Mepivacaine’s Potential Vasoconstrictive Effects
Lidocaine → mild vasodilation at typical clinical concentrations. This can be a double-edged sword:
Pro: may improve local blood flow and, theoretically, oxygen delivery.
Con: may increase bruising, edema, and systemic absorption.
Mepivacaine → minimal vasodilation or slight vasoconstriction in some vascular beds .
In dentistry and peripheral anesthesia literature, mepivacaine is described as having a “neutral to slightly vasoconstrictive” effect — enough that it can often be used without epinephrine and still provide a decent duration of anesthesia .
This reduced vasodilation is part of why Revance is marketing it as potentially lowering bruising risk.
Ischemia Risk in Filler Injections
Occlusion mechanism: Intravascular filler injection → mechanical blockage → ischemia.
With lidocaine-containing filler:
Vasodilation may theoretically increase collateral flow around a partial obstruction.
Lidocaine may also reduce smooth muscle tone in vessel walls, potentially helping microvascular patency.
With mepivacaine-containing filler:
Any vasoconstrictive effect (even mild) could reduce perfusion reserve around the embolized area.
If a vascular occlusion occurred, collateral channels might be less effective in maintaining perfusion.
In theory, this could make ischemic damage progress faster or be harder to reverse with hyaluronidase — especially in tight end-artery territories (glabella, nasal ala, labial arteries).
Counterpoints
Concentration in fillers is very low (0.3%) and diffusion from the bolus into the vessel wall is limited compared to direct anesthetic infiltration in nerve blocks.
The degree of vasoconstriction from plain mepivacaine at this concentration in facial vessels has not been documented — it may be minimal in practice.
Any vessel occlusion from filler is dominated by mechanical obstruction rather than vasomotor tone. Vasoconstriction would be a secondary contributor, not the primary cause.
Hyaluronidase efficacy is more impacted by time to treatment, access to occlusion site, and filler type/crosslinking than by local anesthetic choice.
Knowledge Gaps / Areas for Caution
There is no published human data on whether mepivacaine-containing fillers worsen ischemia outcomes compared to lidocaine-containing ones.
No animal models have been run specifically in the setting of filler embolism with different anesthetics.
Plastic surgery and anesthesia literature focus on dental pulp and peripheral nerve block vasodynamics — not high-risk angiosome territories in the face.
Practical Takeaways
Technique over formulation: Avoiding intravascular injection is still the #1 ischemia prevention — small aliquots, low pressure, aspiration where appropriate, use of cannulas in high-risk areas.
Maintain readiness: Continue to have hyaluronidase, nitroglycerin paste, aspirin, and protocols in place for any vascular compromise — regardless of anesthetic type.
Early recognition is critical: Since vasoconstriction could slightly reduce the margin for error, be extra vigilant for early blanching, pain, or color changes.
Document and monitor: If you adopt mepivacaine-containing fillers, consider logging ischemia/occlusion incidents separately so you can compare internal rates and outcomes to lidocaine filler experience.
Consider site-specific caution: In ultra–high-risk areas (glabella, nose, upper lip), some injectors may opt to stick with lidocaine-containing products until more is known, simply to avoid even theoretical risk.
Mepivacaine vs. Lidocaine in Dermal Fillers: Safety, Myotoxicity, and Tissue Effects 7.2025
Background: Anesthetics in Dermal Fillers
Dermal fillers are often formulated with a local anesthetic to reduce pain during injection. For years, lidocaine (0.3% concentration in the filler) has been the standard additive, improving patient comfort without altering the filler’s efficacyteoxane.comteoxane.com. Recently, manufacturers have started introducing mepivacaine as an alternative anesthetic in hyaluronic acid (HA) fillers (e.g. the Teoxane RHA,“Mepi” line)teoxane.comteoxane.com. This change prompts questions about why mepivacaine is being used and whether it poses any new risks – particularly regarding muscle or tissue health (so-called myotoxicity or other soft-tissue effects).
