CLINICAL

BLOCKED

Dr Ed Robinson discusses the role of dental (peri-oral sensory) nerve blocks in non-surgical aesthetic medicine

Pain management is a foundational component of safe and effective aesthetic practice. As the scope of non-surgical treatments expands, the demand for more sophisticated analgesic strategies has increased. Peri-oral sensory nerve blocks, often referred to informally as dental blocks, encompass targeted anaesthesia of the infraorbital and mental branches of the trigeminal nerve. When performed by appropriately trained practitioners, these blocks can significantly enhance the overal treatment experience.

This article offers an academic overview and is not a procedural guide. Performing nerve blocks requires formal hands-on training, competency assessment, appropriate scope-of-practice and insurance coverage, and compliance with local regulations.

WHAT IS A NERVE BLOCK?

A nerve block involves the targeted deposition of local anaesthetic around a peripheral nerve to temporarily inhibit nerve conduction. Local anaesthetics primarily block voltage-gated sodium channels, which prevents depolarisation and the propagation of action potentials.1 This causes reversible sensation loss and mild motor function, while maintaining consciousness and physiological stability.

Systematic reviews show that regional anaesthesia offers better pain control, lower opioid use, and higher patient satisfaction than topical or infiltrative methods.2,3 These benefits are increasingly recognised in aesthetic medicine as procedures become more advanced and multi-layered.

The infraorbital and mental nerves are particularly relevant because they provide sensory innervation to the upper lip, lower eyelid, medial cheek, nasal alae, lower lip, chin, and labial mucosa, making them powerful adjuncts to peri-oral and periorbital treatment workflows.

BENEFITS OF DENTAL BLOCKS IN NON-SURGICAL AESTHETICS

Superior pain control

Multiple RCTs show nerve blocks are superior to topical anaesthesia for deeper or multi-pass procedures.4,5 Topical agents have limited penetration and are less effective for cannula work, PRP or microneedling, which stimulate deeper nociceptors.

Longer combined sessions are possible

By achieving more profound and predictable analgesia, nerve blocks allow clinicians to perform multi-step or multi-area treatments in a single appointment without exceeding patient discomfort thresholds.

Higher patient satisfaction and retention

Studies consistently show that comfort level is one of the strongest predictors of whether a patient returns.6 Because perioral blocks produce a painless or near-painless experience, they can improve loyalty and perceived professionalism.

Avoidance of reactions to topical anaesthetic creams

Topical anaesthetics, particularly those containing lidocaine and prilocaine, can cause irritant dermatitis, allergic contact reactions, and rarely methemoglobinemia.7 Eliminating the use of topical agents removes these risks.

Improved compatibility with energy-based devices

Many resurfacing and photothermal devices such as fractional lasers, thulium lasers and BBL interact with water-containing substances. Topical anaesthetic creams are water-based, and residual product on the skin can theoretically alter energy absorption profiles, affect ablation depth, or increase the risk of epidermal injury.8 Nerve blocks avoid this variable entirely.

Greater precision and technical consistency

Reduced patient movement, flinching or anticipatory discomfort enables practitioners to place injectables with increased accuracy which is crucial for lip filler, vermillion border definition, corner support, marionette lines and under-eye/lip combination treatment.

Fewer procedural interruptions

A calmer patient allows uninterrupted workflow, reducing treatment time and improving safety.

Professional differentiation

Offering nerve blocks reflects advanced training and positions the practitioner at a higher clinical standard.

RELEVANT ANATOMY FOR DENTAL BLOCKS

Overview of trigeminal distribution

The infraorbital and mental nerves are branches of the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve, respectively. Both are purely sensory nerves at the points targeted for aesthetic blocks.

Infraorbital nerve

The infraorbital nerve exits the skull via the infraorbital foramen, located approximately six to ten millimeters below the infraorbital rim, aligned with the mid-pupillary line. It provides sensation to; upper lip and philtrum, lateral nose, lower eyelid, medial cheek skin, and buccal mucosa above the canine tooth.

Blocking this nerve numbs both upper-lip procedures and under-eye treatments, making it particularly useful for combination treatments.

Mental nerve

The mental nerve is a terminal branch of the inferior alveolar nerve and exits through the mental foramen, typically located between the mandibular premolars. Its distribution includes; lower lip, chin, labial mucosa below the canine and premolars, and anterior gingiva. This block is advantageous for lower-lip fillers, chin augmentation, perioral rejuvenation, and subcision of peri-oral rhytids.

Techniques

• External approach landmark: mental foramen midway between upper and lower mandibular borders, aligned with the pupil.

• Intra-oral approach landmark: mucobuccal fold near the premolar region.

CLINICAL INDICATIONS IN AESTHETIC MEDICINE

Injectable lip treatments (needle or cannula)

Lip injections are among the most painful aesthetic procedures, including polynucleotides. Cannula-based techniques, particularly those involving periosteal anchoring or threading, can be uncomfortable even with topical anaesthesia. Peri-oral blocks can provide full mucosal and cutaneous anaesthesia9 , enabling; precise vermillion border sculpting, controlled tenting or pillar techniques, and smooth cannula advancement.

Energy-based devices

Fractional lasers, thulium lasers, microneedling, RF and BBL around the lips and chin can produce intense discomfort. Nerve blocks eliminate the need for topical creams that might interfere with laser-tissue interaction and ensure greater patient tolerance during stacking passes.

Combination treatments/treatment stacking

Because the infraorbital nerve supplies both the under-eye region and upper lip, its blockade enables complex combinations such as; under-eye biostimulators, lip filler and peri-oral laser resurfacing. This streamlines treatment plans and reduces appointment burden.

CONTRAINDICATIONS

• Known allergy to the local anaesthetic agent

• Infection or cellulitis at the injection site

• Patient refusal

• Bleeding disorders or anticoagulation therapy10

• Inability to comply with instructions or remain still

• Significant facial anatomical distortion (trauma, surgery)

• Extensive dental pathology or oral infection

COMPLICATIONS AND LIMITATIONS

• Bruising

• Haematoma if a vessel is punctured (infraorbital artery, mental artery)

• Ineffective or partial block, requiring additional analgesia

• Transient motor disturbance

• Prolonged numbness (rare)

• Pain or swelling at the injection site

• Nerve irritation (extremely rare)

• Infection

• Muscle movement may be temporarily altered, making assessment of dynamic lip shape less accurate during filler injections

• Immediate post-treatment appearance may be impacted by swelling or asymmetry from the block

• Not all patients tolerate the feeling of numbness

ADVICE AND STRATEGIES TO MITIGATE COMPLICATIONS

• Avoid hot drinks and chewing until sensation returns

• Expect temporary numbness for one to three hours

• Report prolonged numbness or increasing swelling

• Aspirate before injecting to minimise the risk of intravascular placement11

• Use minimal effective volume of local anaesthetic

• Consider ultrasound guidance, which improves accuracy and reduces complication risk12

• Employ meticulous aseptic technique

TIPS AND TRICKS FOR BEST PRACTICE

Buffered anaesthesia

Buffering lidocaine with sodium bicarbonate reduces injection pain and accelerates onset.13

Warm the anaesthetic

Injecting solution at body temperature reduces discomfort.14

Ultrasound guidance

Increasingly used in facial regional anaesthesia due to its ability to visualise soft tissue, vessels and foramina.

Use slow, gentle injection technique

Rapid deposition increases pain and tissue pressure.

Distraction techniques

Vibration devices or verbal distraction can improve patient comfort.

SUMMARY AND CONCLUSION

Peri-oral sensory nerve blocks, including infraorbital and mental nerve blocks, represent powerful adjuncts for enhancing comfort, precision and safety in non-surgical aesthetic medicine. They enable deeper anaesthesia than topical agents and facilitate a wide range of injectables, regenerative treatments and energy-based procedures. The evidence supports improved patient satisfaction, decreased procedural discomfort, and opportunities for more advanced treatment stacking. However, these techniques require specialist training, anatomical expertise and careful patient selection.

Complications can occur and may impact results if not anticipated. As aesthetic medicine evolves, the integration of analgesic strategies such as dental nerve blocks will increasingly differentiate high-quality, medically led clinics and contribute towards safer, more comfortable and sophisticated experiences.

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DR EDWARD ROBINSON

Dr Edward Robinson is a cosmetic physician based in Cheshire. With a background as an anaesthetist, he specialises in skin and hair rejuvenation treatments and male facial treatments, favouring biostimulators and combination treatments. He is an associate member of BCAM and a key opinion leader for Arthrex and Sciton.