Plastic Surgeons Are Using Ketamine to Make Nose Jobs More Pleasant

I might tell myself here, but ketamine isn’t hard to find if you’re looking. Whether you’re prepped with up to an IV on the operating table or you’re going to meet a close lookout for Greg’s cousin at a warehouse in the wee hours, he’s available. But let’s be clear: The medical-grade regulated ketamine that’s been used as a sedative in operating rooms and surgical clinics for years is a far cry from the party drug you might think of. The K has come a long way, and according to anesthesiologists and growing studies, it may be worth asking your doctor if you’re considering cosmetic surgery.

“Ketamine is an old drug that was created in the 1950s, but has recently revived,” says Dan B. Ellis MD, assistant professor of anesthesia at Massachusetts General Hospital. The renaissance is partly due to new studies showing positive effects of a dissociative drug on mental health: the Food and Drug Administration recently approved its use in a prescription nasal spray to treat major depression, and ketamine clinics provide injections and lozenge-style doses for some treatment-resistant cases. Mental illnesses like depression and PTSD are popping up across the United States, and studies now suggest that it can lead to less dependence on opioids in postoperative patients (more on that later). Most commonly, it is performed before or during certain surgeries to help patients’ minds detach from the body and its aches for a calmer experience, as part of the typical multi-sedating anesthetic cocktail. And in recent years, it has been shown to be particularly useful during and during recovery from cosmetic procedures.

One recent study showed that ketamine is very effective in reducing agitation after rhinoplasty, and Dr. Ellis used a humble nose job as an example of its beauty-related benefits: “When patients wake up after rhinoplasty with their nose in a splint, no one likes that feeling,” he says. He says, noting that patients may try to accidentally remove bandages or pieces of equipment while they are “recovering” or awake from anesthesia. “You have to find ways to calm them down — whether verbally or chemically — and bring them into a state of consciousness, and ketamine can be helpful for that. [in the right] dose. “It can also make breathing less stressful during central facial surgery.

“With plastic surgery, we usually supplement patients with oxygen, and if you’re working on someone’s nose or face, we can’t give them the usual type of nasal cannula or face mask to deliver the oxygen,” explains BobbieJean Sweitzer, MD. D., an anesthesiologist and director of preoperative medicine systems at Innova, Virginia. “Ketamine is unique among anesthetics because it actually doesn’t lower ventilation to the same degree as the others. You can get a much deeper state of sedation without inhibiting the respiratory system.”

But as with any drug, recreational or otherwise, taking it in excess can turn a therapeutic experience into an infernal one. While regular ketamine is usually taken for an excessively high or exhilarating, an excessively large dose can drop its user into the K-hole, a party talk for a great out-of-body experience that can leave the user immobile for an extended amount of time. Similar reactions in patients in the hours after surgery were the reason why ketamine was not favored in the medical community in the early years after its discovery: Without major trials with the drug, doctors were using it as a solitary anesthetic in heavy amounts. For almost 70 years, anesthesiologists have mastered more accurate doses, but even the improved ketamine cocktail is not universal. You may not be a candidate if you’re prone to hallucinations, episodes of schizophrenia, or anxiety, says Dr. Ellis.

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