143

Plastic Surgical Nursing/Fall 2001/Volume 21/Number 3

Blepharoplasty Under Hypnosis:
A Personal Experience

This offering for 4.5 contact hours is pro -
vided by the American Society of Plastic
Surgical Nurses (ASPSN), which is accred -
ited as a provider of continuing education
in nursing by the American Nurses Creden -
tialing Center's Commission on Accredita -
tion (ANCC-COA). Accreditation refers to
recognition of continuing nursing education
activities only and does not imply Commis -
sion on Accreditation approval or endorse -
ment of any commercial product that may
be pictured or described within this inde -
pendent study offering. Provider approved
by the California Board of Registered Nurs -
ing, Provider Number CEP 12261. Posttests
must be returned by October 20, 2003.

Chris Haskins, BSN, RN, CNOR,
R N FA, CHT, is a nurse, Night Nurse
A g e n c y, Clarkston, MI.

T

his is a first-hand account of
my experience undergoing
upper and lower blepharo-
plasty with hypnosis as the

primary sedative agent. This came
about due to a number of events: (a)
I am a RNFA with many years expe-
rience in plastic surgery, (b) I have a
familial predisposition for excess
skin and fat herniation of both upper
and lower eyelids, (c) I am trained as
a hypnotherapist, and (d) the sur-
geon I worked with embraces holis-
tic adjuncts to traditional surgery. In
addition, the nursing manager and
the staff at the hospital were open-
minded and their support created an
atmosphere conducive to this innov-
ative approach to surgery.

Contrary to popular belief, hyp-

nosis is not a “sleep” state. It is a
relaxed state in which the subcon-
scious mind remains active and
receptive to suggestion. This allows a
p e r s o n ’s conscious and subcon-
scious minds to believe in the same
message, thus promoting and rein-
forcing this message at the same
time. In this ultra-relaxed state, the
person is able to suspend critical
judgment and exercise selective
thinking (Dunphy, 1990). In such a
state, fear and the perception of pain

can also be suspended. This allows
the patient to become an active par-
ticipant in the surgical procedure, as
well as in the postoperative recovery
p e r i o d .

Mind Over Matter

The power of the human mind

has long been recognized. Stories of
spontaneous recovery from terminal
illness,

super-human

feats

of

strength, and the like can be found
in both secular and religious con-
texts. Examples range from the
B i b l e ’s “laying on of hands” to the
urban myth of the frail grandmother
who lifts a car off her grandchild to
save him. Regardless of the context,
few would dispute the assertion that
the human mind has the capacity or
ability to influence such physical
realities. Although most of these sto-
ries are anecdotal in nature and with
spotty documentation, nurses and
medical personnel are in a particu-
larly good vantage point to see the
m i n d ’s abilities in action.

As nurses, we have all seen the

“miracle” recovery of an extremely
ill patient who possessed a positive
and optimistic attitude and, con-
v e r s e l y, the slow decline and eventu-
al death of patients who have given
up hope.

Hypnosis, simply defined, is

merely a process by which the
power of the subconscious mind can
be accessed and used for the benefit
of the individual. By suggesting to
the subconscious mind that positive
outcomes can be easily achieved,
the road to surgical recovery can be
a smooth and rewarding one.

Chris Haskins

This paper is a first-hand account of my experience undergoing
upper and lower blepharoplasty surgery in which hypnosis was
used as the primary sedative agent. It describes the basics of
hypnosis. It also includes a description of how I prepared
myself for surgery as well as how I helped the surgical team
prepare for this surgery. Recommendations are offered for nurs -
es who would like to incorporate hypnotherapy into the operat -
ing room.

Posttest on Care of the

Aesthetic Plastic Surg e ry

Patient May be Found on

Pages 151-154.

