Anyone with experience using a topical anesthetic prior to LHR with the 1064? Should any adjustments be made with the laser settings?

There is no need to change the treatment parameters with the use of topical anesthetic. I assume you are using it for LHR and vein treatment.

That's what I thought as well. However, after doing several laser treatments for LHR on the face of a male with skin type IV, I started using topical anesthetic to make it more tolerable (I usually do not use a topical). I felt comfortable with this since prior treatments went well with excellent results and no complications. This last time, I applied the topical for about 45 minutes, performed the treatment with the same settings. I had the normal respose during the procedure. It wasn't until over two hours later, that the patient began getting a couple of areas of blistering and scabbing. I had used the same topical once before on him without problems and always used the same laser settings. I'm not sure why this reaction occured. I have never had this happen before and I am conservative with my laser settings. Any ideas?

I would look for other reasons first. It could be inadequate cooling of the area or some prior sun exposure.