Las Vegas Plastic Surgery: Board-Certified Plastic Surgeon Dr. Jeffrey J. Roth
Las Vegas Plastic Surgery


Restylane and Juvederm Facial Fillers Can Now Be Injected With Lidocaine.

One of the latest advancements in facial fillers for cosmetic plastic surgery is the addition of lidocaine, a pain numbing agent, to the filling product.  This enables facial filler products, like Restylane and Juvederm, to have a uniform consistency of numbing medicine throughout the entire filler.  The use of lidocaine with the facial filler injection should ease the temporary discomfort and pain some patients feel when they recieve facial filler injections. This is not a new concept, as the makers of collagen fillers added lidocaine to their products several years ago.  Allergan’s Zyderm/Zyplast (made with bovine, or cow collagen) and Cosmoderm/Cosmoplast (made with human collagen) both have lidocaine in them.

In July 2009, the Food and Drug Administration (FDA)  approved a method for physicians to mix lidocaine with the filler Radiesse (made with calcium hydroxylapatite). Up until this point, the Hyaluronic Acid (HA) fillers that most plastic surgery patients are familiar with, such as Restylane and Juvederm, did not have lidocaine inside of them.  Previously, many physicians and plastic surgeons who performed facial filler injections numbed the treatment area with ice or a topical numbing agent to decrease patient discomfort. Now, the makers of these products have FDA approval to market their HA facial fillers with lidocaine agent in the United States.

Allergan’s HA filler, Juvéderm XC had been available in Europe for around a  year before garnering FDA approval in February 2010. Restylane-L and Perlane-L, manufactured by Medicis Aesthetics Inc. also acquired FDA approval that same month. In the clinical trials of the products, the inclusion of lidocaine has provided less pain with injection. These products performed similarly to their lidocaine-free predecessors in terms of safety and efficacy.  During facial filler injections with lidocaine, most patients did feel the first pinch, and then subsequent sticks were less painful as the lidocaine took effect.

At our Las Vegas based plastic surgery practice, we still numb the facial filler injection treatment area with topical medicine and blocks in addition to using the product with lidocaine which provides the least amount of discomfort and the the best experience possible.  Although originally there were some hypothetical concerns about bruising when the lidocaine formulations were introduced because lidocaine is a well known vaso-dialator,  we have seen no added bruising with patients who use these products.

The popularity of facial filling agents is undeniable.  Today’s facial fillers continue to evolve in terms of safety, efficacy, and decreased discomfort with application. We look forward to further advancements in the cosmetic and plastic surgery industry, and we will keep you informed as they develop.

Please call or email us with any questions.

Jeffrey J. Roth, M.D., F.A.C.S.

Las Vegas Plastic Surgery

(702) 450-0777


A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine.  Weinkle SH, Bank DE, Boyd CM, Gold MH, Thomas JA, Murphy DK.  J Cosmet Dermatol. 2009 Sep;8(3):205-10.

A split-face comparison of a new hyaluronic acid facial filler containing pre-incorporated lidocaine versus a standard hyaluronic acid facial filler in the treatment of naso-labial folds. Levy PM, De Boulle K, Raspaldo H.  J Cosmet Laser Ther. 2009 Sep;11(3):169-73.

RESTYLANE-L Injectable Gel with 0.3% Lidocaine [Instructions for Use]. Scottsdale, AZ: Medicis Aesthetics Inc.; January 2010.

PERLANE-L Injectable Gel with 0.3% Lidocaine [Instructions for Use]. Scottsdale, AZ: Medicis Aesthetics Inc.; January 2010.

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