Sponsored by CAREstream America
Pain associated with aesthetic treatments is multifactorial. It includes physical discomfort and pain, as well as psychological agony due to anxiety that arises from a fear of needles, treatments or an adverse outcome. Managing pain is an important component of an aesthetic practice and can make a difference in patient retention, referrals and even treatment outcomes. Regardless of the type of pain, Pro-Nox from CAREstream America (Lake Mary, Fla.) has both patients and physicians covered.
According to Greg Chernoff, MD, board-certifi ed facial plastic and reconstructive surgeon in Santa Rosa, Calif., the balance between the patient’s experience, (perception vs. reality), and their aesthetic outcome has never been more in the spotlight. “More patients are willing to write a review on their 
treatment provider,” he elaborated. “Prospective patients are giving credence to these reviews, and so the pursuit of the perfect experience continues. Most patients want to look their best, which inevitably improves their self-esteem, but they also want as close to a painless experience as possible. Because of this, Pro-Nox has become the ‘platinum standard of care’ for aesthetic procedures.”
Pro-Nox in Practice
Dr. Chernoff explained that the analgesic effects of nitrous oxide occur by releasing endogenous opioids that act on opioid receptors. “A subsequent surge in serotonin, dopamine and norepinephrine occurs, modulating pain perception, yielding a less stressful and more enjoyable experience. The anxiolytic effects are through activation of the primary Gammaaminobutyric acid receptor (GABA-A). Nitrous oxide also has a central sympathetic stimulating activity that supports blood pressure, systemic vascular resistance and cardiac output. It also stimulates cerebral blood flow and increases intracranial pressure. These factors lend to its safety profi le. Pro-Nox has also negated the necessity for prescribing patients lorazepam or diazepam to help alleviate anxiety prior to arriving for their procedure.” Dr. Chernoff added that he offers Pro-Nox to all patients receiving any in-office procedure that has discomfort and previously required a topical anesthetic. This includes injections, radiofrequency (RF) microneedling, full-face and fractionated CO2 and vaginal rejuvenation procedures.
“Because of Pro-Nox, we can use a device at the most beneficial energy settings to provide optimal outcomes,” explained Doris Day, MD, a board-certified dermatologist in New York City, N.Y. “Patients are happy to talk about the outcomes and the pleasant treatment experience because of Pro-Nox. This results in many patients referring their friends to us, and it builds patient trust because they know we go above and beyond to make sure they have the most comfortable experience possible, and we care about them.
“When a patient comes for a treatment, we ask them to take six to eight deep inhalations and exhalations with the Pro-Nox and then once they feel good, we are ready to begin,” Dr. Day continued. “The device is super easy to use. It does not take up much space and it has wheels so it can be moved from room to room. Most importantly, it has been proven to be very safe for patients and I like knowing that after their treatment, they are lucid to travel and can get home safely.”
Dr. Day reported that she uses Pro-Nox for many treatments including injectables and energy-based devices. “It allows patients, even those who are sensitive and anxious, to tolerate the entire treatment,” she explained. “Additionally, I can use stronger energy and get through treatments quicker because we do not have to take breaks. It is nice to have the option to be more efficient and at the same time provide a great experience for our patients.”
“We use Pro-Nox for both surgical and nonsurgical treatments,” reported board-certifi ed plastic surgeon Jonathan Cook, MD, of Sanctuary Plastic Surgery (Boca Raton, Fla.). “In nonsurgical, we use it with treatments that are often associated with a lot of pain such as RF microneedling, skin tightening and some rejuvenating lasers if their pain thresholds are low. We also use Pro-Nox for our local anesthesia surgical patients. I do it often for awake liposuction. I fi nd the combination of Pro-Nox and MKO Melt (ImprimisRx), as well as tumescent local anesthesia makes it possible to do two areas of liposuction in an awake patient and they are very comfortable and cooperative. And the great thing with Pro-Nox is that the patient is not incapacitated, but instead remains interactive.”
According to Dr. Cook, the insight into anxiety has evolved, making it an important aspect of an aesthetic practice. “I think there is a rising tide of awareness in terms of our own mental health,” Dr. Cook emphasized. “We now have ways of reliably addressing patient concerns when it comes to their anxiety over procedural pain and discomfort and that is a game changer.
“Having Pro-Nox in my armamentarium of tools to help patients feel more comfortable during a treatment allows them to approach treatments that might otherwise be prohibitive for them,” he continued. “I can genuinely walk them through the process such as an awake liposuction, neck lift or eyelid surgery under local anesthesia, with the confi dence that the procedure will not be something that causes them physical pain or emotional trauma. I am confident they can come away feeling as though they were cared for and we minimized their discomfort, and that is a huge advantage.”
Pain Management as Part of the Business Plan
Over the past 30 years, Dr. Chernoff has devoted a substantial amount of time studying the business component of an aesthetic practice. “I have come to appreciate the artistry and the science involved in perfecting a business plan,” he said. “It starts with optimizing the lead for which we spend too much to acquire. Steps to provide an information-filled consultation yielding high (80% plus) conversion to treatment is the next goal. And by adding Pro- Nox to decrease the anxiety of any procedure associated with discomfort, we have seen high levels of cross-selling, up-selling, patient retention and patient ambassadorship.”
Dr. Chernoff professed that adding Pro-Nox has transcended his practice into a higher patient referral network with consistently positive internet reviews. “My offices serve as an example of how Pro-Nox has become not the gold standard, but the platinum standard of care for patient comfort and patient satisfaction,” he concluded. “By overcoming any procedure anxiety and improving outcome efficacy, an increase in patient satisfaction, compliance, retention, loyalty, referrals and positive online reviews follows.”
