Dr. Shervin NaderiFacial Plastic Surgeon specializing in Rhinoplasty & Anti-aging as well as Facial Balancing Botox & Filler Injections

Dental Block Lip Numbing for Lip Augmentation by Northern Virginia Cosmetic Surgeon

3 Sept 2009 · 4 min

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4:09

A short procedural transcript in which a practitioner (Dr. Shervin Naderi) describes performing a dental block for lip augmentation using 2% lidocaine with 1:1000 epinephrine. The speaker explains injection sites (gingiva buccal sulcus, infraorbital and mental nerve foramina, frenulum), technique (advance to bone, inject while withdrawing to create a bleb), risks (bleeding, hematoma in anticoagulated patients), and a wait time of about 5–10 minutes before performing lip injections.

Chapters

So for the dental block, I'm using 2% lidocaine with 1 to 1000 epinephrine. The epinephrine helps with vasoconstriction, and the lidocaine is short acting enough that she won't be numb for hours and hours and hours. It makes the procedure much more comfortable. For the lip injection, lift your chin up for me a little. Relax and let me hold your lips. What I do is I go under the lips in the gingiva buccal sulcus, and I slide up. As I'm going up, I start filling little by little by little. You'll feel some pressure. And I go down right to the bone where the infraorbal nerve exits its foramen. You okay? Mm. Good. I'm gonna feel around, make sure it's sitting right on top of the bone. And after putting some lidocaine right around the nerve, as I'm pulling out, I continue to fill, and I come out and I create a little bleb or bubble right at the gingiva buccal sulcus. That's one side. I got it. You okay? Mm. Do the other side again. Entering right at the hippobuncal sulcus. There's usually a few little vessels that you can see. You want to avoid those, not to create an extra bleeding, penetrate the mucosa. You're going into the soft tissue filling as you go, just to make it more comfortable. From the right hand to the bone, this is where they feel a little pressure. And then fill as I withdraw, Creating a blood in the sulcus. I hold a little pressure in case there's small little vessels that are in the way. Not to end up with a hematoma. It's usually not a nation never had a problem with that. There was a case description of an elderly female that was taking blood thinners who had a similar procedure done. Ended up with a large hematoma. But other than that, I'm not aware of anybody else in the literature that had a problem with this. Last one in the upper lips is actually right at the frenulum just to get the central lip number. So that's it for the upper lips, the lower lips, similar procedure. Pull down on the lip, go into the mucosa, slide right down to the bone where the mental nerve exits its foramen. Feel the bone, fill it up, and then as I pull out, I want to see a bleb form right on the gingival buccal sulcus muscle mucosa. Last injection coming up. Same thing. If you pull the lip out far enough, you actually see the vessels that are around the nerve. You want to have a good grasp of the lips. And a lot of women that wear lipstick or chapstick on their lips, the lip becomes slippery. You just want to be able to grab it and pull it out to do an injection and that's it. We're going to let this work for about five to 10 minutes, and then we'll get started with the lip injection.