Topical Anaesthetics & Cosmetic Procedures
Abstract: Topical anaesthetics are sometimes used by service providers prior to minor cosmetic procedures that may otherwise cause the client/patient significant discomfort. This well written article highlights the importance of using anaesthetics safely.
Topical anaesthetics are sometimes used by service providers prior to minor cosmetic procedures that may otherwise cause the client/patient significant discomfort during the procedures. This document should be regarded as general information only and not a replacement for health or regulatory advice in any circumstances. This publication does not propose to encourage, advocate or promote the use of anaesthetics under any circumstances, always seek advice from a qualified medical practitioner and your local health regulator before using any form of topical anaesthetics.
Whilst there are some commercial preparations available on the market many have significant drawbacks associated with their use prior to or during minor cosmetic procedures due to a variety of factors such as;
A pH scale which is most often described as a range between 0-14 is a logarithmic measurement of hydrogen ions H+ and the scale provides us the indication of acidity or alkalinity of a liquid, a pH of 1 having very toxic acidity (acid) and a pH 14 having very toxic alkalinity (caustic), distilled water is neutral with a pH around 7.
Because it is a logarithmic scale each whole number increment above or below 7 is; 10 times as acidic (when below 7), or 10 times as alkaline (when above 7) e.g. a pH of 3 is 10 times as acidic as a pH of 4, and a pH of 12 is 10 times as alkaline as a pH of 11. Each incremental change of 0.1 on the pH scale represents about a 26% increase in the acidity or alkalinity of the solution as you move away from the neutral point at 7.0 on the scale.
As you can see small changes on the pH scale have dramatic changes in the potentially damaging acidity or alkalinity of a liquid and the human eye is extremely sensitive to even small changes in pH, for this reason a topical anaesthetic that is used anywhere on the face should be in the pH safe region and definitely not outside of the irritant zone indicated below. There are cases within the medical literature where chemical injury to the eye has occurred due to the use of alkaline topical anaesthetics near the eye1.
Symptoms of methemoglobinemia may include a bluish or brownish colouring of the skin, headache, fatigue, shortness of breath, loss of energy, dysrhythmias (irregular heart beat), seizures, potentially leading to coma and death if untreated. Whilst this condition is uncommon it seems prudent to avoid use of the anaesthetics prilocaine and benzocaine which appear to have the greatest risk of triggering the condition2. In addition it has been shown that Lidocaine-Tetracaine eutectic preparations are just as effective in skin anaesthesia as lidocaine-prilocaine3 commercial preparations.
The application of dermal preparations containing lidocaine have been shown to reduce discomfort of the client/patient during a variety of minor procedures4 including mammography5. However it should also be borne in mind that there are risks associated with the use of topical anaesthetics such as lidocaine even in low concentrations if they are used over too large an area, or in excessive amounts, or for prolonged durations.
In 2009 The Food and Drug Administration of the United States Department of Health And Human Services cautioned against using topical anaesthetics in too great an amount, over too large an area, applying to irritated or broken skin, or using wraps or heating pads to increase skin absorption6. The caution issued by the US FDA cited concern due to reports of deaths following similar use of topical anaesthetics by women preparing for laser hair removal procedures.
Ultimately that could lead to significant slowing of the heart, dangerous hearth arrhythmias, seizures, cardiac arrest (the heart stopping altogether) and potentially death.
Prior to purchasing and using anaesthetic products you should ensure that you are;
1) familiar with and in compliance of the Therapeutic Goods Act 1989 and the current Poisons Standard (see appendix 2). If in doubt contact the Therapeutic Goods Administration or if you provide services outside of Australia consult with your local health regulatory authorities.
