BLT numbing cream is a compounded topical anesthetic named for its three active ingredients: benzocaine, lidocaine, and tetracaine. Providers use it to numb intact skin before dermatologic and cosmetic procedures such as laser treatments, microneedling, tattooing, and injectables. It is prescription-only, it is used under the direction of the clinician doing the procedure, and the amount applied, the area covered and the time it stays on all matter.
It is prescription-only, and the reason matters. Over-the-counter numbing products in the United States are limited to 4% lidocaine. BLT is compounded well above that, which is why it is dispensed against a prescription and used under a provider's direction rather than bought off a shelf. The combination is not FDA-approved; each individual anesthetic is an approved drug, but this blend is compounded for an individual patient.
How is BLT applied before a procedure?
Follow the directions your provider gives you rather than a general rule, because the right amount and timing depend on the formulation, the area, and the procedure. Dose and appropriateness are the prescriber's decisions, not the pharmacy's and not the patient's.
The direction written most often looks like this:
- A thin, even layer to clean, intact skin. Not a thick coat, and not beyond the area being treated.
- Roughly 45 to 60 minutes before the procedure, then removed as directed beforehand.
- No occlusion. Do not wrap or cover the treated skin with plastic wrap, a dressing, tight clothing or anything else, unless your provider specifically tells you to.
- Not on irritated, broken, sunburned or freshly shaved skin, and not near the eyes or other mucous membranes.
- Wash your hands after applying.
Applying more than directed, or leaving it on longer than directed, does not improve the result and increases how much is absorbed. Higher-strength preparations are often applied in the office rather than at home for exactly that reason.
Who applies BLT, the patient or the clinician?
BLT is dispensed against a prescription written for a named patient and tied to a specific planned procedure. The clinician performing that procedure decides the strength, the area and the timing, and in many practices applies it in the office and times it on the clock.
It is not a product to reach for at home on your own initiative because a treatment felt uncomfortable last time, and it is not something to share with anyone else the prescription was not written for. If your provider does send it home with you to apply beforehand, apply exactly the amount and area on the label and nothing more, and call the office if you are unsure rather than guessing upward.
What happens if too much BLT is absorbed?
The most serious risk with any high-strength topical anesthetic is systemic absorption. Local anesthetic toxicity depends on the total amount of drug that gets into the bloodstream, not on concentration alone, so a thin layer on one small treatment site behaves very differently from a heavy layer spread across both legs, the back or the whole face.
Occlusion multiplies that absorption. Covering treated skin with plastic wrap, a bandage, a dressing or tight clothing traps the anesthetic against the skin and drives more of it into the bloodstream, and heat does the same. Deaths have been reported in the published literature on high-strength topical anesthetics after large areas of skin were coated and then wrapped ahead of a cosmetic laser procedure. This is the reason the no-wrap instruction is written the way it is.
Signs that too much anesthetic has been absorbed include ringing in the ears, numbness or tingling around the mouth, a metallic taste, dizziness, confusion, blurred vision, drowsiness, an irregular or racing heartbeat, trouble breathing or seizures. These can begin while the product is still on the skin or after it has been removed.
Benzocaine also carries a recognized risk of methemoglobinemia, a condition in which the blood carries less oxygen than it should. The FDA has warned about methemoglobinemia associated with benzocaine products, and the same risk is described for prilocaine, which appears in some other topical anesthetic combinations. Bluish or grey lips, fingertips or skin, headache, shortness of breath and unusual fatigue are the signs to act on.
Seek emergency care for bluish lips or skin, trouble breathing, an irregular heartbeat, ringing in the ears, numbness of the mouth, dizziness, confusion, or seizures. Tell your provider about heart or liver conditions, G6PD deficiency, pregnancy or breastfeeding, and every medication you take.
What is in BLT, and what does each ingredient do?
The three are combined because they behave differently, not because more actives is inherently better.
Benzocaine is an ester anesthetic and the fastest of the three to take effect, acting mainly at the surface. Lidocaine is an amide anesthetic and the most widely used topical anesthetic there is, with moderate onset and duration. Tetracaine, also an ester, is the slowest to take effect and the longest lasting, which is what carries numbing through a longer procedure.
| Ingredient | Class | Onset | Regulatory status |
|---|---|---|---|
| Benzocaine | Ester | Fastest, surface-acting | OTC and Rx forms approved |
| Lidocaine | Amide | Moderate | OTC to 4%, Rx above |
| Tetracaine | Ester | Slowest, longest lasting | Rx |
| BLT blend | Ester plus amide | Layered onset | Compounded, not FDA-approved |
The individual drugs are FDA-approved products. The three-drug blend at compounding strengths is not, and its use before cosmetic procedures is off-label. Common compounded ratios are benzocaine 20% / lidocaine 8% / tetracaine 4% and benzocaine 20% / lidocaine 6% / tetracaine 4%. The full list of preparations, strengths, and sizes is on our BLT numbing cream page.
