Vibration Anesthesia During Invasive Procedures: A Meta-analysis.

Objective: Dermatologic office procedures involving needles including injection of local anesthetic both cutaneously and intraorally, botulinum toxin, fillers and keloids, as well as venipuncture and a plethora of other procedures can often cause pain that ranges from mild to severe. The technique of utilizing vibration frequently lessens pain. Vibration anesthesia is a non-invasive, inexpensive, virtually side-effect free, and well-established method of lessening pain during dermatologic procedures.

Minimizing discomfort during the injection of Radiesse with the use of either local anesthetic or ice.

Radiesse or calcium hydroxylapatite has been used for years in patients with HIV associated lipoatrophy as well as for facial wrinkles and nasolabial folds [2, 3], but can be painful to inject especially in the latter area. This discomfort can be severe enough that after an injection with Radiesse, a patient, despite excellent results, may refuse additional treatments. We hereby describe several methods of minimizing discomfort during Radiesse injections of nasolabial folds and other facial areas.

Ice minimizes discomfort associated with injection of botulinum toxin type A for the treatment of palmar and plantar hyperhidrosis.

Background: The value of botulinum toxin type A (BTX-A) for treatment of palmar and plantar hyperhidrosis (HH) has been limited by injection pain, which in the past has generally required administration of a nerve block. We describe the successful use of ice applied to the intended injection point followed immediately by application of either ice or vibration to skin adjacent to the injection point to reduce discomfort associated with injection of BTX-A for the treatment of palmar and plantar HH.

Results: During needle insertion and injection of BTX-A, both the application of ice to the intended injection point followed by application of ice adjacent to the injection point (ice+ice) and the application of ice to the intended injection point followed by application of vibration adjacent to the injection point have been preferred by our patients to nerve block.

Treatment of HIV-associated facial lipoatrophy with Radiance FN (Radiesse).

HIV treatments frequently include the administration of Highly Active Antiretroviral Therapy (HAART) to combat the disease; although no conclusive evidence exists, it has been suggested that the HAART regimen may lead to facial lipoatrophy, exemplified by fat loss from facial areas, most notably the cheeks. Lipoatrophy can cause severe psychosocial consequences because it can be an identifying marker of HIV infection. Calcium hydroxylapatite (Radiance FN, recently renamed Radiesse) has been postulated to be a long-lasting, biocompatible filler that does not ossify, migratem or calcify.

Vibration anesthesia: a noninvasive method of reducing discomfort prior to dermatologic procedures.

In some dermatologic and cosmetic procedures, local anesthesia is not sufficient for relieving pain; often patients are averse to injections. We propose vibration anesthesia, the use of vibration delivered with commercially available inexpensive massagers to reduce discomfort. We find the analgesic effect of vibration helpful in minimizing pain in patients undergoing injections of botulinum toxin type A treatment for hyperhidrosis, injection of filler substances such as Restylane and Juvederm, laser therapy for leg veins, nail-fold injections, Q-switched laser treatment of tattoos, incision and drainage of abscesses, and cautery of facial warts, as well as facilitating anesthetic injections for needle-phobic patients.