Compounding Pharmacy for Aesthetic Medicine

Mortar and pestle, beaker, balance and unlabeled ointment jars on a compounding pharmacy work surface

Aesthetic practices rely on medications at three points: before and during a procedure, where patients need to be comfortable enough to sit through treatment; after a procedure, where disrupted skin needs to recover cleanly; and between procedures, where ongoing topical therapy for hyperpigmentation, skin aging or hair loss carries the result forward. Commercially available products cover many of these needs. When they do not, because the needed dosage form or combination does not exist commercially or a patient cannot tolerate a particular ingredient, a prescriber may request a customized preparation for that patient. ALWAYS Rx compounds patient-specific topical anesthetics, post-procedure skin preparations, and hyperpigmentation, anti-aging and hair-loss topicals on prescription for patients of aesthetic practices.

How medication customization supports aesthetic medicine

Aesthetic practice covers a wide range of procedures and skin concerns, and a commercial product formulated for one use is not always matched to another. Customization allows a prescriber to specify the combination of actives, the vehicle and the dosage form for an individual patient.

There are four main reasons a prescriber customizes: to obtain a strength that does not exist as a commercially available product; to obtain a dosage form that does not exist commercially, such as a spray; a combination of those two; or to combine an active with other active ingredients in a single preparation. Customization is also relevant when a patient has a documented sensitivity to a component of a commercial product.

FDA-approved treatment landscape

Several products are FDA approved and commercially available, and for many aesthetic needs they are appropriate. Where an approved product meets the clinical need, it is generally the appropriate first consideration.

Topical and injectable anesthetics

Lidocaine-prilocaine cream: approved for topical anesthesia on intact skin and genital mucous membranes.
Lidocaine-tetracaine cream: approved for use before superficial dermatological procedures.
Topical lidocaine in various approved strengths, prescription and over the counter.
Injectable lidocaine and bupivacaine, with and without epinephrine: provider-administered, approved for infiltration and nerve block.

Post-procedure and ongoing topical therapy

Approved topical antibiotics, barrier and wound-care products, topical tretinoin, topical minoxidil, oral finasteride and the approved combination product for melasma are commercially available and are described on the relevant condition and treatment pages.

Status: FDA-Approved Product.

Potential customized categories

Where an identified patient need cannot be met by a commercial product, a prescriber may consider a compounded preparation.

Before procedures

Topical anesthetic creams, gels, sprays, solutions and ointments combining benzocaine, lidocaine, tetracaine and/or prilocaine
Preparations incorporating phenylephrine, a vasoconstrictor
Anesthetic sprays and solutions for the scalp and other hair-bearing areas

After procedures

Post-procedure skin preparations combining tretinoin, niacinamide, pantothenic acid, hyaluronic acid and ascorbic acid

Ongoing topical therapy

Hyperpigmentation preparations combining hydroquinone, kojic acid, tretinoin, tranexamic acid, ascorbic acid, niacinamide and topical corticosteroids
Hair-loss topicals
Anti-aging topicals combining tretinoin, niacinamide and ascorbic acid

Status: Compounded Option. Compounded preparations are not FDA approved and are not equivalent to commercially available approved products.

Dosage forms

Cream, ointment, gel, spray, solution and capsule. The dosage form affects how a preparation is applied and absorbed, not just how it feels.

Creams are water-based emulsions that spread easily over an area.
Ointments are oil-based and occlusive. They stay in place and limit evaporation.
Gels spread easily, dry down and adhere to facial contours.
Sprays and solutions can be applied over hair-bearing or irregular surfaces where a cream cannot be spread evenly.

Covering the skin, the size of the treatment area, skin integrity and contact time all change how much drug is absorbed. The prescriber decides the dosage form and directions for each patient. Our pharmacists can discuss the options.

Working with our pharmacists

Our pharmacists discuss formulation selection with prescribing clinicians directly, considering treatment area, vehicle, storage and patient-specific characteristics. They do not diagnose conditions or prescribe medications.

Frequently asked questions

Does ALWAYS Rx compound injectable anesthetics?

No. ALWAYS Rx compounds topical and oral preparations. Injectable anesthetics discussed on this site are commercially available FDA-approved products.

Is a prescription required?

Yes. Every compounded preparation requires a valid prescription from a licensed prescriber for an individual patient.

How long before a procedure should a topical anesthetic be applied?

It varies by preparation and patient. Follow the prescriber’s directions for the specific preparation.

Can a compounded anesthetic be used on broken or treated skin?

Usually not. Broken or treated skin increases the risk of systemic absorption. This is a prescriber judgment and should be discussed before use.

Safety with topical anesthetics

FDA has warned that topical anesthetics can cause serious harm, including irregular heartbeat, seizures, breathing problems and death, when too much drug is absorbed through the skin. Risk rises with stronger preparations, large application areas, long contact time, covering or wrapping the skin, heat, and irritated or broken skin.

Use the lowest amount that controls pain, on the smallest area, for the shortest time, exactly as the prescriber directs.
Do not wrap, cover or heat the area unless the prescriber instructs you to.
Do not apply to broken, irritated or freshly treated skin.
Seek emergency care for dizziness, confusion, ringing in the ears, bluish skin or lips, shortness of breath, seizure or an irregular heartbeat.

Prescribers: Let’s Collaborate

Compounded preparations are not FDA approved. FDA does not review them for safety, effectiveness or quality before they are dispensed, and they are not equivalent to commercially available approved products. California requires a patient-specific prescription for a compounded preparation, and a pharmacy may not compound what is essentially a copy of a commercially available product unless the pharmacist documents a clinically significant difference for the individual patient or the product is in shortage. This page is general information, not medical advice.

References

Clinical review: Dor Keyvani, PharmD, Pharmacist-in-Charge, California pharmacist license RPH 75634. Clinically reviewed Oct. 20, 2026. Updated Nov. 10, 2026. See our Editorial Policy and Quality and Safety pages.