Sedation or anxiety solutions during dermal fillers?

Question

Years ago I got just one syringe of dermal filler over both cheeks and fainted half-way through due to nerves/vasovagal response. Recently I got Botox for the first time and was close to fainting again, even though it took less than 30 seconds to administer. I would like to do more filler in multiple areas (chin, cheeks, possibly nose) as well as PRP injections for my under eyes -- but I almost know at this point that I could not make it through all this without fainting. Is there anything that I could be given to prevent this or make the treatment doable? (sedation, anti-anxiety meds, etc)? It is not the pain of the procedure but the idea of it that seems to get to me.

Anna Chacon, MD, FAAD · Answer

Thank you for reaching out with your concerns about undergoing dermal filler and PRP injections. It's not uncommon for patients to experience anxiety or vasovagal responses during cosmetic procedures, especially if they have a history of fainting during such treatments.

Here are a few options you might consider to help manage your anxiety and make the experience more comfortable:

Pre-Procedure Consultation: Discuss your concerns with your dermatologist or cosmetic surgeon. They can provide personalized advice and may offer solutions tailored to your specific needs.

Topical Anesthetics: While these primarily help with pain, knowing that the area will be numb might reduce anxiety related to discomfort.

Oral Anxiolytics: Your physician might prescribe a mild anti-anxiety medication, such as a benzodiazepine (e.g., diazepam or lorazepam), to take before the procedure. This can help calm your nerves and reduce the likelihood of a vasovagal response.

Nitrous Oxide (Laughing Gas): Some clinics offer nitrous oxide as a sedation option. It provides quick relief from anxiety and wears off rapidly, allowing you to recover quickly after the procedure.

IV Sedation: In some cases, patients may opt for mild IV sedation, although this is less common for cosmetic procedures like fillers. Discuss the risks and benefits with your provider.

Breathing Techniques and Mindfulness: Practicing deep breathing, meditation, or mindfulness techniques leading up to and during the procedure can help manage anxiety levels.

Support During the Procedure: Having a trusted friend or family member with you can provide emotional support and help ease nerves.

It's crucial to communicate openly with your healthcare provider about your previous experiences and current concerns. They can work with you to develop a plan that ensures your comfort and safety during the procedure.

Eric M. Joseph, MD · Answer

Some people pass out every time they donate blood, and some people pass out every time they see a needle. A vasovagal attack is part of the autonomic nervous system, and in our experience, it is best to use gravity to your benefit, especially if you are not nervous about the procedure. If someone is looking pale, and if they are feeling light-headed during a procedure, we move The examination chair into a more horizontal position, and that prevents somebody from passing out. I hope this helps! Sincerely, Dr Joseph

Lexie Wang, MD · Answer

a few things to make sure is that you hydrate and eat before the injection procedure. if you are already doing those things, I also will have the patient already supine (laying down) as I'm doing the injections so that way you are safe, and then at worst, if you really  need it, there are options to do the injections with pronox/laughing gas, but that will require additional costs.

Stefan Weiss, MD · Answer

If your provider is comfortable with it, he/she could provide valium 1h before, however you would need a driver.

Thomas Spalla, MD · Answer

First and foremost, it's helpful that you recognize this issue and what may be triggering for you. There are a multitude of options. Distraction and talking about something else is a no-risk option. You can hold something in your hand with which to fidget, listen to music, or watch a video. 
Meditation and breathing techniques may help as well.
If possible, having you in a more relaxed and supine position (when not interfering with treatment areas) may help as well.
Beyond this, nitrous oxide is a quick way to achieve anxiolysis. Oral medications such as alprazolam (Xanax) are short acting and can be helpful.

Discuss your concerns with your injector to come up with a plan that feels best for your individual needs.

Camille Cash, MD · Answer

We offer options for patients with anxiety about injections.  ProNox can be administered to help calm patients prior to treatment.  We also use distraction methods such as tapping to assist with anxiety during treatments.  I've included a video I hope you find helpful.

Sedation or anxiety solutions during dermal fillers?

Answers (6)

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