Are there other options for lip augmentation dental blocks when topical blocks and ice are not enough?

The vast majority of surgical and non-surgical procedures performed by Plastic Surgeons would not be possible without proper anesthesia medications and techniques. This is particularly true for the highly-sensitive areas of the lips and face, where the concentration of sensory nerves is the greatest.

For all lip augmentation procedures, and for most filler injections to the nasolabial folds, I employ local anesthetic nerve blocks of the infra-orbital and mental nerves. The small amounts of local anesthesia, if properly placed, give excellent anesthesia to the entire central facial area, and do not distort the anatomy. Although nerve block anesthesia is more time-consuming and labor-intensive than simply applying topical anesthetics, it is also much more effective and humane than the alternative of inadequate anesthesia.

Greetings Bobbi
There are several options for lip anesthesia:
1) Topical medication such as lidocaine. Most concentrations used for topical application need at least 30 minutes to work. If a topical application does not seem to be working, be sure to talk with your physician about the concentration being used and how long it is applied before the procedure is performed.
2) Local injection. As mentioned by other contributors this can distort the anatomy and make things more difficult to get right when applying fillers. A local injection can be done along the upper border of the lip (near the nose) to try to get more of a regional block of the fibers coming down to provide sensation to the lip without distorting the anatomy.
3) Regional nerve block. This is another option which can work well. For the upper lip, this means injecting the infraorbital nerve and for the lower lip, this means injecting the mental nerve.
4) Ice and pressure. These can be a good adjunct to other anesthetic practices. They provide a small amount of anesthesia and a good distraction.
5) Topical mixed with the injectible. While there is still a small amount of discomfort with the injection, the discomfort is generally minimal and quickly goes away as the local takes effect.

This is a great question and one worth talking about. I think performing good lip augmentation can be challenging and requires a tremendous amount of precision. If there is even a small amount of imbalance or asymmetry of the the lips, it can be noticed from a few feet away, so I try to avoid anything that could alter the anatomy of the lips before the procedure.

I think if a topical works, that is wonderful, but often it is not enough, in particular if we are going to mold the injected product into place (it can be uncomfortable without proper anesthetic). I will NOT inject a block directly into the lip before the procedure because it will alter the shape and volume of the lip, causing it to swell, and making it very difficult for the surgeon to judge exactly how much product to place into the specific areas of the lip. Similarly, I will not mix the product with lidocaine, because it will give the immediate result an artificially overdone look, making it difficult to judge if the augmentation is adequate or not.

In short, I will perform a nerve block if the topical aesthetic is inadequate. This is a quick, safe, and effective method of pain control, and it does not risk altering the final cosmetic result.

Hope that helps,

Dr. S