Efficacy of Topical Anaesthetics
Contrary to popular belief the concentrations of a topical anaesthetics active ingredients are not the sole factor in determining the efficacy of the product. There are several factors that will determine the efficacy of a topical anaesthetic product;
Caking/Heating Topical Anaesthetics
You may have seen examples of topical anaesthetics being applied in a thick layer to the skin surface. I stress that caking of topical anaesthetics does not improve the efficiency of the product for anaesthetisation of the dermis, it does however substantially increase the risk of absorption of a dangerous amount of anaesthetic into the blood stream.
A well made topical anaesthetic will easily melt and absorb at normal skin temperature therefore there is no additional benefit being gained by using these methods other than perhaps achieving anaesthetisation a few seconds/minutes sooner. But to save those couple of minutes you substantially increase the risk of absorption of a toxic amount of the product into the clients/patients blood stream, so don't risk using external heating or ultrasonic stimulators!
Caution with Clients with low Body Weight & Both the Young & the Elderly
You should be more cautious with the use of topical anaesthetics with clients/patients who have a low body weight this is because those with lower body weight will potentially develop a toxic blood serum level of anaesthetic quicker than clients with larger body weights, this is a due to the dose/Kg relationship.
The Source of Topical Anaesthetics
There are many places on the internet who are supplying topical anaesthetics such as tattoo equipment suppliers, 'quasi' medicine suppliers, cosmetics suppliers, permanent makeup suppliers etc. I will be blunt and state that I have no doubt that some of those sites are supplying anaesthetics illegally.
Once again I stress this is not a how to guide it is merely a general discussion about some of the general safety precautions that should be considered by an appropriately qualified service provider before using any topical anaesthetic. The number one point here is that topical anaesthetics should only be used by persons who have been trained by a qualified health service provider and in circumstances that are in compliance with the law in your location.
Anaesthetic products should always be used sparingly in the lowest concentrations and quantities possible, applying a thin smear (at least 15-20 mins prior to a procedure) is all that will be required in most circumstances. Caking on large quantities is not likely to improve the effectiveness of topical anaesthetics and doing so may be dangerous.
01) Ensure the client/patient does not have any medical condition that may preclude the use of any of the products ingredients. If in doubt always refer the client/patient to their regular medical practitioner for additional approval/supervision prior to a procedure. Conditions where additional medical review and approval should be sought may include but are not necessarily limited to;
02) Never apply anaesthetics on any woman who may be pregnant nor if they are breast feeding.
03) Ensure the client/patient does not have any allergy or sensitivity to any of the active/inactive ingredients in the products.
04) Ensure you are not using an excessive quantity nor using the anaesthetics over too large a skin area.
05) Never use any products containing epinephrine (adrenaline) near the eye, on fingers, toes, penis, earlobes, nose, nor inside the mouth.
06) Do not use any anaesthetics in the eye nor inside the mouth and do not permit the client/patient to swallow any of the product.
07) Do not apply any anaesthetics to skin that is diseased, damaged or broken down, e.g. not over eczema, psoriasis or skin abrasions.
08) Do not apply occlusive dressings such as glad wrap over anaesthetics products and do not apply external sources of heat or ultrasound to increase absorption.
09) Be extra cautious with the use of anaesthetics on any person below the age of 16 or above the age of 60, consulting with their doctor again is always prudent.
10) Be extra cautious with the use of topical anaesthetics with clients/patients with low body weight e.g. below 55kg.
11) Wear good quality protective latex or vinyl gloves when handling anaesthetics and always avoid contact with product onto your own skin.
12) Do not provide a client/patient with topical anaesthetic products to take away with them after a procedure.
13) Observe the client/patient for signs of adverse side effects during and after the application of any anaesthetic product.
14) Store anaesthetics in a cool dry location away form direct sunlight as per the products recommended storage instructions and discard according to the manufacturers expiry and disposal instructions.
This list is by no means comprehensive however the client/patient should seek medical attention if any of the following side effects are experienced or observed after application of any form of anaesthetic products.
Links for Various Acts & Regulatory Authorities
Australian Capital Territory
New South Wales
Date of most recent revision: 15/03/2013
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