Anesthesia is important because a better job can be done on a patient who is comfortable, relaxed, and still. The environment should be pleasant. Before the visit oral medications can be given for pain including ibuprofen 800 mg or acetaminophen 2 grams. Propranol 40-8- mg, or Valium 10 mg can be given for anxiety.
Topical anesthesia
Eutectic mixture of local anesthetics (EMLA) is a mixture of lidocaine and prilocaine. It is spread on the skin and covered with plastic film for 30-60 minutes. After its removal, anesthesia lasts for 15-30 minutes. LMX-5 is a 5% lidocaine cream that lasts longer, about 30 minutes. Betacaine is a combination of lidocaine and prilocaine in a gel so it does not need coverage with a film dressing. Tetracaine gel is applied for 30-45 minutes under the dressing and lasts up to 4-6 hours. S-Caine Peel can give anesthesia within 20 minutes of application.
Cryoanesthesia
Applying ice before and after injection affords some anesthesia. Ice is placed for 30 seconds to get about 10-15 seconds of anesthesia. Rubbing the ice for about 5 seconds after injection also helps. When treating lips, ice should be placed for 60 seconds before injection.
Local anesthesia has the disadvantage of distorting the skin around the injection making it harder to see the effects of the filler.
Nerve blocks
The advantage of a nerve block is that one injection into a nerve can numb a large area of the face. Nerve blocks can be injected into the brow (supraorbital block) to numb almost half of the forehead. An injection into the upper cheek (infraorbital block) can numb the nose, cheek, lower eyelid, and upper lip. For this block anesthetic ointment is placed over the upper gum inside the mouth, then the needle is inserted above the gum directed at the cheek, and anesthetic injected. The nerve root above the cheek can also be stuck through the outside skin without going through the mouth. Other injection around the temple can anesthetize the outside eye, temple, and outside cheek. Blocking the nerve on the side of the chin either going through the lower gum or the skin will numb the lower lip mouth corner, chin and cheek. Another technique involves injecting anesthetic in 4-5 spots across the upper gum line and another 4 injections along the lower gum line to numb an entire area around the mouth.
The infraorbital nerve block to numb the upper lip and cheek
The mental nerve block to numb the lower lip
Injecting along the gum line to numb the upper and lower lip
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