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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

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