Administering local anesthesia with little to no discomfort is not only a very difficult skill to master but is an art. I pride myself in being able to deliver local anesthesia with minimal discomfort so dermatological procedures can be performed in the office without pain. Lideocaine 1% with epinephrine is the standard local anesthetic in our clinic. It is mixed with 1/10 parts sodium bicarbonate, which allows the pH to normalize to that of a neutral solution compatible with the human body. We use a very small 30 gauge needle to deliver the anesthetic, which is the same size used in botox which can be delivered with minimal pain. I find a pore close to the site needed to be anesthetized and insert the tip of the needle into the pore, so patients cannot feel any sensation of the needle entering their skin and very slowly deliver the lideocaine, which is described as a “mosquito bite” or “a very small pinch” by most of my patients. The area becomes numb almost instantly and typically remains numb for several hours. When a mole or skin cancer is removed, patients typically feel a sensation of movement but not pain or discomfort. In patients allergic to epinephrine of lideocaine, we have other alternative anesthetics that can be used. Most patients are surprised that their skin biopsy is complete or mole is removed in a matter of seconds with no uncomfortable sensation.