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Most treatments in aesthetic medicine need the help of local anaesthesia. These are usually day-care procedures. They do not require a lengthy recovery or a hospital stay. However, aesthetic interventions rarely have medical indications. Therefore, patients have a low tolerance for pain, side effects, or complications.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Aesthetic Medicine.

Overview

Local anaesthetics are essential for providing high-quality cosmetic procedures in primary care. Their role is to enable pain-free treatment. However, they also facilitate the proper conducting of minimally invasive aesthetic interventions and aid the recovery process.

Who can apply local anaesthesia?

The administrator of local anaesthesia is a qualified medical doctor with adequate training in applying local anaesthetics. Pharmacological knowledge about different local anesthetic agents is also necessary.

Cosmetic procedures require an understanding of the facial anatomy, such as muscles, major blood vessels, and nerves.

Additionally, doctors in primary care should be able to provide Basic Cardiac Life Support. Although, aesthetic procedures that do not use consciousness-altering drugs have a low risk of life-threatening complications.

Facility requirements

The procedure room is the place for the application of local anaesthesia. The patient should always lay down horizontally with their face facing up (supine position).

The room should have the equipment for the safe application of local anaesthesia. That includes a stethoscope, blood pressure measuring device, bag valve mask (Ambu bag), endotracheal tube, and an oxygen cylinder.

The following emergency medications are essential:

• Adrenalin
• Atropine
• Hydrocortisone, and
• Pheniramine maleate

Appropriate lighting is vital for avoiding major blood vessels and the correct placement of local anaesthetics.

Factors to consider before administering local anaesthesia

Before receiving local anaesthesia in primary care, patients need to provide informed consent. In some cases, additional consent for an intradermal test is also necessary.

The care provider also needs the patient’s history of chronic diseases, allergic reactions to anaesthetics, and information about the medications they are currently using.

Methods of local anaesthesia application in aesthetic medicine

According to the method of application, local anaesthesia can be:

• Topical,
• Infiltration,
• Field block,
• Peripheral nerve block, and
• Tumescent anaesthesia

Topical anaesthesia application occurs on the surface of the skin or mucosa.

Intradermal and subcutaneous injections of local anaesthetic agents are known as infiltration anaesthesia.

Field block is a type of regional anaesthesia. It involves injecting the local anaesthetic circumferentially around the procedure area.

Peripheral nerve block anaesthetises the peripheral nerve trunk that supplies the treatment area.

Tumescent anaesthesia uses large amounts of diluted local anaesthetics mixed with adrenaline, saline solution, and sodium bicarbonate.

Types of local anaesthetics

There are two groups of local anaesthetics:

1. Amide group

• Lignocaine
• Prilocaine
• Bupivacaine
• Mepivacaine
• Ropivacaine

2. Ester group

• Benzocaine
• Tetracaine
• Procaine
• Cocaine

Amides are less prone to causing allergic reactions. Most doctors prefer using them for safety reasons.

Potential complications

Complications with local anaesthesia are rare but can sometimes be life-threatening. They include:

• Syncope secondary to vasovagal attack
• Hypersensitivity reactions
• Hypotension
• Arrhythmia
• Tachycardia
• Palpitations
• Impaired swallowing
• Laceration of nerve fibres

The bottom line

Local anaesthesia is an indispensable instrument in cosmetic procedures. With proper use, it improves the treatment outcomes and patient comfort. However, inadequate handling can potentially cause serious complications.

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References:

• Giordano D, Raso MG, Pernice C, Agnoletti V, Barbieri V. Topical local anesthesia: focus on lidocaine-tetracaine combination. Local Reg Anesth. 2015 Nov 27;8:95-100. doi: 10.2147/LRA.S41836. PMID: 26664201; PMCID: PMC4669927.
• Eidelman A, Weiss JM, Lau J, Carr DB. Topical anesthetics for dermal instrumentation: a systematic review of randomized, controlled trials. Ann Emerg Med. 2005 Oct;46(4):343-51. doi: 10.1016/j.annemergmed.2005.01.028. PMID: 16187468.
• Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for dermatologic procedures: a review. Dermatol Surg. 2012 May;38(5):709-21. doi: 10.1111/j.1524-4725.2011.02271.x. Epub 2012 Jan 13. PMID: 22243434.
• Berkman S, MacGregor J, Alster T. Adverse effects of topical anesthetics for dermatologic procedures. Expert Opin Drug Saf. 2012 May;11(3):415-23. doi: 10.1517/14740338.2012.669370. Epub 2012 Mar 8. PMID: 22397312.