Plastic Surgical Nursing/Fall 2001/Volume 21/Number 3

144

A Brief History

The use of hypnosis in healing

and surgery predates recorded histo-
r y. According to William J. Bryan,
MD, (1963), “In the religious and
healing ceremonies of all primitive
peoples on the face of the earth,
there exist the elements essential to
place the subjects into a hypnotic
trance... all world travelers are famil-
iar with the Hindus, Fakirs, Yo g i s ,
snake charmers, and eastern magi-
cians who induce themselves and
others in cataleptic states by eye fix-
ation and other mesmeric tech-
niques and were able to perform
unusual physical feats and eliminate
pain” (Bryan, 1963, p. 1).

The principles of hypnosis have

been used for millennia, but the
word hypnosis (derived from the
Greek “hypnos” meaning “sleep”)
was not coined until 1842 by James
Braid. Later in his life, Braid realized
that hypnosis was not a true sleep
state, but an intense concentration
of the mind.

The modern use of hypnosis in

surgery began in the mid 1800s with
the work of Dr. James Esdalie, who
performed more than 300 major surg-
eries under hypnosis while working
for the British East India Company.
This coincides with the discovery and
use of chloroform and ether as the
first chemical anesthetic agents. This
may lead one to wonder how drasti-
cally different our approach to mod-
ern anesthesia would be without the
discovery of these chemicals. As we
enter this new millennium, can mod-
ern medicine incorporate the power
of the mind in the enhancement of
the art of healing? I believe the
answer is “Ye s ! ”

A Personal Perspective

I had long been considering a

b l e p h a r o p l a s t y, but had not serious-
ly formed any plan to have it done.
Some of my concerns revolved
around having seen many surgical
complications, possible problems
with anesthesia, and the idea of sur-
rendering complete control of my
body to someone else. These con-
cerns delayed a decision on my part
and any commitment to surgical
intervention.

In 1998, I met Anne H. Spencer,

PhD, the premier hypnotherapist in

metropolitan Detroit and founder
and executive director of the Inter-
national Medical and Dental Hyp-
notherapy Association. Like most
lay people, I had a very distorted
view of hypnosis, which had no basis
in fact. Under the instruction of Dr.
S p e n c e r, I learned how hypnosis
works and how it could be used in
the operating room. I saw that hyp-
nosis during a blepharoplasty was a
solution for me and addressed the
concerns I had about having the ble-
p h a r o p l a s t y. I was intrigued with the
idea of having awareness during
s u r g e r y, not needing chemical anes-
thesia and narcotics clouding my
perception, and, most of all, main-
taining some control over my own
s u r g e r y. I was excited about the abil-
ity to become an active participant
in the surgical process. I decided to
proceed with the surgery.

Preoperative Period

With the collaboration between

D r. Michael H. Freedland, the plastic
surgeon, and Dr. Spencer, a plan was
developed. Since this was the first
procedure done under hypnosis at
our hospital, the cooperation and
support of the surgical staff was
elicited. The nurse manager, who is
an CRNA, was immediately positive.
Her response gave me a sudden feel-
ing of empowerment. She allowed
D r. Spencer to be in the operating
room and allowed the use of various
monitoring

equipment,

which

included the standard monitors
(ECG, respiratory and pulse ox) to
monitor my physical state. To moni-
tor my level of consciousness, we
borrowed a Bispectral Index Monitor,
which acts much like a simplified
EEG to monitor the level of con-
sciousness. A representative from
the hospital’s biomedical engineering
department was present during the
procedure since we did not routinely
use Bispectral Index Monitoring. The
nurse manager allowed me to select
the progressive and open-minded
surgical staff who would be present
in my surgery. All of these things cre-
ated an atmosphere conducive to
hypno-anesthesia, which is a deeper
state of hypnosis known as somnam-
bulism or selective amnesia state.

In this state of hypno-anesthesia,

reality is momentarily suspended and

a suggestion is made in which the
hand is numbed, as if being immersed
in ice water. This numbness can be
transferred to any body part by
touching the part with the numbed
hand. This is also known as “glove
anesthesia.” This technique has been
used very successfully in many med-
ical and dental procedures.

