Dr. NIkolas Chugay, plastic surgeon & LGBTQ pioneer

Date Published: 
Wed, 2014-07-09


So, thinking about having plastic surgery? The issues to consider: Cost, recovery time and pain management. Costs vary from doctor to doctor and recovery time is similar for most, though things like age, general healthfulness, drinking, smoking, etc., are all factors that affect recovery.

Most surgeons recommend a general anesthetic, which makes it possible for you not to feel a thing during your surgery. New practices and technologies can also make recovery time quicker and reduce pain greatly during recovery. Dr. Barry Friedberg, who practices anesthesia for cosmetic surgery and works with Dr. Nikolas Chugay, discussed with The Rage Monthly his approach to anesthesia and healing.

Some experts say the anesthesia during surgery is often more risky than the surgery itself, is that true?

In surgeries prior to 1996, we were only able to measure vital signs (i.e. heart rate and blood pressure, reflecting only brain stem activity (not the actual brain). Because we don’t want people to be awake or in pain, most anesthesiologists err on the side of too much to be sure patients are comfortable during the procedure. If anesthesia overdosing results, it can mean more days of recovery (like ‘brain fog’), not from the surgery, but actually from too much anesthetic.

Do you have a better method?

Yes. In 1996, the FDA approved a brain monitor, the Bispectral (BIS) Index, to directly measure your brain response to anesthesia. Giving anesthetics, based on individual response, means that the patient is “controlling” the dose while comfortably asleep. With this method, the dosage cannot be too much or too little, but always just the right amount, kind of like the “Goldilocks” reference.

The BIS sensor sits on the forehead and reads the electroencephalography (EEG) and then processes the BIS value that is delayed only 15 to 30 seconds from real time. A software switch displays the real time electric signal (EMG) from the muscle between the eyes, similar to the electric signal of the heart muscle (EKG). BIS/EMG monitoring also means a dramatic reduction in the possibility of being awake when your anesthesiologist thinks you are asleep.

This is significant how?

It means that drugs can be used in precise dosages for the first time. We use them to trick the brain into blocking pain before the body ever felt it. As a consequence, patients do not have the “look” of having been operated upon and healing time can be much faster. Also, nausea and vomiting, common with regular anesthesia, is virtually non-existent and without need for anti-nausea drugs, which can have their own undesirable side effects.

If this technique has been around so long, why aren’t more doctors using it?

Politics and economics mainly. There are larger profits when a hospital uses more drugs and people take longer to recover. Out system is designed for profit over patient care, so if patients don’t know about the option or who provides ir – they don’t get access to it.

How do you give people options?

Goldilocks Press published a new book, Getting Over Going Under: 5 Things You Must Know Before Anesthesia. It is written in plain language for the public and is available on Amazon, Kindle and Audio books.

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