Fillers are one of the most popular minimally-invasive cosmetic treatments requested today, with many patients using them to enhance or augment their lips. While they are generally well tolerated, most people require a numbing cream or other type of pain control to make the injections more comfortable.

Types of Lip Fillers

Most fillers that are given now use hyaluronic acid as their main ingredient. The concentration being higher or lower does not make the filler better. The more important question is what the desired goal is for the filler. The area where the filler will be used and whether the effect should be more or less subtle are important considerations.

Restylane: Average concentration of hyaluronic acid. Lasts 6-9 months.

Juvéderm Ultra XC: Higher concentration of hyaluronic acid than Restylane. Lasts up to one year.

Juvéderm Volbella: Lowest concentration of hyaluronic acid. Provides a more subtle effect. Lasts up to one year.

Collagen Fillers: These fillers use collagen instead of hyaluronic acid. They are not given as frequently now that hyaluronic acid fillers are widely available. Collagen fillers last longer but may provide a less natural appearance.

How are Fillers Used?

Fillers can be used for a variety of applications on the face. Lip enhancement is just one of them. Other uses include filling in nasolabial folds, reducing the appearance of lines and wrinkles, and filling in the cheeks. Fillers can provide a significant change in appearance without looking overdone. The effect is sometimes subtle and sometimes not so subtle depending on the patient’s goals. Compared to some cosmetic treatments, fillers have a quick recovery with almost zero downtime. However they can be painful or uncomfortable when being administered making the use of pain control essential for most patients.

Pain Control for Lip Fillers

Lip fillers are administered using a needle or cannula that is inserted into the lips. Compared to previous forms of fillers like collagen, a relatively larger needle is required which may be more painful for the patient. There are a few different methods that may be used to numb the lips and make the administration of the filler more comfortable.

Topical anesthetic/numbing cream: A numbing cream is usually the preferred method of numbing the lips prior to a filler injection. The cream is applied and allowed to work which can take around 30 minutes. Once the lips are anesthetized the cream is removed. Topical anesthetic has the additional benefit of vasoconstriction which may reduce bruising and bleeding.

Local injection of anesthetic: An injection of anesthetic can be given in or around the lips. Unfortunately, injecting in the lip area immediately before the fillers can distort the appearance of the lips and make it more difficult to administer the fillers correctly. In addition, an injection is an additional needle which may only serve to increase anxiety and discomfort for the patient.

Dental block: Injection into the oral mucosa can provide numbing for different parts of the face including the nasolabial folds, lip corners, and other lines on the face. However for the lips themselves a cream often works better.

Ice/pressure/vibration: An ice pack will often be used immediately after the filler is injected to reduce swelling. This can also sometimes distract from any lingering pain from the injection. Vibration can also be used to improve the comfort of the procedure. A vibration device is applied to the face which can help prevent the sending of pain signals.

The issue with local anesthetic injections and dental blocks is often that it adds a layer of complexity to a filler administration that would otherwise be a routine procedure. Especially if the injector is not a physician, performing an injection of anesthetic may be unfamiliar and make the procedure less comfortable for them and the patient. Numbing creams are easy to apply and with a few precautions can be utilized in most cases.

Compounded Topical Anesthetic

There are numerous over-the-counter numbing creams available that usually contain the same ingredients in similar concentrations. Lidocaine in percentages from 2.5% to 5% are common as is benzocaine 20%. A compounded anesthetic can include multiple anesthetic ingredients in higher concentrations. For example, our compounding pharmacy makes a cream that includes benzocaine, lidocaine, and tetracaine in one cream with a variety of strengths (referred to as BLT cream).

Method of Using Topical Anesthetic on the Lips

Using a compounded topical anesthetic can expedite a patient’s appointment and make the experience more comfortable. This procedure may be used to effectively administer the topical for upper and lower lip anesthesia.

1. As soon as patient is seated, a barrier is made that prevents the cream from entering the mouth which could potentially increase the systemic levels of topical anesthetic and/or numb the mouth and throat. This also keeps the cream in the area that is being numbed to make sure it is effective. The barrier can be made from a 5 x 10 cm piece of non-adherent pad.

2. To make the barrier, take the 5 x 10 cm pad and cut 1cm slits on the top and bottom and a 5cm slit cut in the middle for breathing and speaking. To position, the patient should keep their teeth closed and lips relaxed.

3. Compounded topical anesthetic is liberally applied to the lips, 1cm around the lips on the skin, and adjacent mucosal services. Using anesthetic around the lips provides the additional numbing that makes the anesthesia of the lips most effective and consistent. Cream should be applied to the skin thick enough so that the skin cannot be seen.

4. It is possible that numbing will occur within 15 minutes, however generally practitioners will wait 20-30 minutes before removing the cream. One way to keep track of this is to put a timer on the outside of the patient’s door.

5. Cream is removed completely and the barrier removed from the mouth. Fillers can now be administered.

Tips for Using Topical Anesthetics

Our page on BLT cream includes some tips for applying compounded topical anesthetics in general – not just for lip fillers. There are important safety considerations when using a compounded topical anesthetic as the anesthetic ingredients are in higher concentrations than are found in manufactured creams. Only a trained practitioner should apply compounded topical anesthetics and the proper precautions should always be followed.