Next, the plastic surgeon and I

developed the actual surgical plan.
Having performed this surgery
together countless times, we were in
concert on the technological aspects
of the surgery. This plan seemed so
different without the consideration of
“regular” anesthesia. In our plan, it
was important to control the atmos-
phere in the operating room (OR) –
providing a quiet, safe place with
pleasing, relaxing music; limiting the
distracting noise associated with the
bustle and activity in the OR; and the
elimination of unnecessary “table
talk.” Controlling the environment
allowed Dr. Spencer to induce hypno-
sis and maintain it with positive
imagery and relaxation techniques.

Once the plan was made, we

chose the surgical date, and it felt
like there was little time for me to
practice the hypno-anesthesia.

As the date approached, Dr.

Spencer and I had three hypnosis
sessions. First, I was familiarized
with the somnambulism or selective
amnesia state. We went through the
entire process of “glove anesthesia”
and deepening of the relaxation
state. After these sessions, I was able
to induce the glove anesthesia state
in myself through self-hypnosis and
deepen my relaxation through
i m a g e r y. In the OR, I imagined
myself lying in a hammock in my
backyard. I completed six practice
sessions where I actually did lie in
the hammock in the back yard. This
technique has been used very suc-
cessfully in many medical and den-
tal procedures. The sessions to learn
this, as well as practicing this tech-
nique, gave me the confidence I
needed to control and negate the
conscious response to pain.

The Surgery

On the day of my surgery, I

assisted the plastic surgeon, Dr.
Freedland, in four surgeries using
traditional anesthesia. I was the fifth

145

Plastic Surgical Nursing/Fall 2001/Volume 21/Number 3

of his patients that day. Because of
all of the prior preparation and my
intimate involvement with the entire
process, I felt empowered rather
than anxious. The surgical staff that
I had hand-selected was present and
r e a d y, and there was great excite-
ment over the prospect of this
surgery with “new age” hypno-anes-
thesia. Would it work? Would I
“freak out?” Would I be over-
whelmed with pain and require
unplanned general anesthesia?

The CRNA for my surgery insist-

ed that I have an intravenous line
(Heplock) inserted in the event of a
vagal response secondary to the ocu-
lomotor stimulation of the surgical
technique. I allowed this only to
appease my co-workers and then
reclined on the OR table. Dr.
Spencer quickly placed me in a
relaxed state, then the deeper som-
nolent state, and then applied the
“glove anesthesia” effect.

I was prepped and draped in the

usual sterile fashion. Throughout the
procedure, I was aware of my sur-
roundings. Relaxing music, that I
chose ahead of time, was playing. All
voices were intelligible. The typical
sounds of the OR were recognizable,
and my sense of touch was intact.
Because I had so much experience
first-assisting with this particular
procedure, I was aware of each indi-
vidual step. The sensations of pain
and time were absent. (I later
learned that actual skin-to-skin time
was an hour and a half).

The first test of the hypno-anes-

thesia was with the injection of
approximately 5 cc of 1% lidocaine
with 1:150,000 epinephrine for each
eye. (Dr. Freedland and I had
already agreed on the minimal use of
local agents). I felt no discomfort,
only slight pressure, as the spinal
needle entered above and below my
orbits. Next, I was aware of the
scalpel moving along the lash of my
right lower lid, followed by the tug of
retraction and the sound of the
Bovie. Again, I felt no pain or anxiety
as I listened to the usual OR table
manners

while

equipment

is

requested and passed. I felt the pres-
sure of the “mosquito” clamping the
fat pads of my lower lids. At this
point, I was registering alpha and
theta levels of consciousness on the

Bispectral Index Monitor. The alpha
level is a subconscious or innercon-
scious state associated with emo-
tional feeling and intuition. The
theta level is an even deeper sub-
conscious state that is associated
with creativity. These states do not
necessarily connote sleep.

Although everyone enters these

states during sleep, through practice
one can achieve such states during
wakefulness. The beta or waking
state reflects the outerconscious with
cognitive and logical thought with a
full realization of space and time.
These are the thought processes sus-
pended during hypno-anesthesia.

