Unit 10: Anaesthesia

Providing adequate anaesthesia is an important part of performing derma filler procedures.

Anaesthesia methods for dermal filler include:

• Injectable
• Local infiltration
• Ring blocks
• Topical
• Ice and other coolants

The anaesthetic 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 hence may require injectable anaesthetics for a more comfortable procedure. Clients with high pain thresholds can be made more comfortable with the use of topical anaesthetic creams or topical coolants, especially when lidocaine-based dermal fillers are used which have less treatment discomfort.

Before using anaesthetic:

• Confirm that the client has no previous allergies to anaesthetics 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 anaesthetics:

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

Complications with injectable anaesthetic:

• Vasovagal episode
• Hypoglycemia
• Anxiety
• Bruising
• Infection
• Nerve injury
• Allergic reaction
• Anaphylaxis
• 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)
• Epinephrine adverse response (Tachycardia, Tremor, Anxiety, Local hypoperfusion)

Topical Anaesthetics

Topical anaesthetics are often used with dermalfi ller 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 topical anaesthetic and a dermal filler product with lidocaine.

Commonly used topical anaesthetics:

L-M-X (lidocaine 4%-5%)

EMLA (lidocaine 2.5%. prilocaine 2.5%)

Complications of topical anaesthetics

• 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