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Injectable fillers are a tremendously popular method for immediate enhancement of the lips and cheek-lip grooves. They have revolutionized cosmetic improvements of thin lips, lip lines, and a deepening nasolabial groove. With over a dozen injectable fillers to choose from, patients have a variety of options in both the cost of treatment and how long the effects will last.

One choice patients don’t have, however, is that the treatment requires a needle to create its effect. Despite it being a very small needle for most types of fillers, it is not a pain-free experience. Patients may enjoy the benefits but they have to endure the injection session to get it. The manufacturers of these materials is well aware of this concern and many now incorporate a local anesthetic in the injectable filler. While this provide some numbing effect, the needle must first pierce the skin to inject the filler-local anesthetic combo.

Therefore, a need still remains to get past the discomfort of the needle passing through the skin. While many use ice and other topical strategies, they are not that effective. One highly effective method, but one that uses a needle as well, is that of intraoral or dental nerve block techniques. On the surface, the use of one needle to defer the pain from another seems contradictory. However, skillfully placed intraoral injection can be made near painless with the right technique. The problem is that most practitioners have never been trained or are unaware of these time-tested facial local anesthetic techniques.

The first step in this technique is to use only a 1cc syringe and a long 30 gauge needle. Use a 2% lidocaine solution for the injection. While the use of epinephrine in the lidocaine may not seem needed for any lasting effect, it seems to create more profound skin anesthesia. For the cheek-lip groove, two injections placed just under the maxillary vestibule of 0.5cc each using the canines as vertical guides can really make these injections painless. If you shake and squeeze the lip while giving these injections (an old but effective dental maneuver), they can barely be felt.

An alternative to these maxillary vestibular injections is to inject the cheek-lip groove right under the skin. These are quick and not as uncomfortable as injecting a viscous filler material under pressure. The easy flow of the liquid anesthetic through a 1” long 30 gauge needle makes the injection minimally uncomfortable. But the anesthesia is profound and prepares the area well for the greater distension from the various filler materials.

For making the upper lip numb, these same two injections are used. But these alone will not block the entire upper lip. The central third, or the tissue between the philtrums, will be missed by these injections. It requires a small injection (.25cc) just above the upper lip frenum. This is a very tender area but is less painless than injecting a completely sensate middle third of the upper lip.

For the lower lip, injecting the vestibule just below the canines can effectively block most but not all of the lower lip. Again the central third is often missed and the vestibule below it may need a supplementary injection.

Having as comfortable as possible injectable filler treatment session is important given their temporary nature. If your injector is not taking the time or putting forth this effort to make you comfortable, it may be time find someone else who will.

Dr. Barry Eppley

Indianapolis, Indiana

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