Nerve Blocks for HIFU Treatment

High intensity focused ultrasound (HIFU; Ultherapy, Merz) changed the nonsurgical skin tightening game when it received FDA approval for skin lifting and tightening in 2009, first for the brow then for the face, neck, and décolletage. Although the energy device filled the gap to deliver less invasive results with less downtime, however, patients who experienced the HIFU treatment reported significant discomfort.

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In a recent article in the Aesthetic Surgery Journal, study authors examined the use of nerve blocks prior to HIFU treatment to provide pain relief. Their hypothesis, that nerve blocks before HIFU treatment would significantly reduce treatment-related pain and be well-tolerated, is reflected in the title, “Nerve Blocks Prior to Microfocused Ultrasound are Safe and Reduce Patient Discomfort.”

The study included 65 patients undergoing HIFU who were given the choice to be in one of three groups: split face nerve block (n=28), bilateral block (n=19), or control/no block (n=18). Blocked nerves included the infraorbital, supratrochlear, supraorbital, zygomaticofrontal, mental, great auricular, and cervical plexus. Pain was assessed using a 10-point Wong-Backer FACES Pain score.

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Resulting pain scores showed a statistically meaningful difference between those patients who received a bilateral block and those who received no block in the control group (mean pain score 3.9 vs. 5.1, respectively; P=<0.001). Results were also significant in the split face patient group, with a 7.5 mean pain score on the unblocked side of the face versus 2.9 on the blocked side (P<0.001). Pain scores were low for local anesthetic injection for the split face and bilateral patient groups (2.7 and 1.4, respectively). No adverse events were reported.

The Journal gave this study a Therapeutic (2) Level of Evidence on their Evidence Rating Scale for Therapeutic Studies.

References:

Polacco MA, Butz DR, Bass R, et al. Nerve Blocks Prior to Microfocused Ultrasound Treatment are Safe and Reduce Patient Discomfort. Aesthet Surg J. 2020;40(8):887-891.

Sullivan D, Chung KC, Eaves FF, Rohrich RJ. The level of evidence pyramid: indicating levels of evidence in Plastic and Reconstructive Surgery articles. Plast Reconstr Surg. 2011;128(1):311-4.