S u d d e n l y, I was startled to feel

an electrical shock arching to my
forehead through the ground pad of
the Bispectral Index monitor. Due to
this shock, I brought myself out of
the hypnotic state to tell the surgical
staff of this “shocking” experience.
From that point on, a “hot temp”
coagulation device was used instead
of the Bovie. Then, Dr. Spencer
quickly returned me to hypnotic
state through voice and therapeutic
touch. Since she had been holding
my hand throughout the surgery,
she was consciously aware of my
s t a t e .

The remainder of the surgery

was uneventful until the end when I
heard a voice say, “I don’t like this.”
I felt no pain but had a bit of anxiety
related to this statement. (I later
learned that my left lower lid closure
was less than perfect and was subse-
quently revised). The next thing I
remember in this state of hypnosis
was Dr. Spencer telling me to return
to full consciousness.

I then sat up on the edge of the

OR table, hopped down, removed
my unused Heplock and walked to
the lounge where I pranced around
in triumph and reveled with my col-
leagues. Half an hour later, I had din-
ner with the first assistant and drove
myself home (a 70-minute drive).

Postoperative

Due to the post-hypnotic sugges-

tions given prior to surgery, I had no
postop discomfort and little swelling
and bruising. I took only Vi o x x ®
each morning, more for its anti-
inflammatory action rather than for
discomfort. I applied Arnica M o n t a n a

gel several times a day. Arnica Mon-
tana is an herbal extract recognized
to reduce bruising and swelling and
is used by many athletes. It has been
used in holistic medical practices
s u c c e s s f u l l y. I took no narcotics.

On postoperative day (POD) #1,

I went to a weekend seminar, and on
POD #3, I returned to work, assisting
in a full day of surgeries. Within 2
weeks, there was no sign of surgical
intervention, with the exception of
my improved appearance. The
entire experience was very positive,
and I thank the doctors and my OR
staff wholeheartedly.

I have reflected a lot about my

surgical experience and have come
to some conclusions regarding hyp-
nosis and surgery, in general. First,
the environment of the OR and the
attitude maintained during surgery
is paramount. I know now that an
unconscious patient is fully aware of
his or her surroundings regardless of
the anesthetic agents used. Patients
can hear all the sounds and state-
ments made in the OR and register
them mentally. Statements such as,
“ We’re losing him,” “He’s bleeding
like a stuck pig,” or “This looks like
a malpractice suit waiting to hap-
pen” may be self-fulfilling prophe-
cies. As nurses in the OR, we need to
be particularly aware of what we say
in the OR and how we say it. A
p a t i e n t ’s postop recovery can be
influenced by inadvertent com-
ments. Conversely, positive and
reassuring statements made to
patients can speed recovery and pro-
mote healing. This is also true of
touch. Although a patient cannot
respond, he can recognize rough
handling or a gentle, more therapeu-
tic touch. The entire surgical team,
from the pre-op holding area to the
recovery room, can be instrumental
in facilitating positive outcomes sim-
ply by maintaining positive postures
and attitudes.

E p i l o g u e

Since my own surgical experi-

ence, I have used the principles of
hypnosis in my practice. I routinely
give post-hypnotic suggestions after
administration of Versed® (a power-
ful chemical hypnotic agent). These

continued on page 160

Plastic Surgical Nursing/Fall 2001/Volume 21/Number 3

160

may result in the need for less anes-
thesia, ease of awakening from anes-
thesia, less postop pain and nausea,
etc. Using these principles has
appeared to improve patient out-
comes and increase overall patient
satisfaction. Hopefully, as the trend
towards a holistic approach to
patient care expands, it will some-
day permeate the sterile environ-
ment of the operating room.

C o n c l u s i o n

As we enter this new millennium,

it is my hope that modern medicine
and nursing embrace a more holistic
approach to patient care and com-
bine age-old techniques and treat-
ments with modern technology. As
nurses, we use many techniques used
in hypnosis daily (e.g., therapeutic
touch, guided imagery). Nurses can
become educated through weekend
seminars, books and other education-
al materials, and practice of the tech-
nique. Then, they may integrate hyp-
nosis into his or her clinical practice
with very positive results: improved
pain management, speedier healing,
behavioral changes, etc. In the future,
I see an office in every hospital with a
sign on the door saying, “Hypnother-
a p i s t ! ”

R e f e r e n c e s

D u n p h y, R.M. (1990). H y p n o t h e r a p i s t s .

