PEER-REVIEW | DERMATOLOGY | Anaesthesia Application techniques
TOPICAL ANAESTHESIA BLT Cream (Benzocaine 20%/Lidocaine 6%/Tetracaine 4%) topical anaesthetic given 1 hour before before treatment
■ Apply to entire facial area, with particular care at the periorbital areas and other lateral facial regions not easily covered by a regional block
REGIONAL ANAESTHESIA The author typically gave regional anaesthesia during the procedure
REGIONAL AREA Supraorbital and supratrochlear nerve block
METHOD ■ Locate supraorbital foramen and insert needle. Lateral to supraorbital foramen. Direct needle medially, parallel to brow, toward nose
■ Infiltrate the mid-two thirds of the lower edge of eyebrow. Use 1 cc of 1–2% Lidocaine. Inject just above bone level
REGIONAL AREA Infraorbital nerve block
METHOD ■ Locate infraorbital foramen
■ Insert needle. Insert inferior to the foramen by 1 cm (slightly medial). Direct needle toward supraorbital foramen. Avoid approaching orbit
■ Infiltrate at infraorbital foramen. Use 1 cc of 1–2% Lidocaine. Inject just above bone level
REGIONAL AREA Mental nerve block
METHOD ■ Locate mental foramen ■ Insert needle. Insert 1.5 cm posterolateral to the mental foramen Direct needle toward mental foramen. Avoid approaching orbit
■ Infiltrate at mental foramen. Use 1 cc of 1–2% Lidocaine. Inject just above bone level The patients were treated under topical and
regional anaesthetic. IV sedation was not required for any patients, although 5 mg of midazolam can provide useful anxiolysis if required.
■ 30 W DOT mode ON, spacing 300–500 µm, scan dwell time 500–800 µs
■ 30 W DOT mode ON, spacing 300–1000 µm, scan dwell time 2000, stack 2 or 3.
Pre-procedure For full-face resurfacing, the author typically prescribes the following analgesic medications to be started on the day of treatment. One hour before treatment, the patient applies a thin layer of BLT Cream (Benzocaine 20%/ Lidocaine 6%/Tetracaine 4%) topical anaesthetic to the entire facial area. This is used with particular care at the periorbital areas and other lateral facial regions not easily covered by a regional block. For anxiety and analgesia, Valium (diazepam 5–10 mg
orally) and Tylex (co-codamol) to be given 45 minutes prior to the procedure, are usually prescribed. Every patient is prescribed Valtrex (valciclovir) 500 mg
twice daily for 8 days, starting 3 days before surgery. (The author noticed a <5% viral outbreak in over 450 patients before using strict anti-viral prophylaxis with every patient when using fractional devices.) If the patient had a strong history of acne, By-Mycin
(doxycycline 100 mg daily) or Augmentin-Duo (amoxicillin trihydrate/potassium clavulanate) was prescribed for 7 days, starting 1 day before surgery. If the patient had a history of frequent yeast infections, Diflucan (fluconazole 150 mg daily) was prescribed, starting 1 day before surgery. The author does not routinely prescribe antibiotic and antifungal medication. If just the periorbital area or neck are to be treated in isolation, no specific medication is usually prescribed.
Treatment procedure The patients were treated under topical and regional anaesthetic. IV sedation was not required for any patients, although 5 mg of midazolam can provide useful anxiolysis if required. For ActiveFX, the treatment parameters used were
density 3/9/5, 100–125 mJ, rate 125 Hz. The CPG was set to maximum size and an energy density of 2–5 depending on the area of the face being treated, as necks are treated at lower settings. The author used the square-shaped
Figure 3 (A) Prior to treatment, (B) 2 days post-treatment, and (C) 1-month post-treatment 52 ❚ October 2013 |
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