Anxiety, including needle phobia, is a reality for many patients who undergo nonsurgical cosmetic procedures. To address patient discomfort, cosmetic surgeon Alexander Rivkin, M.D., says he uses nitrous oxide, or laughing gas.
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. Rivkin, who has a nonsurgical cosmetic practice in the Brentwood area of Los Angeles, Calif., says nitrous oxide can be a patient pleaser during injections and laser procedures. He uses nitrous oxide, with or without topical anesthetic, for patients who are particularly anxious.
“The ones that are okay with just topical anesthesia just get that. But the people who have a low pain threshold or have anxiety may get laughing gas,” he says.
Dentists use nitrous oxide delivery systems with nasal prongs, but cosmetic surgeons often work in that area and the prongs can get in the way, according to Dr. Rivkin. But a device redesign makes it possible for cosmetic surgeons to use laughing gas in their offices unhindered, according to Dr. Rivkin.
The device that Dr. Rivkin has in his practice has two hoses — one hose connecting the gas to the mouth, with a small adapter, and another that goes from the mouth out.
The second hose, he says, trails down to the floor. That’s important because it prevents patients from breathing nitrous oxide out, in the direction of providers.
“Because laughing gas is heavier than air, the gas stays down and doesn’t impact the practitioner,” Dr. Rivkin says. “Patients put a plastic mouthpiece in and breathe the gas in through their mouths a few times and breathe it out through their mouths. Then, I do the injections and pause and have them breathe again a few times and do the injections. That seems to work quite nicely.”
Patient recovery is fast. Laughing gas’s effects only last a few minutes, according to Dr. Rivkin. Pulmonary disease patients are among those who aren’t candidates, he says.
Nitrous oxide addresses what topical anesthetic doesn’t, according to Dr. Rivkin.
“Needle phobia is not necessarily connected to pain; it’s connected to anxiety. This agent, which is safe and easy to use, really tackles anxiety,” he says.