Local Anesthetics in Cosmetic Dermatology https://www.mdedge.com.
(6) Boonsiri, M. MD, Diaz, DeAnna MS, et. al., Journal of Clinical and Aesthetic Dermatology, online article, Comparative Study of Compounded Aesthetic Benzocaine/Lidocaine/Tetracaine With and Without Abrasive Particles https://pubmed.ncbi.nlm.nih.gov.
(7) Reeves, C. PhD, Deutsch, M. MD, University of California, San Francisco, UCSF Transgender Care, Hair Removal, https://transcare.ucsf.edu.
(8) Draelos, Z. M.D., Dermatology Times, Dermatologist Discusses Permanent Eyeline, Microblading, https://www.dermatologytimes.com.