Therapy and rehabilitation (4th ed.)
(pp. 1-4). Moravia, NY: Chronicle
Guidance Publications.

Bryan, W.J., Jr. (1963, January). A history

of hypnosis. Journal of the American
Institute of Hypnosis, 1, 1-19.

Additional Information

American Association of Professional

Hypnotherapists; P.O. Box 731;
McLean, VA 22101

International Medical and Dental Hyp-

notherapy Association; 4110 Edge-
land; Royal Oak, MI.

Blepharoplasty Under
Hypnosis

continued from page 145

tion, harassment, and inappropriate
employment conduct) involving
employees,

former

employees,

employment applicants, and third
parties such as vendors or patients.
This coverage is sometimes included
as part of an employer’s professional
malpractice insurance. Terms and
conditions of the policy may vary,
thus it is important that an employ-
er or facility refer to his/her/its actu-
al policy. This type of policy does not
cover workers compensation, dis-
a b i l i t y, unemployment, disputes
over retirement plan administration,
strikes and lockouts, or liability aris-
ing from requiring retraining.

Liability insurance. This policy

provides the physician and facility
general liability coverage. Depending
on the carrier, the premium may be
for an aggregate amount or assessed
per patient/client seen/treated. Cov-
erage includes bodily injury or prop-
erty damage liability arising from the
building (malfunctioning door, fire
system, elevator, etc.) and personal
property (malfunctioning wheel
c h a i r, gurney, cautery, ripple in car-
pet, etc.). A variant of this insurance
is coverage for the physician, facili-
t y, or governing body when disputes
occur due to their alleged failure to
perform certain responsibilities.
Some carriers provide this coverage
within their professional liability
p a c k a g e .

Property insurance. This prod-

uct covers loss arising out of direct
physical damage to building, equip-
ment, etc. and can include loss of
income due to interruption of the
business. There is a wide choice in
the perils to be covered (fire, earth-
quake, flood, etc.) and the types of
property to be covered (contents,
patient records, computer media,
etc.). Property coverage is typically
provided along with liability cover-
age on a package policy.

Workers compensation. Wo r k e r s

compensation provides coverage for
work-related injury/illness to employ-
ees and is a mandatory coverage.

Disability insurance. This impor-

tant but often overlooked coverage
can be purchased through an individ-

ual or group policy to provide income
in the event of a disability. A variant of
this insurance is coverage for expens-
es (rent, salaries, supplies, etc.)
accrued should the physician become
disabled. These products provide
income for a specified period of time.

Health insurance. This type of

insurance is perhaps the most sought
after employee benefit. Employers
may purchase either individual or
group policies. These policies can
provide basic medical care or include
added benefits such a eye examina-
tions, dental care, pharmacy ser-
vices, etc. An optional benefit is acci-
dent insurance for after work hours.

Life insurance. This insurance

is a very desirable optional benefit. It
may be term insurance (the premi-
um covers the insured for a specified
time period) or whole life (premium
paid results in a specified disbursed
after a period of time).

Employee bonding. This prod-

uct provides a bond against certain
illegal or unauthorized activities
(stealing, breech of confidentiality,
etc.). Many believe that bonding is a
poor investment because the ripple
effect (due to bad publicity, loss of
good faith, the need to file a police
report, etc.) resulting from the nega-
tive activity is far greater than the
coverage provided.

Administrators and managers

are encouraged to perform a risk
assessment of their practice and
surgery center to identify areas of
potential liability. Risk management
guidelines are available from all of
the major insurance providers as
well as professional organizations
such as the American Medical Asso-
ciation and the American College of
Surgeons. A heightened awareness
of this subject coupled with a gen-
uine interest in providing a safe
environment for staff and clients will
go a long way to limiting physician
and facility liability; however, it is
also essential to have certain insur-
ance products available should a
genuine emergency occur.