Pain Scores Associated with Lidocaine-Tetracaine Versus Lidocaine-Prilocaine Topical Anesthesia During Facial and Cervical Microneedling: A Retrospective Single-Center Observational Analysis.

Background

Effective topical anesthesia is essential to patient comfort and adherence during minimally invasive esthetic procedures. We retrospectively reviewed pain scores recorded after microneedling in a single private clinic where two topical anesthetic formulations-lidocaine 7%/tetracaine 7% (Pliaglis) and lidocaine 2.5%/prilocaine 2.5% (Anesderm)-were used as part of standard clinical practice on different anatomical sites and under different application protocols.

Methods

Records were reviewed from 26 healthy female patients (mean age 42 ± 4 years; range 34-48) who underwent microneedling on the face and neck during 2024 in a single private clinic. According to the established clinic protocol, which was not modified for research purposes, Pliaglis was applied to the face without additional occlusion (self-occlusive peel-off film, in accordance with the manufacturer's recommendation) and Anesderm was applied to the neck under plastic-film occlusion (also in accordance with the manufacturer's recommendation), both for 45 min prior to microneedling at a fixed depth of 1.25 mm. Treatment allocation was determined by clinic workflow; patients and the operator were not blinded, and the order of the two products within each session was not randomized. Post-procedural pain was recorded using a Visual Analog Scale (VAS, 0-10), with one decimal precision, separately for each anatomical site. Within-patient differences were analyzed using a paired-sample t-test, with a Wilcoxon signed-rank test as a non-parametric sensitivity analysis.

Results

Pain scores were lower at the facial site (Pliaglis, no occlusion) than at the cervical site (Anesderm, occlusion): mean VAS 3.00 ± 0.63 vs. 5.38 ± 0.75; mean within-patient difference 2.38 points, 95% CI 1.97-2.80; paired t(25) = 11.87, p < 0.0001; Cohen's d = 2.33. The Wilcoxon signed-rank test produced a concordant result (p < 0.0001). A within-patient pain reduction of at least 30% on the facial site relative to the cervical site was observed in 81% of patients (21/26). Both products were well tolerated, with only mild transient erythema reported.

Conclusions

In this retrospective, non-randomized, non-blinded single-center analysis, lower pain scores were observed at the facial site (treated with lidocaine-tetracaine 7%/7% without additional occlusion, per manufacturer instructions) than at the cervical site (treated with lidocaine-prilocaine 2.5%/2.5% under occlusion, per manufacturer instructions) within the same patients. Because formulation, active-drug concentration, anatomical site, and the manufacturer-mandated occlusion technique co-varied between the two conditions, the observed difference cannot be attributed to formulation alone. These findings should be regarded as hypothesis-generating and require confirmation in prospective, randomized, split-region or split-face studies that disentangle formulation effects from site- and protocol-related factors.