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Pain-Relief Options Available For Cosmetic Procedures


 

WAILEA, HAWAII — Ice, vibrators, "talk-esthesia," and sundry topical anesthetic creams and gels were advocated as safe and effective options for relieving pain during a mini-symposium at the annual Hawaii dermatology seminar sponsored by the Skin Disease Education Foundation.

"How much is a happy patient worth? If you hurt them, they won't come back," said Kevin C. Smith, M.D., a dermatologist practicing in Niagara Falls, Ont.

The discussion focused on patients undergoing cosmetic procedures, but the techniques, listed here, can be used on medical dermatology patients as well:

Ice. It's effective and about as cheap as pain relief gets. "We use it a lot," said Alastair Carruthers, M.B., a dermatologist in practice in Vancouver, B.C.

Vibrators. Snickers aside, the Hitachi Magic Wand with a Wonder Wand attachment provides excellent pain relief when applied under a patient's chin during facial procedures by blocking pain signals to the brain, said Dr. Smith.

The devices can be found at the Web site www.drugstore.com

Talk therapy. "It's not enough to put some cream on a patient," Dr. Smith said. From the time a patient first calls the office, the staff and the physician should convey calm reassurance. Patients will have less pain if they feel "confident of your skill and your care."

He said he always uses "talk-esthesia" to talk patients through procedures, even when other forms of pain relief are used.

Analgesics. Some procedures call for up-front pain relief. Dr. Smith sometimes advises patients to take an NSAID in combination with acetaminophen for an additive effect. Patients who do not have asthma may be prescribed propranolol, which provides analgesia but does not interfere with a patient's ability to drive.

L.M.X. 4. This 4% lidocaine cream (formerly ELA-Max 4%) is sold over the counter, does not require occlusion, and provides anesthesia 30 minutes after application, Dr. Carruthers explained.

He tested it against a vehicle cream in 24 patients receiving Botox (botulinum toxin type A) injections for crow's feet.

"I like to think this is not a very painful procedure, so in order to reduce the discomfort, this stuff has to work very well," he said.

The study showed a significant difference in patient visual analogue scale scores and observer ratings of discomfort when L.M.X. 4 was used, with P values in the range of .005.

L.M.X. 5. This anorectal anesthetic cream is more appropriate for use in the mouth than alcohol-containing topical gels, which can cause sloughing of mucous membranes and irritation and stinging if they get in the eyes, Dr. Smith said.

For lip procedures, optimal anesthesia can be obtained by numbing the mucosal surface of the lips, including the anterior mucosae of the anterior labioalveolar sulci down to the gingival sulcus as well as the vermilion and a 1-cm margin around the vermilion border.

To achieve this without getting anesthetic all over the inside of the patient's mouth, he cuts a Telfa pad to mimic a plastic laser shield designed to protect the teeth from laser work performed around the mouth. He cuts a 3-by-4-inch Telfa pad in half, lengthwise, then folds it over and cuts a slit in the middle (to allow the patient to breathe) and slits at the top and bottom to accommodate the frenula.

He inserts the pad into the patient's mouth, against the teeth. He then uses a tongue depressor to apply L.M.X. 5 thickly over the lips and gums and attends to other patients for 30-45 minutes, until his watch alarm sounds to remind him to return to perform the procedure.

At that time, he can inject lidocaine painlessly or, for simple filler procedures, move directly to injections of Restylane (nonanimal stabilized hyaluronic acid gel).

Dr. Smith noted that previous research has determined that the anesthetic mixture in L.M.X. 5 does not produce toxic blood levels, even when applied to mucous membranes.

Dr. Carruthers disclosed that he has financial ties to Allergan Inc., which distributes Botox. Dr. Smith received L.M.X. 5 samples from Ferndale Laboratories Inc. for his research.

The Skin Disease Education Foundation and this newspaper are wholly owned subsidiaries of Elsevier.

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