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Anxiety, including needle phobia, is a reality and even a precluding factor for many patients who undergo surgical or even nonsurgical cosmetic procedures. To address patient discomfort, cosmetic oculofacial plastic surgeon John R. Burroughs, M.D., says he uses nitrous oxide (laughing gas) as a supplement to local anesthesia and oral sedation. He was a faculty member and speaker at a recent cosmetic meeting in Miami, Florida and heard about this device and wanted to bring it to his practice as he cares as much about the patient experience as he does the cosmetic results.

Mixed with oxygen, nitrous oxide is a safe and effective sedative that, when breathed in, helps people relax, according to the American Dental Association. Researchers Reported on the use of nitrous oxide in 24 cosmetic dermatology patients in 2013. They found lower subjective pain intensity among those treated with nitrous oxide and all but one of the people studied chose nitrous oxide for their next treatment.

Dr. Burroughs, who has a surgical and nonsurgical cosmetic practice in the Colorado Springs, CO, says nitrous oxide has been accepted with high patient satisfaction during injections, resurfacing, and even for his office-based surgeries. He uses nitrous oxide, with or without topical anesthetic and local injection anesthesia, for patients who are particularly anxious.

Some patients either have a very low pain threshold or have anxiety and they find the laughing gas to greatly improve their experience. Dentists use nitrous oxide delivery systems with nasal prongs or a mask in a continuous flow manner, but cosmetic surgeons often work in this area and the prongs can get in the way and continuous nitrous oxide can require more intense patient monitoring. Pro-Nox devised a device that makes it possible for cosmetic surgeons to use laughing gas in their offices unhindered and it is completely patient administered.

The device that Dr. Burroughs uses has two hoses — one hose connecting the gas to the mouth, with a small adapter, and another that goes from the mouth out for the exhalation that is directed downward toward the floor to keep it from being breathed by the surgical team.

Laughing gas is heavier than air, so the gas stays down and doesn’t impact the doctor or their team. Patients put a plastic mouthpiece in and breathe the gas in through their mouths a few times and breathe it out through their mouths. II can then perform local anesthetic nerve or field blocks or aesthetic injections and pause and have the patient breathe again a few times and keep doing the treatment. For my surgical patients, usually this only needs to be done at the beginning as once the local has been injected the rest of the surgery is typically very well tolerated.

Patient recovery is fast. Laughing gas’s effects only last a few minutes, according to Dr. Burroughs. If a patient has only had the laughing gas and no other IV or oral sedation then they can drive on their own after just 10-15 minutes. Pulmonary disease patients are among those who aren’t candidates, and if oral/IV sedation has been given or if the vision has been temporarily impacted by the treatment or surgery we always require a driver for patient safety.

Needle phobia is not necessarily connected to pain; it’s often mostly connected to anxiety. Nitrous Oxide, which is safe and easy to use, really tackles anxiety,” but we have found for lengthy or more painful procedures that it best to still give an amnestic oral sedative agent in addition to maximize the patient experience. Many patients don’t want an IV or general anesthesia and we now have another tool to make patient anxiety and comfort even better. At his practice, Dr. Burroughs has used Nitrous Oxide for cosmetic upper and lower eyelid surgeries, facelifts, facial resurfacing, and for cosmetic dermal filler injections. As far, as we know we are the only surgical and med-spa practice in Colorado Springs offering this device. When ever I research a new technology or procedure, my main questions I ask are: 1) Is it safe?; 2) Does it work?, and 3) Does it hurt? The Pro-Nox system is very safe and is even used in labor and delivery. It definitely works, and it helps reduce patient pain and anxiety. It was a no-brainer purchase decision, and we are proud to offer this to our Springs Aesthetics patients.