When a prescriber wants a single agent rather than a three-drug blend, compounded lidocaine cream or ointment is the more common order, at a strength the prescriber specifies.
Why does BLT require a prescription?
In March 2024 the FDA warned consumers to avoid high-strength topical anesthetic products, including ones marketed for use before cosmetic procedures such as microdermabrasion, laser hair removal, tattooing, and piercing. The agency cited the risk of irregular heartbeat, seizures, and breathing difficulties, and advised consumers not to use over-the-counter pain relief products containing more than 4% lidocaine on their skin (FDA, March 26, 2024).
That warning is about products sold directly to consumers without a prescription, and it is the reason a compounded anesthetic goes through a prescriber. The cautions themselves apply to any high-strength topical anesthetic, including a compounded one: do not apply heavily over large areas of skin, do not apply to irritated or broken skin, and do not wrap or cover treated skin with plastic wrap or any other dressing unless your provider specifically directs it. Covering the area increases how much anesthetic reaches the bloodstream.
Why is BLT compounded rather than bought off the shelf?
There is no FDA-approved benzocaine, lidocaine, and tetracaine combination, so BLT exists only because a compounding pharmacy prepares it. Compounding is what allows the specific strengths and bases providers use for aesthetic procedures, including a cream for non-laser work and an ointment for laser work.
As a 503A compounding pharmacy, Bayview prepares each order in small batches under USP 795 non-sterile compounding standards, against a prescription written for a named patient. We do not supply BLT as clinic or office stock; that is the role of a 503B outsourcing facility, which Bayview is not. Prescribers can e-prescribe to Bayview Pharmacy, 3844 Post Rd, Warwick, RI 02886, or fax 401-284-4506. Account setup and ordering are covered on our for providers page.
What Bayview compounds for this
Bayview prepares compounded BLT topicals on a prescriber's order, as a cream for non-laser work and an ointment for laser work, in the benzocaine, lidocaine and tetracaine strengths the prescription specifies, starting at $90. Sizes and bases are listed on the BLT preparation page.
Practices that order anesthetics for procedure days also order in-office preparations such as cantharidin for wart and molluscum work, prepared to the concentration the clinician requests.
For the weeks around a procedure, prescribers write for skin preparations on their own assessment of the patient, including blends such as a tretinoin, niacinamide and hyaluronic acid gel. What suits a given patient is the prescriber's call.
The rest of the skin list sits under dermatology and skin in the catalog.
The preparations that aesthetics and dermatology practices order most are described on the dermatology compounding page.
Everything Bayview compounds, across every therapy area, is in the searchable catalog of compounded preparations.
Talk to your prescriber
Bring the procedure to the conversation, not just the product. Your prescriber needs to know the area being treated, how large it is, what you have used before an appointment previously, your heart and liver history, whether you have G6PD deficiency, whether you are pregnant or breastfeeding, and everything else you take.
What a compounded preparation costs, and the states where Bayview is licensed to ship, are covered on the FAQ page. Compounded preparations are not billed through insurance, so the price you are quoted is the price.
Compounding for skin covers far more than anesthetics, and dermatology compounding, when it helps and when it does not walks through the rest of the category.
Numbing skin for a procedure is a different job from managing ongoing pain, which is covered in compounded alternatives to opioids for pain management.
Frequently asked questions
What is BLT numbing cream?
A compounded topical that blends benzocaine, lidocaine, and tetracaine to numb the skin before cosmetic procedures. It is prescription-only and compounded to your provider's order.
What procedures is it used for?
Providers use it before laser hair removal and resurfacing, microneedling, tattoos and permanent makeup, and injectables like fillers. Your provider decides if it fits your treatment.
When do I apply it?
Usually about 45 to 60 minutes before your procedure, exactly as your provider directs. Apply a thin, even layer only to the area they specify, and never to broken skin. Do not cover it with plastic wrap unless specifically told to, and let your provider know when you applied it so they can time the procedure.
Is it safe?
Used as directed on a limited area of intact skin, yes. Do not cover it with plastic wrap or heat, or leave it on longer than told, since that raises absorption. Seek care for bluish lips, trouble breathing, dizziness, or an irregular heartbeat.
Cream or ointment, which do I get?
Cream is typically used for non-laser procedures such as microneedling, injectables, and tattoos, while ointment is preferred for laser work because of how it sits on the skin under laser energy. Your provider picks the base, strength, and size that fit the procedure, so you do not have to choose.
How do I get it from Bayview?
Your provider sends a prescription and we compound your order, then ship it to you or directly to the office where your procedure is scheduled. Bayview fills for patients in RI, MA, CT, NY, NJ, NH, FL, and ME. If your appointment is coming up soon, call us and we will do our best to time delivery to it.
