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Preprocedure
Preprocedure
After thorough evaluation and discussion, written consent should be obtained, and the skin sterilized with isopropyl alcohol, chlorhexidine, or equivalent agent.6 Clean technique from the start to finish helps prevent contamination and seeding of the implant. This should be adhered to when handling, mixing, injecting the filler, and prepping the skin as well. Gloves should be changed after contact with the oral mucosa.
Anesthesia to decrease discomfort from injections is another component of many treatment protocols. Some newer agents (i.e., Restylane, Perlane, Juvederm,
Bellafill/Artefill) come premixed with lidocaine, while others require physicians to compound their own off-label (Table 58-3). Cryoanesthesia with ice or commercial devices and topical anesthetic preparations, such as benzocaine, lidocaine, prilocaine, and/or tetracaine, are other common adjunctive methods. Less often, nerve blocks or regional anesthesia can be used to limit pain associated with injections.
Table 58-3. FDA-Approved Soft-Tissue Fillers in the United States