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Dr. Barry Eppley

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Posts Tagged ‘topical anesthetic creams’

Plastic Surgery Product Review: Pliaglis Topical Anesthetic Cream

Monday, December 17th, 2012


Pain from an injection, laser procedure or minor surgery in plastic surgery is a common concern for many patients. While numbing of areas to be treated can be done by the injection of local anesthestics, this is often impractical due to the size of the surface area or represents another painful and feared experience. This has led to the use of topical forms of local anesthesia to create enough of a numbing effect to lessen the procedural discomfort.

Over the years various concentrations of lidocaine and tetracaine, the most commonly used local anesthetics, have been used in various topical preparations with up to 4% concentrations being commercially available. They are applied topically, covered with a clear dressing to prevent being wiped away, and take up to 45 to 60 minutes to achieve optimal penetration into the dermis of the skin to be effective.

In October 2012, the FDA approved a new topical anesthetic cream known as Pliaglis. (Galderma) Pliaglis contains a 7% concentration of lidocaine and tetracaine, the highest concentration ever approved for an anesthetic cream. It is intended for use in adults for superficial cosmetic and dermatologic treatments such as injectable fillers and laser procedures. It is to be applied 20 to 30 minutes for most procedures and for up to one hour prior to procedures that cause the most pain. Pliaglis uses a proprietary phase-changing technology that allows the cream to form a pliable peel on the skin when exposed to air.

It is logical to assume that a concentration of 7% topical anesthetics would be more effective than the traditional use of 4% concentrations. Higher local anesthetic concentrations may not only provide more profound anesthesia but maybe in a shorter time after application also. There are a wide variety of cosmetic procedures in which Pliaglis could be used including Botox, injectable fillers, facial laser resurfacing, high-intensity pulsed light treatments, laser hair removal and laser-assisted tattoo clearance

While recently approved, Pliaglis will not be available for commercial use until early 2013.

Dr. Barry Eppley

Reducing The Pain From Botox Injections

Thursday, November 22nd, 2007

Reducing the Discomfort from Injecting Botox

The use of Botox for controlling excessive facial expression and resultant wrinkles is both exceedingly effective and rapid to perform. It works particularly well for forehead wrinkles and crow’s feet around the eyes. Because Botox requires needle injections to reach the desired muscle sites, some pain and patient apprehension may be experienced. As the injection sites are often done in the forehead and around the eyes, some patients will experience more sensitivity and anxiety than if done in other facial or body areas.
The use of a topical anesthetic cream applied to the skin prior to injecting Botox has been a technique that I have used over the past five years. EMLA cream or LMX4 are well known topical anesthetic creams that produces numbness of the skin. It costs just a few cents to apply. The longer the cream is applied, the better the numbness gets. For Botox injections, I apply it first as dots or spots where I intend to do the injections. This also communicates with the patient exactly where I am going to inject to make sure that is where the patient wants it. I usually like to wait at least five minutes after it is applied before injecting, but waiting fifteen to twenty minutes is even better.
Next time you go for Botox, ask for it. It makes getting Botox even better!

Dr Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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