While the rise of nonsurgical procedures like Botox, fillers and lasers has been cause for celebration (No risky surgery! A fraction of the recovery time!), it has come with its own inconvenient little truth: This stuff hurts. A lot.
As any serious patron of the medi-spa can tell you, the trade-off for avoiding the scalpel—enduring the sensation of the needle or laser as it’s plumping or sloughing your skin—is often brow-sweating, breath-holding, seat-clutching pain. “Fraxel feels like a thousand little needles going into your face,” one patient says of the popular resurfacing laser. Now, in an attempt to make such sessions more bearable, scientists are equipping popular antiaging devices and injectables with nerve distractors and numbing agents. Think of it as built-in bedside manner.
When the radio-frequency tightening device Thermage debuted in 2002, doctors dubbed it “the nonsurgical facelift.” Despite the lack of incisions, however, many patients reported feeling a deep burning sensation during the up-to-90-minute procedure that peaked at nearly intolerable levels along the jawline. “People had to be heavily medicated—multiple Valiums, Percocets, anything to get them through it,” says dermatologist Anne Chapas, who does research trials for Solta Medical, the maker of Thermage. The machine’s third iteration, Thermage CPT, uses more frequent, less potent pulses of energy, thus reducing the ouch factor. “You don’t have that peak in pain sensation,” Chapas explains. The device also features a vibrating tip that is meant to lessen pain.
It might sound far-fetched—after all, your skin is still being heated—but Susan, a fortysomething dancer who tried the new machine last fall, found it a major improvement. Whereas her past Thermage treatments felt “irritating, prickly and burning,” she says, this time it didn’t bother her “in the least.”
Lasermakers are also attempting to cut down on patient discomfort. In the past, doctors have used a device to shoot chilly streams of air at skin while lasering. The new Fraxel Re:store Dual system incorporates a so-called forced air cooler into its tip. “In addition to getting the temperature stimulus, you’re also getting a little bit of sensation from the air rushing on the skin, which feels good,” says Rebecca Giles M.D., founder of FIX skincare clinic in Malibu. “It’s another competing message that your brain is processing that’s taking you away from that feeling of, Wow, this really hurts.”
When it comes to making injectables less painful, topical numbing creams and good old-fashioned ice have long been among the most popular palliatives. Injections of a local anesthetic are a no-no before fillers because they can cause swelling, which leaves doctors unsure about which areas need plumping. While some derms add the liquid form of lidocaine to fillers before injecting them, versions of Juvéderm, Restylane and Perlane already laced with the anesthetic have just arrived on the market. Doctors say the difference is noticeable. New York dermatologist and psychiatrist Amy Wechsler served on the advisory board for Allergan’s lidocaine-enhanced filler, Juvéderm XC. “There’s more immediate relief [with it] thanks to the fact that the lidocaine is powdered, not liquid,” she says. “Plus it’s FDA-approved. Once you open a syringe and mess with it, the company doesn’t stand behind you should anything happen.”
Of course, the best solution would be reducing the demand for such procedures—or even replacing them altogether. Scientists do seem to be getting closer to the latter goal. Studies have shown that repeated injections of certain fillers have the ability to increase the body’s natural collagen, leading to longer-lasting results and less frequent injections. And while dozens of antiagers claim to be “Botox in a bottle,” Revance Therapeutics has developed a topical gel form of botulinum toxin type A, to be administered only in a doctor’s office. Early reports are enthusiastic—it’s currently undergoing clinical trials—though some doctors worry that surface application will lead to less precise outcomes.
But until the gel is approved, there’s still a place for bedside manner of the human variety. For every woman so tough she can inject herself, Giles says there are just as many “who come with their shaman and aromatherapy oils.” Because “anxiety is a huge component of pain,” she finds that engaging patients in conversation while she works goes a long way toward reducing discomfort. Says Giles, “I call it talkesthesia.”