Are you using numbing cream for laser hair removal? What are you using? Do you apply it in the clinic (extending the appointment 30 min or so) or do they apply it at home (overdosing concerns)?

I am also hoping that someone would share their tricks on how to minimize the pain with lhr. I have tried advising pts to apply 2% lidocaine gel 20 minutes prior to the appointment and this doesn't help. Any suggestions?

First I hope you both are physicians or nurses/ pa because it is dispensing of medication. People believe its just topical but in reality it is a medication and does have systemic absorption.
first question> Yes there are concerns for overdose and that is why you should not hand out tubes of topical. Patients feel if x is good the 2x is twice as good. Its best to have them come in put on the topical wrap it in saran wrap for a half hour then wash oit off.
Yes there are absorptions problems and you have to consider surface area. If you are using emla look at the package insert, it will tell you to max surface area you can cover. Overdose is possible as well as death.

Question #2 simple 2% lido may not be strong enough. EMLA is 2.5% lido and 2.5 tetra. The most potent combos are the compounded blt cream benzo-lido-tetra 20%- 20%-10% for 20 min then washed off.

The lido should be washed off not simply wiped.
There you have it from board cert anesthetiologist/intensiveist turned aesthetic MD.

I use BLT topical in the office for LHR about 20-30 mins prior to treatment. I don't give it to clients to take home due to concerns they will have a toxic reaction from leaving it on too long and apply too much.

I also use a BLT topical for certain areas for laser hair removal, bikini is the most popular location and occasionally for the upper lip/chin. We order it in a 60gm jar and then divide that into 6 smaller jars (larger surface areas) or 13 smaller jars (upper lip/chin and used pre-filler). Patients are given specific instructions on how to use it. We have been doing it this way for 5 years with no complications.

Only PAs, RNs and MDs can administer prescription numbing cream, depending on your state regulations. In CT this is the case. We have our front desk call in EMLA for our clients and they apply it themselves 30 mins prior to the procedure.