Vibration anesthesia: a noninvasive method of reducing discomfort prior to dermatologic procedures.

In some dermatologic and cosmetic procedures, local anesthesia is not sufficient for relieving pain; often patients are averse to injections. We propose vibration anesthesia, the use of vibration delivered with commercially available inexpensive massagers to reduce discomfort. We find the analgesic effect of vibration helpful in minimizing pain in patients undergoing injections of botulinum toxin type A treatment for hyperhidrosis, injection of filler substances such as Restylane and Juvederm, laser therapy for leg veins, nail-fold injections, Q-switched laser treatment of tattoos, incision and drainage of abscesses, and cautery of facial warts, as well as facilitating anesthetic injections for needle-phobic patients. We expect that additional uses will be found as experience with this modality grows. Although the use of vibration anesthesia generally does not eliminate pain completely, it can serve to make the injection or procedure much more tolerable.

Treatment of HIV-associated facial lipoatrophy with Radiance FN (Radiesse).

HIV treatments frequently include the administration of Highly Active Antiretroviral Therapy (HAART) to combat the disease; although no conclusive evidence exists, it has been suggested that the HAART regimen may lead to facial lipoatrophy, exemplified by fat loss from facial areas, most notably the cheeks. Lipoatrophy can cause severe psychosocial consequences because it can be an identifying marker of HIV infection. Calcium hydroxylapatite (Radiance FN, recently renamed Radiesse) has been postulated to be a long-lasting, biocompatible filler that does not ossify, migratem or calcify. We present three patients with HIV-associated lipoatrophy who were treated with Radiance FN. Touch-up treatments were performed 1 month later for two patients. The percentage of improvement following the initial treatment ranged from 75 to 90 percent. Although there has been some loss of improvement over time, there has been significant persistence for up to 9 months. No complications have occurred, and patients were highly satisfied with treatment results. Our experience with Radiance FN has shown it to be a potentially valuable tool for treating facial lipoatrophy.