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Local Anesthetic for Dermal Filler Injections

Injections of dermal fillers are used as an aesthetic treatment to fill in unwanted wrinkles and scars. There can be substantial pain associated with dermal filler injections. For this reason, local anesthesia is often used to eliminate or minimize the pain. This local anesthetic can be administered one of two ways: either by injection or through the use of topical creams and ointments. Numbing cream for filler injections is most common. Anesthetic injections will ensure a more pronounced anesthetic effect. However, topical numbing cream will often provide adequate local anesthesia without the associated pain and inherent recognized risks that accompany injections.

Compounded Numbing Creams for Filler Injections

Many clinicians use compounded numbing cream for filler injections. The reason for using a prescription compound is that it can be supplied in much higher concentrations and also in multiple active pharmaceutical ingredient (API) form. There are studies that demonstrate the efficacy of the triple anesthetic formulation commonly known as BLT. There are some inherent risks associated with to the use of compounded topical anesthetic for dermal filler injections.

Legal Risk:

One problem with utilizing compounded numbing creams is that they require a prescription on a per patient basis. However, if a practice procures these prescription compounds by submitting a prescription for a multi-use container of the product, and then applies that numbing cream on multiple patients, that provider is committing a violation known as drug diversion. The risk increases in the event of any adverse event where the State Health Department or FDA is called in to investigate.

Cross Contamination:

risk of cross-contamination. The use of multi-use jars and tubes opens the product within the container to be contaminated at some point during the reopening and using stages between each new patient visit

Systemic Absorption:

Some pharmacists supply very high concentrations of anesthetic API’s, like lidocaine and benzocaine, in an effort to completely numb patients in preparation for a painful treatment. While this idea has merit in terms of increased numbing capability, it also exposes patients to the risk of adverse events derived from high API systemic absorption.

Are Dermal Filler Injections Painful?

Dermal filler injections are used all over the face; cheeks, lips, under the eyes (tear troughs), nasolabial folds (nose to mouth lines) and marionette lines (mouth to chin lines). This is important when discussing pain. Areas such as under the eyes, lips and cheeks are less painful than nasolabial folds and marionette lines. The areas associated with higher pain caused by dermal filler injections have a higher number of nerves that innervate the skin and deeper layers.


Most clinicians offer topical anesthetics (a numbing cream) before filler treatments to reduce pain sensations. Most topical anesthetics take between 15 – 60 minutes to take effect. It is a common belief that topical anesthetics make dermal filler injections less painful and therefore, more comfortable. In addition to topical anesthetics, many dermal fillers contain a local anaesthetic within the filler itself. This means after the first injection there will be further numbing to the treatment area.

Another factor to consider is the viscosity of the filler. Fillers that are injected deeper (for example cheeks) require a thicker filler in order to provide structural support for the tissue and skin layers above. This can be associated with a sensation of fullness or tightness in the treatment area.

Numbing Creams for Lip Filler Injections

There are many types of dermal fillers that can be injected in your lips and around your mouth. But the most common fillers today are products that contain substances similar to hyaluronic acid. Hyaluronic acid is a natural substance found in the body. It helps increase volume in your lips. Since these treatments can be painful, the majority of clinicians use numbing cream for lip injections.


The most common product brands of lip injections are:

  • Restylane
  • Restylane-L
  • Restylane Silk
  • Juvederm Ultra
  • Juvederm Ultra Plus
  • Belotero Balance
  • HylaForm
  • Elevess
  • Prevelle Silk
  • Captique

Some of these products contain lidocaine, a local anesthetic. This local anesthetic helps to numb the treatment area to reduce the associated pain. However, the initial injections can still cause pain. Further the lidocaine often causes additional initial pain when first injected. In order to ease the pain of both the lidocaine included injections and even, more so, those that do not include the lidocaine, most clinicians use a numbing cream for lip injections as a pain management pre-treatment method prior to the procedures. Using numbing cream for lip injections prior to the treatment helps to make the procedure much more comfortable and manageable. Without the use of numbing cream, clinicians have found that the procedure is most often too painful for the patients to manage.

How do Dermal Filler Injections Work?

Dermal filler injections, also known as “soft-tissue fillers,” do just what their name suggests: they fill in the area under the skin. Some dermal filler injections are natural and some are synthetic. They all work to improve the appearance of aging skin in the following ways:

  • filling in wrinkles, fine lines and deep creases
  • improving other imperfections like scars
  • filling out thin or wrinkled lips
  • plumping up cheeks
  • contouring the jaw line and other areas of the face

Most of these wrinkle fillers are temporary because they are eventually absorbed by the body. Some people may need more than one injection to achieve the wrinkle-smoothing effect. The effect lasts for about six months or longer. Successful results depend on health of the skin, skill of the health care provider, type of filler used.

Potential Risks Associated with Dermal Filler Injections

While properly administered dermal filler injections are very safe procedures, there remains a risk of complications related to them. Most common, although still infrequent, complications of dermal filler injections are infection and filler irregularity/ migration. The infection usually resolves with antibiotic treatment, if indicated. Small grannulomas (nodules) may resolve on there own, be treated with steroid injections, or , if noticeable and large, may be excised via small skin incision. One of the more serious complications associated with dermal filler injections is tissue necrosis, which results from occlusion of the small blood vessels feeding the area by the filler. This is extremely rare, however, if occurs, it usually leaves a patient with permanent scarring/ deformity.

Which Dermal Filler Injections are Best?

Various dermal filler injections are better used for various areas. One example of specific dermal filler products for a specific area is the use of Juvederm/ Restylane for lip augmentation. Another specific product for a particular use is the use of Radiesse for midface, nasolabial folds, temples, jaw line, etc. Choosing the right doctor is more important than choosing a filler. An appropriately experienced and well trained doctor will make the most appropriate determination in terms of which dermal filler to satisfy your personal needs.


The most common product brands of dermal fillers are:

Restylane®, Perlane®, Juvederm Ultra®, Emervel®, Stylage®, Restylane Vital®, SubQ®, Voluma®, Belotero®, Teosyal®.