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Judicious reduction of skin temperature and the application of topical pressure are effective means of minimising pain, bleeding and swelling in general in the management of patients receiving injections.
We use water filled balloons that have been frozen and treated with a surface antiseptic (i.e. aqueous clorhexidine) for reducing skin temperature while applying gentle pressure to the treated area. The balloon can be used slightly melted at the surface or hard.
We routinely use this method for procedures such us the injection of botulinum toxin type A to treat dynamic facial wrinkles, the injection of filling substances for aesthetic purposes, before injection of local anaesthesia, or after excisional skin procedures.
This method prevents the discomfort and inconvenience of the water dripping from a solid and relatively large piece of ice. Care should be taken to avoid cold-induced headache particularly using the ice-balloon on the forehead, this self-limited phenomenon can be prevented by adjusting the time and pressure of contact with skin (i.e. letting the patient apply the balloon as shown in Fig. 1) . Ice balloons can be made of different colours, sizes and shapes for better adaptation to the contour of different anatomical areas (i.e. nasolabial fold, glabella).
Fig. 1(Above) The ice balloon being applied by patient pre-injection to the glabella. (Middle) Different balloon shapes for different anatomical areas. (Below) Ice balloons ready to use in the office setting.
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