Recommended BLT Cream Strengths for Medical Microneedling
For medical microneedling procedures, the recommended BLT (Benzocaine, Lidocaine, Tetracaine) cream should contain 20% benzocaine, 4% lidocaine, and 2% tetracaine to provide optimal pain control while minimizing risks of adverse effects. This combination provides effective topical anesthesia for the discomfort associated with microneedling procedures.
Topical Anesthesia for Microneedling
Recommended Formulation
- Benzocaine: 20%
- Lidocaine: 4%
- Tetracaine: 2%
This formulation is based on FDA-approved concentrations for these individual components 1, 2, which when compounded together provide effective pain management for microneedling procedures.
Application Protocol
- Apply a thick layer of BLT cream to treatment areas
- Ensure application at least 30 minutes prior to the procedure
- Cover with occlusive dressing to enhance penetration
- Thoroughly remove cream before beginning the procedure
- Ensure skin is well lubricated with appropriate solutions during the procedure
Safety Considerations
Maximum Safe Dosages
- Lidocaine: Maximum 7 mg/kg with epinephrine for adults 3
- For larger treatment areas, be cautious of total applied amount
- For children, reduce dosage to 3.0-4.5 mg/kg of lidocaine with epinephrine 3
Risk Minimization
- Use compounded topical anesthesia from a pharmacy rather than over-the-counter products 3
- Avoid application on broken skin to prevent excessive systemic absorption
- Be aware of early signs of local anesthetic toxicity (circumoral numbness, facial tingling, light-headedness)
- Have lipid emulsion 20% available for potential toxicity treatment 4
Contraindications
- Active infections at treatment site
- True allergy to any component of the BLT cream
- Severe hepatic disease (impairs metabolism of local anesthetics)
- Use with caution in patients with cardiac conditions
Microneedling-Specific Considerations
Needle Depth and Anesthesia Requirements
- Superficial treatments (0.25-0.5mm): BLT cream usually sufficient
- Medium depth (0.5-1.5mm): BLT cream with proper application time
- Deep treatments (1.5-2.5mm): May require supplemental anesthesia methods
Treatment Areas
- Follow directional and depth recommendations for different facial regions 3
- Map out problem areas such as scarring for special treatment with stamping techniques at greater depth 3
- Avoid microneedling over tattoos or permanent makeup 3
Alternative Anesthetic Options
If patient has allergies to components of BLT cream, consider:
- Ester-type local anesthetics for patients with amide anesthetic allergies 3
- 1% diphenhydramine injection as an alternative 3
- Bacteriostatic normal saline (0.9% benzyl alcohol in normal saline) 3
Post-Procedure Care
- Advise patients to avoid sunlight and heavily scented facial products for 24 hours post-procedure 3
- Expect normal post-procedure effects including transient erythema and edema lasting 24-48 hours 3
- Provide clear instructions on when to seek medical attention for adverse effects
Microneedling with proper anesthesia is generally well-tolerated with minimal adverse effects when performed correctly 5, 6. The BLT cream formulation recommended provides effective pain control while maintaining the safety profile that makes microneedling an attractive minimally invasive treatment option 7, 8.