Usage
Hyaluronic acid + lidocaine is prescribed for correcting moderate to severe facial wrinkles and folds (e.g., nasolabial folds), lip augmentation, restoring facial volume loss (e.g., cheeks, temples), and treating other aesthetic concerns, such as under-eye hollows or volume deficits on the back of the hands.
Pharmacological Classification:
- Hyaluronic acid: Hydrating agent, dermal filler
- Lidocaine: Local anesthetic
Mechanism of Action: Hyaluronic acid is a naturally occurring polysaccharide that attracts and retains water, adding volume and hydration to the skin. Lidocaine blocks sodium channels, inhibiting nerve impulse transmission and providing local anesthesia, reducing pain during injection.
Alternate Names
Hyaluronic acid fillers with lidocaine are marketed under various brand names, including Juvéderm® Ultra XC, Juvéderm® Ultra Plus XC, Juvéderm® VOLBELLA® XC, Juvéderm® VOLIFT® with Lidocaine, Juvéderm® VOLUMA® XC, Juvéderm® VOLLURE® XC, Restylane® with Lidocaine, Restylane® Lyft with Lidocaine, Restylane® Silk, Restylane® Refyne, Restylane® Defyne, Restylane® Kysse, Restylane® Contour and Belotero Balance.
How It Works
Pharmacodynamics: Hyaluronic acid exerts its effect by physically filling the extracellular matrix, leading to increased skin volume and smoothing of wrinkles and folds. Lidocaine’s pharmacodynamic effect is local anesthesia, achieved by blocking voltage-gated sodium channels in nerve fibers, thereby inhibiting nerve impulse propagation.
Pharmacokinetics: Hyaluronic acid, when injected, integrates into the dermal tissue. It is gradually degraded by naturally occurring enzymes in the body, with a duration of effect that varies depending on the product and individual. Lidocaine, at the concentrations used in fillers, is absorbed into the systemic circulation following injection. It is then metabolized primarily in the liver by CYP enzymes, with subsequent renal excretion of the metabolites.
Mode of Action: Hyaluronic acid acts by attracting water molecules, which creates volume and hydration within the skin. Lidocaine acts by reversibly binding to sodium channels on nerve membranes, blocking the influx of sodium ions and preventing depolarization, thereby inhibiting the generation and conduction of nerve impulses.
Elimination Pathways: Hyaluronic acid is degraded into smaller molecules, such as oligosaccharides and ultimately water and carbon dioxide. Lidocaine is metabolized primarily in the liver, with renal excretion of the resulting metabolites.
Dosage
Standard Dosage
Adults:
Dosage varies depending on the specific product, the area being treated, and the desired outcome. Typically, 0.5 mL to 2.0 mL is injected per treatment site, not to exceed 20mL per 60 kg body mass annually.
Children:
Use is generally not recommended for individuals under 18 years of age. Safety and efficacy have not been established in this population.
Special Cases:
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Elderly Patients: No specific dosage adjustments are typically required. However, skin thinning and decreased elasticity in elderly patients may necessitate careful injection technique and product selection.
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Patients with Renal Impairment: No specific adjustments are needed.
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Patients with Hepatic Dysfunction: No specific dosage adjustments are needed for hyaluronic acid. For lidocaine, caution is advised, but generally, adjustments are unnecessary due to the low concentration used in fillers.
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Patients with Comorbid Conditions: Exercise caution with patients who have bleeding disorders or are undergoing immunosuppressive therapy.
Clinical Use Cases
Dosages in these settings align with standard adult dosing and are determined by the specific area being treated and the desired effect. No special dosage adjustments are typically mentioned for these clinical situations.
Dosage Adjustments
Dose modifications are based on the specific product, treatment area, and individual patient factors.
Side Effects
Common Side Effects:
Swelling, redness, bruising, pain, itching, tenderness, and small bumps at the injection site. Headache is also possible.
Rare but Serious Side Effects:
Infection, allergic reactions (including anaphylaxis), vascular occlusion, Tyndall effect (bluish discoloration), and granuloma formation.