Why consider mepivacaine? Mepivacaine is an amide-type local anesthetic, like lidocaine, with decades of safe use in dentistry and regional anesthesiajournals.lww.com. It has a similar rapid onset of action (on the order of 5–10 minutes, comparable to lidocaine) and produces comparable pain reliefjournals.lww.comjournals.lww.com. However, a key difference is that mepivacaine causes less vasodilation than lidocainemdpi.commdpi.com. Lidocaine tends to dilate blood vessels, which can increase bleeding/bruising and speed systemic absorption. Mepivacaine, in contrast, tends to preserve or even decrease local blood flowmdpi.com. This pharmacologic trait yields two potential benefits in the filler context:
Lower risk of bruising and swelling: Reduced vasodilation may translate to less injection-site bleeding or hematoma. While clinical studies did not report large differences in bruising, the theoretical benefit is that mepivacaine “may limit bruising” due to its lack of vasodilatory activityjournals.lww.com.
Lower systemic exposure: By not dilating vessels, mepivacaine is absorbed into the bloodstream more slowly than lidocaine, resulting in a lower peak plasma concentrationmdpi.com. In preclinical comparisons, lidocaine actually reached higher plasma levels faster than mepivacaine when injected with fillermdpi.com. The slower absorption is considered an added safety factor, reducing the risk of systemic toxicitymdpi.commdpi.com. Notably, mepivacaine’s lipid solubility is a bit lower than lidocaine’s, which also might slightly reduce its systemic potencymdpi.com.
Another practical point: because mepivacaine causes minimal vasodilation, it doesn’t require co-formulation with epinephrine for most uses. (By contrast, lidocaine often is paired with epinephrine in medical anesthesia to prolong its effect and limit bleeding – something not done in fillers due to epinephrine’s own risks in facial injections.) Mepivacaine’s duration of action is considered medium-acting – slightly longer than lidocaine’s. For example, mepivacaine’s anesthesia can last roughly 2 hours for nerve blocks (vs. ~1.5 hours for lidocaine), and it has a longer half-life (about 114 minutes vs. 96 minutes for lidocaine)journals.lww.com. This modestly longer-lasting numbness might extend post-injection comfort by a small margin.
From a formulation standpoint, studies indicate that substituting mepivacaine for lidocaine in HA filler does not alter the gel’s properties or performance. In lab tests, HA fillers with 0.3% mepivacaine showed no significant differences in rheology (elasticity, viscosity), stability, or degradation profile compared to the same fillers with 0.3% lidocaineteoxane.comteoxane.com. The extrusion force needed to inject the filler remains low and similar, meaning mepivacaine does not make the gel harder to push through a needleteoxane.com. Importantly, the presence of mepivacaine did not interfere with filler breakdown by hyaluronidase in case dissolving is needed (no change in enzymatic degradability)teoxane.com. Furthermore, cytotoxicity assays have shown no harmful effect on skin cells: in one test, HA fillers containing mepivacaine were not toxic to cultured human fibroblast cells, with no differences in cell viability compared to lidocaine-containing fillermdpi.com. These findings support that, aside from the anesthetic’s pharmacologic effects, the new “mepi” fillers should behave like the familiar lidocaine formulations.
Clinical Experience and Safety of Mepivacaine in Fillers
To understand real-world implications, it’s useful to look at clinical trial data. A 2022 split-face trial (Kaufman-Janette et al., Dermatol Surg.) directly compared HA fillers with mepivacaine vs. with lidocaine in the same patients. Each patient received lidocaine-formulated filler on one side of the face and the mepivacaine-formulated version on the other, in treatments of nasolabial folds and perioral wrinkles. The results were reassuring:
Pain control: Mepivacaine was non-inferior to lidocaine for injection comfortjournals.lww.com. Patients reported equivalent pain relief on both sides. In fact, both anesthetics substantially reduced pain during injection compared to what would be expected with no anesthetic, and neither was clearly better than the otherjournals.lww.com. This aligns with the expectation that 0.3% mepivacaine provides effective local numbness just as 0.3% lidocaine does.
Effectiveness: The aesthetic outcomes (wrinkle reduction) were the same on both sidesjournals.lww.com. Both fillers achieved equivalent improvements in wrinkle severity, with identical responder rates (~97% of patients)seeing significant improvement regardless of anestheticjournals.lww.com. Thus, mepivacaine did not negatively impact the filler’s cosmetic performance or longevity over the one-month follow-up.
