Thank you for your question.
You submitted a question without a photo and you state in your question that you don’t
respond to topical anesthetic and is it possible to get nerve blocks for laser treatment.
Well, I can certainly give you some guidance with this question.
We have several lasers in our practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been performing lasers in my practice for over 20 years in Manhattan and Long Island.
And certainly, in our practice, we have several different types of lasers.
And basically, the question you’re asking, first of all is of course is yes.
But what you didn’t specify in your question is what type of laser treatment are you getting.
Let me explain a little bit about that.
You see, when it comes to topical anesthetics, there are many different choices.
We actually get topical anesthetic that’s custom formulated by a compound pharmacy to
work a little bit more effectively than what is generally commercially available.
But that being said, that topical anesthetic can really be very helpful but depending on
the kind of laser treatment, it may not be adequate.
So let’s say, for example, you’re having some type of resurfacing or you’re having,
let’s say, the most limited level, a micropeel, you might be more sensitive than someone who
tolerates this with topical.
I remember after the CO2 laser, the first level of CO2 laser, the early Erbium lasers
came out at the mid to late 90s, and it was commonplace for colleagues to say that, especially
if they were using the laser for demonstration that the patient can tolerate it.
And I remember just putting a few spots of that laser and my patient was uncomfortable.
So I decided, okay we’ll just treat this like any other procedure and give local anesthetic.
For a physician performing local anesthetic is perfectly fine.
There’s another example and a more modern example we have in our practice is the Q-Switch
laser that we use for tattoo removal.
And it is routine and standard practice to just use topical anesthetic for that laser.
But because tattoo pigment is so deep in the skin, when the laser hits the tattoo pigment
and the tattoo pigment literally explodes, well that can be pretty uncomfortable.
So I routinely give local anesthetic for that treatment.
And there are other examples where let’s say you’re undergoing laser hair removal,
in our practice, one of the laser hair removal devices we use is the Nd:YAG laser.
And when we do this laser hair removal treatment, we use a device that blows cool air onto the
skin so that it cools the top layers of the skin and has an anesthetic effect which makes
the heat energy of the laser become less significant.
So that’s an example where you use cooling with air.
For example, pulsed light treatment, you could use a cold roller on the skin to make the
skin cold before you apply the pulsed light.
So again, the answer to the question is really, yes, you can use a local block.
There’s only one situation where we don’t use a local block but it is really not indicated
is when we do non-surgical skin tightening and fat reduction using long pulsed Nd:YAG
laser.
This is a kind of situation where we want to hit a target temperature and we actually
want the patient to be able to tell us if the skin is getting too warm.
The same applies to radiofrequency device like Pelleve when you’re using radiofrequency
to heat the skin.
You actually don’t want the person to be numb.
You want the feedback.
So if you go above a certain temperature, it’s kind of an intrinsic safety.
But because it’s called the long pulse, the heating is more gradual.
It’s actually more tolerated.
So I think that if you’re uncomfortable where you are currently going for the laser
and if you are going to a place where you’re having laser treatment done by an aesthetician
or someone who isn’t licensed to do injections, they may be trying to dissuade you not to
do that.
I think that you’re now better off finding a physician and figuring out that maybe there’s
an alternative laser or other treatments.
And if you need local anesthetic, by all means, get the local anesthetic.
So I hope that was helpful, I wish you the best of luck and thank you for your question.