Question: I am very pain sensitive – the regular topical anesthetic isn’t strong enough for me when I get Botox. Is there anything stronger?
Answer:
Yes, there are much stronger compounded topical anesthetics, but they are used with caution. Here’s why.
Lidocaine 4% is the standard topical anesthetic – and it works for most people if left on for 20 minutes. Lidocaine is an amide form of topical anesthetic.
The stronger topical anesthetics are mostly esters – you may know them as tetracaine and benzocaine. They are stronger, but more likely to cause a rare but severe reaction called methemoglobinema. What happens? The compound attaches to your blood so you cannot absorb oxygen. It is estimated to happen once in every thousand people – rare, but enough to be riskier than amide topical anesthetics.
Because the risks are higher in children, these topical creams should never ever be used in children.
Ask your plastic surgeon if s/he has or can order for you an extra-strong topical anesthetic – these are usual available through compounding pharmacies. However, if you have any history of allergic reactions or if methemoglobinema runs in your family – please don’t try it!