Safety and reactions: No new or unexpected side effects emerged with mepivacaine. The incidence of typical post-injection reactions – redness, swelling, bruising, tenderness, etc. – was similar between mepivacaine and lidocaine sides, with no clinically significant differencesjournals.lww.com. Adverse events were few and comparable on both sidesjournals.lww.com. In short, the overall safety profile was equivalent. The authors concluded that HA fillers with either mepivacaine or lidocaine are “equally performant and safe” for cosmetic usejournals.lww.com. Notably, in the perioral wrinkle study, investigators even assessed lip function after treatment to check for any motor impairment; no issues were found, indicating the anesthetic did not measurably affect muscle function in the area.
These clinical findings support that substituting mepivacaine in fillers is not introducing obvious new risks in practice, at least in the short term. Patients experience the same level of comfort and adverse reaction profile. That said, the question remains: What about more subtle or longer-term effects, like myotoxicity or tissue damage? Given mepivacaine’s pharmacology (and some clinicians’ familiarity with bupivacaine being “myotoxic”), it’s prudent to examine whether mepivacaine could harm muscle or other soft tissues when used in filler injections.
Understanding Local Anesthetic Myotoxicity
Myotoxicity refers to the toxic effect a substance can have on muscle tissue. It’s well-established in anesthesiology literature that all local anesthetics (when injected into or around muscle at sufficient concentration) can cause a degree of muscle fiber damage. This phenomenon was first described decades ago and has been confirmed in many animal studies and some human observationspubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. Key points about local anesthetic myotoxicity include:
Universality: Every local anesthetic tested has shown myotoxic effects on skeletal muscle. Amide anesthetics (like lidocaine, mepivacaine, bupivacaine, etc.) as well as older ester anesthetics can all induce muscle fiber necrosis to some extentpubmed.ncbi.nlm.nih.gov. The severity varies by drug and conditions, but none are completely free of this effect.
Spectrum of severity: There is a rough hierarchy: procaine (an ester) tends to cause the least muscle injury, while bupivacaine (a long-acting amide) causes the most severe injury in comparative studiespubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. Lidocaine and mepivacaine fall in the middle of this spectrum – both are more myotoxic than procaine but less so than bupivacaine. In practical terms, bupivacaine’s myotoxicity is notorious enough that it has been deliberately used to cause selective muscle atrophy in certain medical treatments (e.g., injection into extraocular muscles to treat strabismus)sciencedirect.comjamanetwork.com. Lidocaine and mepivacaine, being shorter-acting, generally induce a more transient and milder injury.
Dose and exposure dependence: The extent of muscle damage is highly dose- and concentration-dependentpubmed.ncbi.nlm.nih.gov. Higher concentrations of anesthetic, larger volumes injected, and longer exposure (for example, a continuous infusion near muscle) all increase muscle fiber necrosisbjanaesthesia.orgpubmed.ncbi.nlm.nih.gov. Repeated injections into the same area can compound injury. Conversely, very dilute solutions or tiny amounts cause proportionally less damage.
Pathology: The muscle injury follows a fairly predictable course. Within hours of injection, exposed muscle fibers develop hypercontraction (contracture bands) and then begin to degeneratepubmed.ncbi.nlm.nih.gov. Over 1–2 days, there is edema and infiltration of inflammatory cells, and the affected muscle fibers undergo necrosis (cell death)pubmed.ncbi.nlm.nih.govbjanaesthesia.org. Importantly, the damage is usually localized to the region around the injection – it doesn’t kill entire muscles, only a subset of fibers near where the drug diffused. Within a few days, the muscle’s stem cells (satellite cells) activate to start repairs. Regeneration of muscle tissue is typically well underway by one week, and by 3–4 weeks the muscle architecture can be largely restoredpubmed.ncbi.nlm.nih.gov. The supporting connective tissue (basal lamina, endomysium) and the muscle’s nerve supply often remain intact, which helps guide muscle fiber regrowthpubmed.ncbi.nlm.nih.gov. In cases of limited injury, the muscle may recover completely. With larger or repeated insults, there can be some residual fibrosis (scar tissue) or incomplete restoration of original muscle fiber alignmentpubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.
