Using a lidocaine mix with hyaluronic acid (HA) fillers to help mitigate pain is not an uncommon practice. But can adding epinephrine to lidocaine further offset bruising and pain?
A research team led by facial plastic surgeon Amir Moradi, M.D., Vista, Calif., investigated the severity of bruising and pain in patients treated with the cohesive polydensified matrix HA (CPMHA; Belotero Balance; Merz) in three different preparations: CPMHA (BEL), CPMHA with lidocaine (BEL-L) and CPMHA with lidocaine and epinephrine (BEL-LE).
In a blinded, split-face, 14-day study, the research team divided 30 patients into three groups of 10. One group received 1 mL of BEL in the perioral lines on one side and 1 mL of BEL-LE on the other. A second group received 1 mL of BEL on one side and 1 mL of BEL-L on the other. The third group received 1 mL of BEL-L on one side and 1 mL of BEL-LE on the other. Over three visits, the treating investigator, the patients and a blinded investigator rated the bruising.
The findings show that patients in each group experienced bruising on the first day but that it resolved for half the patients by the seventh day and for all by day 14. Split-face comparison revealed no significant difference in pain and bruising scores among the patients treated with the three preparations.
“Studies with a considerably larger sample size are warranted to determine statistically significant and clinically meaningful differences between and among the various formulations,” the authors write.
The study was published April 23, 2015, online in the Aesthetic Surgery Journal.