05/16/2026
Lidocaine Toxicity: The Silent Risk Aesthetic Providers Need to Talk About.
As aesthetic medicine continues to evolve, providers are performing more extensive procedures than ever before. With that growth comes a quiet but significant concern: lidocaine toxicity - a real risk when cumulative dosing and patient factors are not carefully considered.
Local Anesthetic Systemic Toxicity (LAST), whether injection or topical, remains under discussed in aesthetic education, leaving many aesthetic providers unprepared for an event that is both preventable and treatable.
AWARENESS: Lidocaine toxicity often begins subtly, with early neurologic symptoms such as circumoral numbness, tinnitus, or a metallic taste. These signs can easily be dismissed in a busy clinic, but they are the body’s first warning that systemic levels are rising. Without prompt recognition, toxicity can progress to seizures, cardiovascular instability, and even cardiac arrest.
PREVENTION: Safe dosing calculations, incremental injection techniques, detailed medical history and a clear understanding of total lidocaine exposure are essential.
CLINIC READINESS: the clinic must have 20% lipid emulsion immediately accessible, safety protocols/ policies in place for its use and ensuring staff are trained to recognize LAST.
Lidocaine toxicity is not a topic meant to instill fear—it’s one that empowers providers. When we talk about it openly, teach it consistently, and prepare for it deliberately, we elevate the standard of care across aesthetic medicine.
Chamoun G, Forsyth A, Kazemeini S, et al. (2025) Systemic Risks of Topical Anesthetics in Barrier-Compromised Dermatologic Patients. Cureus 17(5): e84157.
Voute M, Morel V & Pickering G (2021) Topical Lidocaine for chronic pain treatment. Drug Design, Development and Therapy.15:4091-4103.
CMAC Webinar. Complications of local and topical anesthesia in aesthetic practice. Dr Rienke Smit May 2025