Mechanism: Why do local anesthetics kill muscle cells? The exact molecular mechanism isn’t fully understood, but research points to disturbances in calcium homeostasis within the muscle cell as a triggerbjanaesthesia.orgpubmed.ncbi.nlm.nih.gov. Local anesthetics can affect muscle cell membranes and the sarcoplasmic reticulum, causing a release of calcium or preventing its reuptake. Excess intracellular calcium is toxic to muscle fibers, leading to protease activation and cell death. Notably, direct chemical toxicity and membrane solubility also play a role (hence more lipophilic, longer-acting agents like bupivacaine tend to be more myotoxic). The process is distinct from simple ischemia; even without cutting off blood flow, the anesthetic’s presence can injure the muscle. Fortunately, because the muscle stem cells survive in most cases, the muscle is capable of self-repair after the anesthetic is metabolized and clearedpubmed.ncbi.nlm.nih.gov.
Clinically, myotoxicity from local anesthetics is uncommon to notice because it’s usually subclinical and reversible. Patients who get a single injection of lidocaine for a dental procedure, for example, don’t later report muscle problems – yet if you biopsy the injection area, you’d see temporary muscle fiber changes. The body heals it without any evident deficit. Only in scenarios of high doses or unusual susceptibility does it manifest as a clinical problem (e.g. prolonged muscle pain or weakness). Documented clinical cases of anesthetic myotoxicity have mostly involved special situations like continuous nerve block infusions (delivering anesthetic near muscle for days), multiple trigger-point injections, or ocular blocks (extraocular muscles are small and sensitive, so damage there can cause noticeable double vision)pubmed.ncbi.nlm.nih.gov. In these cases, patients have developed problems like local myositis, muscle atrophy, or diplopia, and recovery took weeks to months. The incidence is still low – for instance, in cataract surgery (peribulbar anesthesia), persistent muscle issues are quite rare (well under 1% in large series)bjanaesthesia.org. Nonetheless, the potential is real and relevant when considering any new use of an anesthetic agent.
Is Mepivacaine Myotoxic? (Evidence from Literature)
Yes. Mepivacaine has been studied in the lab and, like other anesthetics, it has demonstrated myotoxic effects when injected into muscle. Classic research by Basson and Carlson in 1980 examined mepivacaine 2% injections in rat muscles. The findings were clear: “Single injection studies showed that mepivacaine is a myotoxic drug, producing a lesion which ultimately results in degeneration and subsequent regeneration of large amounts of muscle.”pubmed.ncbi.nlm.nih.gov Under the microscope, the area injected with mepivacaine had muscle fiber necrosis with inflammatory cleanup, followed by new muscle fiber growth over the next days. When they gave repeated injections(mimicking a scenario of multiple procedures in the same site), the damage was more extensive: more muscle fibers were destroyed, and although regeneration still occurred, some muscles showed residual scarring (patches of increased connective tissue) instead of perfectly restoring normal muscle structurepubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. This rat study emphasized two practical points: (1) even one exposure to mepivacaine can kill muscle fibers (but they will regrow), and (2) serial exposures can overwhelm the muscle’s regenerative capacity, leaving some permanent changes (fibrosis).
Studies in other animals (e.g. monkeys and rabbits) have similarly shown that mepivacaine, lidocaine, and bupivacaine all cause qualitatively similar muscle damage, differing mainly in magnitude. In monkey experiments, small intramuscular injections of mepivacaine, lidocaine, or bupivacaine each led to muscle fiber degeneration within a few days and complete or near-complete regeneration by about a monthpubmed.ncbi.nlm.nih.gov. Bupivacaine’s lesions were the most pronounced, but lidocaine and mepivacaine also produced clear zones of muscle necrosis. Under electron microscopy, all three agents caused disruption of muscle fiber structures in the same pattern – there was no unique “mepivacaine damage” versus “lidocaine damage,” only a difference in severity (with bupivacaine worst, as expected).
It’s worth noting that lidocaine itself is myotoxic too. Lidocaine might even be slightly more myotoxic than mepivacaine on a equi-concentration basis, though the data are mixed. Some researchers consider lidocaine and mepivacaine roughly equivalent in myotoxic potential since both are intermediate-duration amide anesthetics. For instance, in ophthalmic blocks, switching from lidocaine to mepivacaine has not eliminated the rare complications of muscle damage – both can cause it, and studies have found no strong evidence favoring one over the other in terms of muscle safety. In a cataract surgery anesthesia study, investigators stated they “found no argument to favor lidocaine over mepivacaine” with regard to myotoxicity risk in the extraocular musclesresearchgate.net. In practice, lidocaine’s muscle toxicity is something anesthesiologists have lived with for years (without significant harm in the vast majority of patients), and mepivacaine falls in the same category.
A crucial factor for us is concentration and context. The myotoxic studies typically used concentrations like 2% mepivacaine (which is 20 mg/mL) injected directly into muscle tissue. In dermal fillers, however, the mepivacaine concentration is only 0.3% (3 mg/mL)journals.lww.com, an order of magnitude lower. This dilute anesthetic is delivered primarily into the dermis or subcutaneous fat, not intended for intramuscular injection. During a filler treatment, some diffusion into adjacent muscle may occur (especially in areas like the lips or around the mouth where facial muscles lie just beneath the skin), but the exposure of muscle fibers to mepivacaine will be far less than in an intentional intramuscular anesthetic injection. The small volumes used in each location further limit the dose per muscle site. All of this suggests that the likelihood of any clinically significant myotoxic effect from mepivacaine in fillers is extremely low. The muscle might see a tiny amount of anesthetic, possibly killing a few fibers at the injection vicinity, but this would be microscopic damage well within the muscle’s capacity to regenerate quickly. Indeed, patients do sometimes report a day or two of mild soreness in areas like the cheeks or lips after filler – while most of that is due to mechanical injection trauma and swelling, one could speculate a minor component is local anesthetic effect on muscle. In either case, it resolves quickly.
The available clinical trial data backs up this reassurance: In the RHA® fillers study, there was no report of any motor dysfunction or delayed-onset muscle pain that would hint at problematic myotoxicity. If mepivacaine were causing meaningful muscle damage in patients, we might expect to see signs like prolonged muscle stiffness, weakness in the lips (difficulty pucker or smiling), or hard scar nodules forming weeks later. None of these were observed – lip mobility was normal and adverse events were equivalent to lidocainejournals.lww.comjournals.lww.com. This aligns with the expectation that at the diluted dose used and with single-treatment exposure, mepivacaine’s myotoxic effect is minimal and subclinical. Muscle tissue can handle that limited insult and recover without noticeable issues.
Other Soft-Tissue Effects and Considerations
Beyond muscle, could mepivacaine harm other tissues (skin, fat, etc.) or degrade the filler material itself? Current evidence and experience suggest no significant problems here:
Skin and fat: Local anesthetics in general can cause mild irritation to tissues, but true necrosis of skin or subcutaneous fat from mepivacaine is exceedingly rare. In fact, mepivacaine is often chosen for patients in dentistry or medicine when epinephrine-containing lidocaine is contraindicated, precisely because mepivacaine alone tends to be gentler on tissue perfusion. There have been occasional reports of tissue necrosis with anesthetic injections, but those usually involve epinephrine (excessive vasoconstriction causing ischemia) or direct arterial injection in perilous locations, rather than a direct toxic effect of the anesthetic itself. Mepivacaine without a vasoconstrictor has not been linked to skin necrosis in normal use.
One theoretical concern is whether repeated filler injections with mepivacaine could cause any localized atrophyof fat or other soft tissue. Steroid injections are known to atrophy fat, but anesthetics are not known to do this chronically. If anything, any minor injury from the anesthetic could induce a bit of reactive fibrosis, not tissue loss. For example, if a muscle did get a bit of scar from repeated exposure, that’s a localized fibrous change, not a spreading degradation. In the context of cosmetic fillers, patients usually don’t get the same area injected multiple times in a short span – treatments are spaced by months to years – giving tissues ample time to fully heal. Thus, the risk of cumulative damage is very low.
Filler material integrity: As noted earlier, studies show mepivacaine does not break down the hyaluronic acid gel. The filler’s mechanical properties, stability, and susceptibility to enzymatic breakdown remain unchanged with mepivacaineteoxane.comteoxane.com. Mepivacaine is chemically compatible with HA; it doesn’t cause the gel to prematurely biodegrade or polymerize. There was some investigation into whether mepivacaine might interact with hyaluronidase (the enzyme that can dissolve HA), but no adverse interaction was foundmdpi.commdpi.com. In other words, if needed, an emergency dissolution with hyaluronidase would work the same on a mepivacaine-laced filler as on a lidocaine-laced filler.
Inflammation: Every injection causes a bit of inflammation. There’s nothing to indicate that mepivacaine provokes more inflammatory reaction than lidocaine does. The clinical trial showed equal rates of swelling and rednessjournals.lww.com. Histologically, the presence of a local anesthetic in a filler doesn’t seem to increase granuloma formation or anything of that sort; the body responds mainly to the filler itself (which is designed to be biocompatible). If anything, by reducing trauma (due to pain, patients move less, etc.), the anesthetic could indirectly reduce some inflammation.
Implications for Practice and Recommendations
From the above analysis, switching to fillers containing mepivacaine instead of lidocaine appears to be a sound innovation with certain benefits and no significant new drawbacks demonstrated. Here are some key points and recommendations to communicate with your staff:
Equivalent Safety and Efficacy: Emphasize that clinical studies have found mepivacaine-formulated HA fillers to be just as safe and effective as the traditional lidocaine versionsjournals.lww.com. Pain control is equivalent, and cosmetic outcomes are unchanged. In other words, practitioners and patients should not expect any loss of performance or safety by using the new formulation. All standard aftercare and precautions remain the same as with lidocaine-containing fillers.
Potential Benefits: Educate staff on the subtle advantages of mepivacaine’s pharmacology. Its lack of vasodilator effect means you may see less immediate bruising or edema in some casesjournals.lww.com. Also, systemic absorption is slower, which provides a bit more safety margin, especially if treating larger areas (though the total anesthetic dose in cosmetic use is very small anyway). These benefits are not dramatic, but they are nice pluses that can be mentioned to patients who ask about the difference.
Myotoxicity Awareness: Acknowledge that mepivacaine, like all local anesthetics, can be myotoxic to muscle tissue in high doses or direct intramuscular injectionspubmed.ncbi.nlm.nih.gov. However, reassure the team that in the context of dermal filler use, this is unlikely to be clinically relevant. The dose is low (0.3%), and we are injecting into the dermal/subdermal plane – we are not doing deep muscle injections. To date, there have been no reports of any muscle injury or functional issues from mepivacaine in fillers. Muscles exposed to tiny amounts might have microscopic injury, but they will regenerate quicklypubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.
Injection Technique: Continue to follow best practices for injection placement. Avoid injecting filler unnecessarily deep into muscle tissue – not specifically because of mepivacaine, but because proper plane injection yields the best aesthetic result and avoids other complications. By staying in the intended tissue plane (e.g. mid-dermis for fine lines, subcutaneous for deeper folds), you inherently minimize any contact the anesthetic has with muscle. In areas like the lips or perioral region, where the orbicularis oris muscle is very close to the dermis, be gentle and precise. If a patient experiences a bit of post-procedure muscle soreness, it’s usually benign and short-lived; you can manage it with cold packs or NSAIDs if needed.
Avoiding Repeated Trauma: While there’s no concern for occasional treatments, it’s wise to avoid excessiverepeated injections in the exact same spot within short intervals. This is already standard to prevent other issues like scarring or filler overload. In terms of myotoxicity, animal studies showed repeated injections in the same muscle in one session caused more damagepubmed.ncbi.nlm.nih.gov. In practice, we rarely, if ever, would inject the same site multiple times in one day with anesthetic-laden filler. Nonetheless, plan touch-ups or additional sessions with appropriate time in between (weeks apart) so tissue has time to recover. The good news is that even if someone had multiple sessions, the worst-case scenario of any small muscle injury would be some temporary weakness that would heal – but we haven’t observed this happening with cosmetic fillers.
Patient Communication: If patients are curious or concerned about the new “mepivacaine” ingredient (since it’s less known than lidocaine), you can explain: “Mepivacaine is just another anesthetic like lidocaine. It has been used safely in medicine for decades. In our fillers, it numbs the area just as effectively as lidocaine did. Some studies even suggest it causes less swelling or bruising, which is a nice benefit. Importantly, all the safety data show it’s just as safe – there’s no evidence of any added tissue harm or side effects. It’s a tiny change that should make your experience just as comfortable, if not more so.” This kind of explanation can reassure patients. If someone specifically asks about muscle damage (which is unlikely, unless very scientifically inclined), you can further reassure them that the concentrations are low and it hasn’t shown any damage in clinical trials or practice.
