Skincare
4 min readNumbing Creams Compared: Lidocaine-Prilocaine vs Pliaglis
Educational reading for licensed practitioners — not clinical or injection guidance.
Topical anaesthesia is one of the quieter decisions in an aesthetic clinic, but it shapes how a treatment feels and, often, whether a patient returns. Two formulations account for most of the numbing done before injectables and energy-based work: lidocaine-prilocaine creams and Pliaglis, a lidocaine-tetracaine cream. They are not interchangeable, and choosing well means understanding how each behaves on skin.
How Topical Anaesthetics Work
A topical anaesthetic blocks sodium channels in the sensory nerve endings of the skin, dulling the signal before a needle, cannula or acid ever reaches them. The two variables that matter clinically are onset — how long the cream needs to work — and depth, meaning how far into the dermis the effect reaches. Intact skin is a barrier, so most creams rely on time under occlusion to penetrate. The chemistry of the active agents, and whether they form a eutectic mixture that lowers the melting point and improves absorption, largely determines both.
Lidocaine-Prilocaine: The EMLA Class
Lidocaine-prilocaine 5% (the original brand being EMLA, though generics are widespread) is the long-standing workhorse. The two anaesthetics form a eutectic emulsion that absorbs reasonably well into intact skin. It is typically applied as a thick layer under occlusive film and left for around 30 to 60 minutes; longer application generally deepens the effect. It is inexpensive, familiar and, in many markets, available without prescription, which is part of why it remains the default.
Its limitations are worth naming. Onset is slow, so it demands clinic time or at-home pre-application. Prilocaine carries a small, dose-related risk of methaemoglobinaemia, which is why very large surface areas and use in young infants warrant caution. And the depth of anaesthesia can be modest — adequate for superficial work, less so for deeper injection planes.
Pliaglis: Lidocaine-Tetracaine
Pliaglis pairs lidocaine 7% with tetracaine 7% in a cream that dries into a peel-off membrane, removing the need for occlusive dressings. The higher combined concentration and the self-occluding film tend to produce a faster, more profound effect than the EMLA class, with application times often in the 20 to 30 minute range for facial procedures. Practitioners frequently favour it where a denser block is wanted or where dressing multiple sites is impractical.
The trade-offs are cost and access — it is a prescription product in most markets and pricier per treatment — and tetracaine's own sensitisation profile, so patient history matters. For a fuller look at where it fits, see our note on Pliaglis as a newer topical anaesthetic.
Matching the Cream to the Procedure
The right choice depends less on brand loyalty than on what is being done:
- Dermal filler and injectables. Many HA fillers already contain lidocaine, so topical numbing is about the initial needle entry. Either cream suffices for most facial injecting; Pliaglis earns its place for more sensitive zones or lower pain thresholds.
- Microneedling. Devices such as the Dr. Pen Ultima M8S or an AQUAGOLD microchannelling tool create hundreds of superficial punctures across a whole area — a scenario where an even, reliable field of anaesthesia counts. A faster-onset, self-occluding cream can streamline a busy list.
- Chemical peels. For a superficial-to-medium peel like PRX-T33, numbing is used judiciously — the practitioner still needs to read the skin's frosting and response, so anaesthesia is about tolerability rather than a total block.
- Regenerative injectables. Polynucleotide treatments such as Plinest and bio-remodelling with Profhilo can sting on placement, and a well-timed topical makes multi-point protocols far more comfortable.
Safety and Application Notes
Two principles keep topical anaesthesia safe. First, respect surface area and dose: applying either cream over a large expanse of skin, under prolonged occlusion, increases systemic absorption and the associated risks. Second, respect the skin barrier — broken or freshly lasered skin absorbs far more than intact skin, changing the calculus entirely. Patch testing for allergy history, checking for contraindications, and timing application so the cream is fully wiped before the procedure begins are the unglamorous details that prevent problems. None of the above is a dosing instruction; it is a prompt to follow product labelling and local prescribing rules.
The Takeaway
Lidocaine-prilocaine remains a dependable, accessible default for superficial and moderate work, while Pliaglis offers a faster, denser block at higher cost and with prescription access. Match the cream to the depth and area of the procedure rather than defaulting to one for everything, and treat surface area, timing and skin integrity as the safety fundamentals. Comfortable numbing is also what makes fuller regenerative protocols tolerable — explore the microneedling range to see where topical anaesthesia does the most work.