Fillers are a fast and easy way to correct all sorts of facial contour defects whether they are lines, wrinkles, creases but their main drawback is that they are not painless, there is some real discomfort. So anything we can do to make this experience less uncomfortable makes it better for the patient and recently filler manufacturers have started adding local anesthetic right into the material of the filler to help to decrease the pain. And interestingly, a lot of my patients tell me that fillers with local anesthesia actually hurt much less than fillers without them. Now, I never argue with success and I think that's really great, but I have to tell you quite frankly, I don't understand why filler with local anesthesia makes it less uncomfortable. Now let me explain. There are two parts to the event of having a filler treatment that cause discomfort. The first is the insertion of the needle actually through the skin. Now let me show you what I mean. I take the syringe with the needle and I push it through the skin. That needle has punctured the skin and it doesn't matter what's in the filler. It doesn't matter if there is local anesthesia there or not because that discomfort was caused just by the needle pricking the skin. Of course topical anesthetics like EMLA, put on the skin for 20 minutes before the treatment can help decrease the discomfort. But after the needle has gone through the skin the second part of the discomfort actually comes from the infusion of the filler into the skin. Let me show you what happens when I push on the syringe. As you can see there is white material coming out, this is the filler, and it actually forms a volume in the skin, it re- expands the skin because it's the collapsing of the skin that's caused lines and wrinkles and creases, and by re-expanding that it makes the skin smooth. Well when you stretch the skin back to where it should be you also stretch nerves. And when you stretch nerves, you fire them. And that's what causes the pain. We know that local anesthetic usually takes a few seconds to work to make your skin numb, but the expansion of the skin from the insertion of the material happens instantaneously, yet people don't have any discomfort despite the fact that there's been no time for the local anesthetic to work. This is the bottom line, patients tell me it works, patients tell me that it's less uncomfortable, so the next time you go for a filler treatment ask your Doctor if your Doctor has filler with local anesthesia.