Allergy Consideration: Remember that mepivacaine and lidocaine are in the same amide anesthetic family. True allergy to amide anesthetics is exceedingly rare, but if a patient has a documented lidocaine allergy, they couldpotentially react to mepivacaine as wellaccessdata.fda.gov (cross-reactivity within the amide class can occur). Our staff should continue to screen for any history of anesthetic reactions. For a patient with a serious prior reaction to lidocaine, one might avoid anesthetic-containing fillers altogether or do an allergy test. This isn’t a new issue, just one to keep in mind with any local anesthetic use.
Monitoring: As with any new product, stay attentive to patient feedback. If a patient were to report any unusual symptom – say, prolonged firmness or a muscle feeling “weak” weeks after treatment – document it and evaluate it. It’s highly unlikely to be from the anesthetic (could be a mild hematoma or scar or unrelated neuropathy, etc.), but good monitoring helps build our own dataset of experience. So far, neither studies nor early adopters have noted anything concerning with mepivacaine fillers, which should give us confidence.
Conclusion
After a thorough review of the literature and available data, we can conclude that mepivacaine is a safe and effective alternative to lidocaine in dermal fillers. Its introduction is backed by both preclinical studies and clinical trials showing no negative impact on filler performance or safetyjournals.lww.com. The theoretical concern of anesthetic myotoxicity is well-recognized in medicine, but at the low doses and superficial injection planes used in aesthetics, mepivacaine’s myotoxic potential should remain an academic footnote rather than a clinical problem. All local anesthetics can cause localized muscle fiber injury, yet this effect is typically dose-dependent and reversible, and indeed has been routinely tolerated in medical practice for years without issuepubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.
In the context of cosmetic injections, the switch from lidocaine to mepivacaine is supported by data indicating comparable patient comfort and no increase in adverse eventsjournals.lww.comjournals.lww.com. Mepivacaine’s pharmacological profile (less vasodilation) might even offer incremental advantages such as reduced bruising and lower systemic exposurejournals.lww.commdpi.com. Meanwhile, there is no evidence of any deleterious effect on soft tissues like skin or fat; on the contrary, both histology and cell studies show mepivacaine is not causing tissue necrosis or accelerated filler breakdownmdpi.comteoxane.com.
Our recommendation is to comfortably integrate the new mepivacaine-containing fillers into practice. Standard injection techniques and precautions remain appropriate. Providers should be aware of the myotoxicity concept but also understand that in practical terms it does not change how we use these fillers. By staying informed and cautious, we ensure patient safety as we take advantage of innovations that may improve the treatment experience. Based on current evidence, you can confidently inform your staff (and patients) that the likelihood of mepivacaine in fillers causing myotoxicity or any soft-tissue degradation is very low, and that this advancement has been vetted to provide the same level of safety we expect from lidocaine-containing productsjournals.lww.com. As always, we will continue to monitor outcomes, but all signs point to this being a positive refinement in our injectable toolkit – “innovation in every tiny detail,” as the webinar title says, without compromising safety or results.
Sources:
Basson, M.D. & Carlson, B.M. (1980). Myotoxicity of single and repeated injections of mepivacaine (Carbocaine) in the rat. Anesth Analg, 59(4):275-82pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.
Zink, W. & Graf, B.M. (2004). Local anesthetic myotoxicity. Reg Anesth Pain Med, 29(4):333-340pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.
Hussain, N. et al. (2018). Local anaesthetic-induced myotoxicity in regional anaesthesia: a systematic review. Br J Anaesth, 121(4):822-841bjanaesthesia.orgbjanaesthesia.org.
Kaufman-Janette, J. et al. (2022). Patient Comfort, Safety, and Effectiveness of Resilient Hyaluronic Acid Fillers Formulated With Different Local Anesthetics. Dermatol Surg, 48(10):1065-1070journals.lww.comjournals.lww.com.
Brusini, R. et al. (2022). Comparative Preclinical Study of Lidocaine and Mepivacaine in Resilient Hyaluronic Acid Fillers. Pharmaceutics, 14(8):1553mdpi.commdpi.com.
Teoxane Laboratories. (2023). Mepivacaine: a potential safer anesthetic compound for dermal fillersteoxane.comteoxane.com. (Summary of internal research on rheology, stability, and release profiles of lidocaine vs. mepivacaine in HA filler).