Reducing pain with Botox, Dysport, Restylane, Juvederm, and Perlane injections: the roles of topical anesthetic cream, laughing gas, ice, and dental blocks (Plano, Frisco, McKinney, Allen, Flower Mound, Lewisville, Dallas, Carrollton, Southlake)
Injectables such as Botox and Dysport are great for reducing wrinkles between the eyes (glabella), in the forehead, and along the crows’ feet regions. Injectables such as Restylane, Juvederm, and Perlane are great for filling wrinkles around the mouth and cheeks, restoring facial volume, and improving lip definition and volume.
Unfortunately, these procedures can be uncomfortable. Though ice is often sufficient to make Botox and Dysport easily tolerated, it is usually insufficient for Juvederm, Restylane, and Perlane injections.
Let’s face it: no one likes pain.
What can we do to reduce the pain associated with injectable procedures:
1. Laughing gas (nitrous oxide): We have laughing gas available at no additional charge for all patients undergoing injectible procedures and minor cosmetic surgery procedures (such as earlobe repair and scar revision). The laughing gas will make you feel as if you had a few margaritas, but it wears off quickly so that you can safely drive yourself home. I do not know any other plastic surgeon in the Plano, Frisco, McKinney, Irving, or Southlake areas who offers laughing gas. For most of my patients, it makes a very big difference.
2. Topical anesthetic ointment: We have a proprietary ointment made by a compounding pharmacy specifically for our cosmetic surgery patients. It is much more effective than the standard anesthetic ointments we tried in the past. The ointment consists of high concentrations of lidocaine, tetracaine, and benzocaine. For patients undergoing hyaluronic acid injections (Juvederm, Restylane, Perlane), I recommend placing anesthetic ointment over the areas for at least 20 to 30 minutes prior to injection.
3. Use of Restylane and Juvederm with lidocaine: Medicis (the manufacturer of Restylane and Perlane) and Allergan (the manufacturer of Juvederm) now offer their products with lidocaine (same as xylocaine or novocaine). This significantly reduces the pain associated with injections. Although the manufacturers charge us a higher price for the addition of lidocaine to their products, we do not pass this cost on to you.
4. Dental blocks: I used to routinely inject lidocaine inside the mouth to block the infraorbital and mental nerves to reduce the discomfort of injections for lip enlargement and lip wrinkles. Although a few patients still prefer dental blocks, the use of items 1-3 (above) has eliminated their routine use in my practice.
5. Ice: This is often effective for Botox and Dysport. It is basically useless for Juvederm, Restylane, and Perlane.
People often say, “It hurts to be beautiful.” This doesn’t have to be true. In my experience, the pain associated with nonsurgical procedures can be minimized in the vast majority of patients using ice, laughing gas, topical anesthetic ointments, and injectable products that incorporate local anesthetics.
I personally perform every Botox, Dysport, Juvederm, Restylane, and Perlane injection.
Our patients come from Dallas, Plano, McKinney, Richardson, Allen, Prosper, Celina, Denton, Lewisville, Highland Village, Irving, Grapevine, Southlake, Colleyville, and Trophy Club. Before and after photos of Botox, Dysport, Restylane, Juvederm, and Perlane injections are available at www.plasticsurgerydallas.com
or more information, please visit www.plasticsurgerydallas.com or call us at 469-467-0100.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas