Powder Brows procedure and anesthetic creams
It’s numbing time!
Topical anesthetics are commonly used in the field of permanent makeup (PMU), including the Powder Brows procedure, to minimize discomfort during the treatment. They contain various active ingredients that can numb the skin. In this post, you can read about the actual effects, worst-case scenarios, and approaches of several professional artists regarding using those.
“Often an artist ensures the client’s tolerance to ingredients in numbing creams, such as lidocaine, by enquiring about prior experiences with lidocaine-based dental numbing. The mark of true professionalism, however, lies in educating the client about potential risks and obtaining written consent that acknowledges the client’s understanding and acceptance of any potential side effects associated with the anesthetic cream.”
Lidocaine-based creams
Lidocaine is a local anesthetic that provides numbing by blocking nerve signals in the body. Products such as Emla, Dr. Numb, and Topicaine often contain lidocaine.
Benzocaine-based creams
Benzocaine is another local anesthetic. It's often used in oral medications but can also be found in some topical anesthetics.
Tetracaine-based creams
Tetracaine is a potent anesthetic that's often combined with other numbing agents to enhance the numbing effect.
Prilocaine-based creams
Prilocaine is often combined with lidocaine in products like Emla.
These are often used in combination to create a more potent numbing effect.
How does numbing actually happen during numbing?
Local anesthetics like lidocaine, benzocaine, tetracaine, and prilocaine cause numbness by blocking nerve signals. They do this by inhibiting voltage-gated sodium channels, which are necessary for the initiation and conduction of nerve impulses.
When applied to a specific area of the skin, these anesthetics permeate the skin and block the sodium channels of the nerve cells located in that area. When the sodium channels are blocked, the nerve cells are unable to generate a signal. As a result, any sensation, including pain, is not perceived because the brain doesn't receive any signal from the numb area.
Therefore the key to achieving much more effective numbing is to open up the skin slightly in order to maximize the effect of the cream. That results in the effect of numbing happening much faster. When it comes to the Powder Brows procedure, the real effect of the creams occurs when the artist uses the PMU machine to gently go over the whole brow area prior to applying the cram.
Risks and potential side effects of the numbing creams
Despite their benefits, topical anesthetics are not without risks. The side effects may vary depending on the specific anesthetic used, the concentration, the duration of application, and individual sensitivity. Here are some common side effects:
Skin reactions
This can include redness, itching, or swelling, in some rather rare cases, a rash or hives, at the site of application. Many Powder Brows artists have confirmed, that generally, minor side effects such as skin irritation or redness may occur almost immediately or within minutes to a few hours after the application of the numbing cream. This is typically due to a localized reaction to the product.
More serious side effects related to an allergic reaction or systemic absorption of the anesthetic can occur after a variable amount of time, depending largely on the individual's sensitivity, the anesthetic used, and the amount that is absorbed into the bloodstream. It can range from a few minutes to hours post-application. However, there was rarely actual anatomic causation to side effects that happen days after the procedure (although some clients may express such concerns). If there are no visual signs of skin reaction by the next morning after the procedure, the connection to the anesthetic and its contents after that would be extremely rare.
Allergic reactions
Some people may be allergic to anesthetics or other components in the cream. This can cause more severe reactions, including hives, difficulty breathing, and even anaphylaxis. More serious side effects can be both visible and felt. For example, an allergic reaction may cause hives, severe itching, and swelling around the eyes or face. This might also be accompanied by difficulty breathing, dizziness, and a rapid heartbeat, which are serious symptoms requiring immediate medical attention.
Artists often make sure that the client has tolerance for lidocaine (and other substances that the numbing cream contains) by asking if the client has had lidocaine-based numbing used for a dental procedure. However, what sets the professional artist apart from the ordinary, is explaining the risks to the client prior to the procedure and always getting written consent before the actual numbing, saying that the client confirms her tolerance and takes full responsibility regarding the potential undesired effects of lidocaine (and all other substances in the anesthetic cream).
Methemoglobinemia
This rare but serious condition is most often associated with the use of anesthetics that contain benzocaine, lidocaine, prilocaine, or certain other local anesthetics. These medications can convert hemoglobin into methemoglobin, inhibiting its ability to transport oxygen. Thus it can be said that it is in its essence a blood disorder in which an abnormal amount of methemoglobin, a type of hemoglobin, is produced. (Hemoglobin is the component in the blood responsible for carrying oxygen around the body, and when methemoglobin levels increase, it can reduce the amount of oxygen carried in the blood.)
The likelihood of developing methemoglobinemia from topical anesthetic use is rather low. However, it can be higher in people who are using higher concentrations of the cream, using it on larger areas of skin, or using it on broken or irritated skin, which may allow for greater absorption of the anesthetic. From the practical perspective, it means that the artist applies a rather substantial amount of cream containing those substances (particularly benzocaine) on top of opened skin many phases in a row, rubbing it in with the glove for example. Also, the worst-case scenario presupposes that the client has methemoglobinemia, a genetic predisposition to develop such reactions, does not know about it herself (himself), or has not (for whatever reason) shared this information with the Powder Brows technician.
As said, methemoglobinemia symptoms in such cases can range from mild to severe, depending on the level of methemoglobin in the blood. Those can include headache, dizziness, shortness of breath, fatigue, and skin, lips, and nail beds turning a blue or gray color. In extreme cases, it can lead to seizures, heart arrhythmias, very rapid heart rate, or theoretically even coma or death (although we know no case where a Powder Brows artist would have actually killed the client this way and we get input from thousands of artists all over the world).
In the event of a suspected case of methemoglobinemia, the artist should immediately stop the procedure, remove the anesthetic cream, and seek immediate medical attention for the client. Methemoglobinemia can be a medical emergency and requires prompt treatment, usually with a medication called methylene blue that helps to reduce the levels of methemoglobin in the blood.
Reducing the risks and taking advantage of the placebo effect
PMU artists can reduce the risk of methemoglobinemia and other adverse reactions by using anesthetic creams as directed. Many artists have also said that after the first phase when the skin is opened, they start with very small quantities of the cream. Often the numbing effect is rather immediate and if there is no actual need for additional numbing.
Also, the psychological placebo effect of applying numbing cream should not be underestimated. Multiple artists have confessed that in case the client believes that the numbing cream is applied and that there should be less pain, also less pain is felt. One should not run such experiments on clients to evaluate the "placebo" component of the numbing, however, what can be done is express the expectation for numbing with small quantities of the cream to facilitate the reaction the responsive reaction in the client.
Pregnancy, breastfeeding, and numbing creams
Regarding pregnant and breastfeeding women, the safety of topical anesthetics depends on the specific anesthetic used and the amount that is absorbed into the bloodstream. Lidocaine, for example, is generally considered safe in normal doses, but excessive use could potentially lead to harmful levels in the mother's blood and could theoretically affect the baby. It's always recommended that pregnant or breastfeeding women consult with their healthcare provider before using any medications, including topical anesthetics.
When it comes to the professionalism of the artist, the fact that there could be a theoretical (taking into account the microdose of lidocaine in numbing creams - we can even say - highly theoretical) connection between the health of the baby and the application of the cream, one should not do the procedure during pregnancy. The main reason is very pragmatic.
If something (anything) happens to the baby, for example, the baby has some health problems of any sort, or in the worst case ends up stillborn or the pregnancy ends with a miscarriage, then the artist who opts for such numbing may be in serious trouble. One aspect is legal and usually, that can be solved based on written consent, etc. The other aspect, that should never be underestimated, is related to potential damage to the public profile of the artist. In case the mother happens to connect the artist's usage of the numbing cream to the troubles in her mind, she may launch into a lifelong endeavor to destroy the artist's reputation no matter what. That is something no artist should want to be at the receiving end.
Regarding breastfeeding, it should be said that there effect of lidocaine on a baby's health is of a rather theoretical nature, and the scientific research papers so far describe it the following way: "There is a small potential risk, but it is generally considered to be very low. " From our experience from a huge number of artists we have never received any information regarding any cases of baby's health being reported to worsen by the lidocaine that was absorbed into the mother's bloodstream.
However, there is another reason why many artists do not want to do the procedure for breastfeeding mothers and that is related to the fact, that probably it is impossible to achieve as good a result as possible due to the hormonal imbalance of the mother. Thus they either refuse the procedure or make sure that the expectations of such clients are aligned with the anatomical relativity of more pigment potentially fading off due to the fluctuating hormonal levels in the client's body.