Long-Term Effects:
While rare, some patients might experience prolonged swelling, firmness, or nodule formation at the injection site.
Adverse Drug Reactions (ADR):
Anaphylaxis, vascular occlusion leading to skin necrosis.
Contraindications
Absolute contraindications include active infection at the injection site, known allergy to hyaluronic acid or lidocaine, severe allergies with a history of anaphylaxis, bleeding disorders, porphyria, and active autoimmune disease. Relative contraindications include pregnancy, breastfeeding, and patients with a history of keloid formation or hypertrophic scarring.
Drug Interactions
No significant drug interactions are known for hyaluronic acid. Lidocaine, when used systematically, can interact with other medications metabolized by CYP enzymes in the liver. These interactions are typically not clinically relevant with the small, localized doses of lidocaine in fillers.
Pregnancy and Breastfeeding
The safety of hyaluronic acid + lidocaine fillers during pregnancy and breastfeeding has not been established. Use is generally not recommended due to limited safety data.
Drug Profile Summary
- Mechanism of Action: Hyaluronic acid provides volume and hydration. Lidocaine provides local anesthesia.
- Side Effects: Common: Swelling, redness, bruising, pain. Serious: Infection, allergic reaction, vascular occlusion.
- Contraindications: Active infection, allergy to hyaluronic acid or lidocaine, severe allergies, bleeding disorders, porphyria, active autoimmune disease.
- Drug Interactions: No significant interactions known for hyaluronic acid. Lidocaine can interact with drugs metabolized by CYP enzymes in the liver, though not usually relevant with the small amounts in fillers.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Varies by product and indication, typically 0.5 to 2.0 mL per site, not to exceed 20 mL per 60kg/year.
- Monitoring Parameters: Observe the injection site for signs of complications such as prolonged swelling, infection, or vascular compromise.
Popular Combinations
Hyaluronic acid fillers are often used in combination with other aesthetic treatments such as botulinum toxin injections, chemical peels, or laser treatments. The combination of treatments aims to address different aspects of aging skin.
Precautions
- General Precautions: Conduct thorough patient history including allergies, medical conditions, and previous aesthetic treatments.
- Specific Populations: For pregnant and breastfeeding women, use is not recommended. No specific precautions are noted for children, elderly, menstruating individuals or other groups.
- Lifestyle Considerations: No specific lifestyle considerations are associated with the use of these fillers.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Hyaluronic Acid + Lidocaine?
A: The dosage varies depending on the product and the area being treated, ranging from 0.5 mL to 2.0 mL per site.
Q2: What are the common side effects of Hyaluronic Acid + Lidocaine?
A: Common side effects include swelling, redness, bruising, pain, and tenderness at the injection site.
Q3: Are there any serious side effects I should be aware of?
A: Though rare, serious side effects can include infection, allergic reaction, vascular occlusion, and granuloma formation.
Q4: Can Hyaluronic Acid + Lidocaine fillers be used in pregnant or breastfeeding women?
A: It is generally not recommended to use these fillers during pregnancy and breastfeeding due to a lack of safety data.
Q5: What are the contraindications for using these fillers?
A: Contraindications include active infection at the injection site, known allergy to hyaluronic acid or lidocaine, severe allergies, bleeding disorders, and active autoimmune disease.
Q6: How long do the effects of the treatment last?
A: The duration of effect varies depending on the product and the individual, typically lasting from several months up to a year.
Q7: How is Hyaluronic Acid + Lidocaine administered?
A: It is administered via injection into the skin by a qualified healthcare professional.
Q8: Can I get other cosmetic treatments alongside Hyaluronic Acid + Lidocaine fillers?
A: Fillers can often be combined with other aesthetic treatments, but it’s crucial to discuss this with your doctor.
Q9: What should I do if I experience any side effects?
A: Contact your healthcare provider immediately if you experience any side effects, especially prolonged swelling, pain, or signs of infection.