Is BLT stronger than over-the-counter numbing cream?
Yes, substantially. Over-the-counter numbing products are limited to 4% lidocaine. BLT combines benzocaine 20%, lidocaine 6–8%, and tetracaine 4%, which is well above that limit — and that is exactly why it requires a prescription rather than being something you pick up yourself. The FDA has warned consumers away from high-strength topical anesthetics sold without a prescription, including ones marketed for use before laser, tattooing, and piercing. Higher strength also means the cautions matter more, not less: no heavy application over large areas, not on broken skin, and no wrapping the area unless your provider directs it.
How long before a procedure should I apply it?
A typical direction is 45 to 60 minutes before the procedure, but follow the instructions your provider gives you rather than a general rule — the right timing depends on the formulation, the area, and what is being done. Benzocaine acts fastest, tetracaine is the slowest to take effect and the longest lasting, and the blend is built around that spread. Applying earlier than directed does not make it work better and increases how much is absorbed.
Can I wrap or cover the area after applying it?
Not unless your provider specifically tells you to. The FDA advises against wrapping skin treated with topical pain relief products in plastic wrap or any other dressing, because covering the area increases how much anesthetic passes into the bloodstream and raises the chance of serious side effects such as irregular heartbeat, seizures, and breathing difficulties. Occlusion is sometimes used deliberately under clinical direction; it is not something to do on your own. The same goes for applying heavily over a large area or to broken or irritated skin.
Can BLT be used before a tattoo?
Tattooing is one of the procedures topical anesthetics are commonly used for, and Bayview compounds BLT against a valid prescription from a licensed provider. What Bayview does not do is decide whether it is appropriate for you or for a particular procedure — that is your provider's call, and a prescription is required. Be cautious about the high-strength numbing products sold directly to consumers online for tattoo work; those are the products the FDA's March 2024 consumer warning was about.
What is the difference between the cream and the ointment?
Same active ingredients, different base. Bayview compounds the cream for non-laser procedures and the ointment for laser procedures, and your provider selects which one to order. A lidocaine 23% / tetracaine 7% ointment is also available for laser work. The base affects how the preparation sits on the skin and how it is removed, which matters more for some procedures than others.
How much does BLT numbing cream cost?
BLT is typically $60 for 30 g and $90 for 60 g, with the price varying by strength and base. Compounded preparations are cash-priced and are generally eligible for HSA and FSA cards. Call us at 401-284-4505 with the formulation and quantity your provider ordered and we will quote it before we make it.
How is it different from the lidocaine cream at the store?
Over-the-counter lidocaine products are limited to 4%. Anything above that requires a prescription. In 2024 the FDA warned people not to use unapproved store-bought or online numbing products that contained more than 4% lidocaine, some as high as 40%, after reports of serious harm when they were spread over large areas or covered before tattoos and cosmetic procedures. A compounded prescription is written for a specific area and use, and comes with directions from your prescriber and pharmacist.
What are the signs of too much lidocaine?
Numbness or tingling around the mouth, a metallic taste, ringing in the ears, dizziness, blurred vision, drowsiness, confusion, or slurred speech are early signs. At higher levels, muscle twitching, seizures, trouble breathing, or an irregular heartbeat can follow. Bluish lips or skin with unusual tiredness can signal methemoglobinemia, a rare reaction. Stop using it and get emergency care if any of these happen.
What Bayview compounds for this
Important: Compounded medications are prepared to a prescriber's order for an individual patient. They are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. This article is educational and is not a substitute for advice from your prescriber or pharmacist.
This preparation contains a controlled substance. Controlled-substance prescriptions carry refill limits, must be e-prescribed, and can only be shipped to states where Bayview holds the required licensure.
Uses discussed here may be off-label, meaning they are not part of any FDA-approved labeling. Off-label use is a decision for you and your prescriber, based on the available evidence.
Veterinary preparations are compounded to a veterinarian's order for a specific animal and are not FDA-approved animal drugs. Never give a compounded human medication to an animal without veterinary direction.
Compounded prescriptions are paid for directly rather than billed through insurance. Most are HSA/FSA-eligible, and many patients submit the receipt to their plan for possible reimbursement. Pricing depends on the strength, dose form and quantity your prescriber orders. Read more about cost and insurance.
Compounded BLT topicals start at $90, with the final price depending on the strength, the base and the size your prescriber orders. Compounded preparations are not FDA-approved products and are not billed through insurance, so the quoted price is what you pay at the time of dispensing.
Bayview Pharmacy is an NABP-accredited compounding pharmacy in Warwick, Rhode Island, licensed to fill and ship compounded prescriptions for patients in Rhode Island, Massachusetts, Connecticut, New Jersey, New Hampshire, Florida, New York and Maine. Controlled substances are not shipped to New York addresses. See where we ship and how to get started.
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