Chicago-based plastic surgeon Anil Shah, MD, FACS, has developed a nerve block technique that minimizes pain and reduces the need for narcotics in rhinoplasty recovery. By integrating ultrasonic technology and complementary therapies, he aims to improve patient outcomes. He explains more below.

Plastic Surgery Practice: What inspired you to develop the nerve block technique for pain-free rhinoplasty?

Anil Shah, MD, FACS: My mother—who, by the way, is not a medical professional—taught me the importance of addressing pain. She once had wrist surgery performed by an esteemed hand surgeon.

Due to my early and late working hours, I didn’t check in with her until three days after her procedure. I expected her to be in significant pain and possibly annoyed with me for not calling sooner. Instead, I was surprised to find out she was out grocery shopping and pain-free. Curious, I asked her how that was possible, and she casually mentioned the doctor had used “some nerve block thing.”

That was my eureka moment. I thought, “Why doesn’t anyone use nerve blocks for rhinoplasty?” Around the same time, I was deeply affected by Netflix documentaries on the opioid epidemic. It really hit home, and I began to wonder: could we eliminate or at least reduce the need for opioids in rhinoplasty? My initial nerve block technique was published in 2023 in Facial Plastic and Aesthetic Medicine and validated to be highly effective in reducing patients’ pain associated with rhinoplasty.

PSP: How does the Piezo Ultrasonic Rhinoplasty technique differ from traditional methods, and what are its advantages?

Shah: Ultrasonic rhinoplasty has significant advantages, especially when it comes to reducing pain. The lining of your nose is full of blood vessels and nerves. Traditional rhinoplasty techniques using a chisel or osteotome inherently disrupt the neurovasculature during bone work. In contrast, ultrasonic techniques work through precise vibrations that target only the bone, preserving the surrounding soft tissue.

Preservation of the nasal lining means less trauma, reduced swelling, and a decreased likelihood of pain. It’s a technological leap that allows patients to recover faster and more comfortably.

PSP: Can you explain how red-light therapy, essential oils, and binaural beats contribute to reducing swelling and pain post-surgery?

Shah: There’s promising science behind all these techniques, but they are best used as complementary treatments rather than standalone solutions.

  1. Red light therapy: Low-level light therapy (at 660 nm) has been shown to improve neuropathies, arthritis, and post-surgical discomfort. This photobiomodulation can start as early as the recovery room, which is exactly what we do for all our patients. It reduces swelling and accelerates tissue repair.
  2. Essential oils: Studies have shown that lavender and damask rose oils improve pain management in conditions like pregnancy and burns. For rhinoplasty, peppermint and eucalyptus oils can help decongest the nose, improving airflow and alleviating sinus pressure almost immediately. In my practice, we use lavender to help alleviate anxiety in the pre-op area and a combination of peppermint and eucalyptus oils to help decongest the nose in the post-op area.
  3. Binaural beats: Binaural beats are a fascinating phenomenon where two slightly different frequencies presented to each ear create a calming effect on the brain. This reduces cortisol levels, which in turn reduces pain. It’s an effective, non-invasive way to manage post-operative anxiety and discomfort. When patients are in the operating room, which can be slightly intimidating, binaural beats are played to help relax and trigger sleep waves in the brain. I even use binaural beats myself every night to help me sleep!

PSP: What challenges did you face in obtaining special clearance for in-house surgical procedures?

Shah: Fortunately, most of my patients are exceptionally healthy. For patients over 50, I require medical clearance from their primary physician to ensure they can handle surgery safely. That said, most of my rhinoplasty patients tend to be younger and have fewer health concerns.

PSP: How do you ensure patient safety while minimizing the use of narcotics in post-operative care?

Shah: We strive to avoid opioids throughout the entire rhinoplasty process, even during anesthesia. I’ve adapted an ERAS (Enhanced Recovery After Surgery) protocol specifically for rhinoplasty, which was published in Life (Basel) this year.

By eliminating narcotics, we significantly increase the margin of safety. For example, a single 10 mg dose of Norco may be safe for some patients, but doubling it—whether intentionally or accidentally—could lead to an overdose. This risk becomes even higher with the potential use of alcohol, marijuana, or other medications. Avoiding narcotics simplifies recovery and reduces these dangers.

PSP: What are the key benefits patients experience with your unique recovery protocol compared to traditional approaches?

Shah: Traditional recovery protocols often leave patients mentally foggy and impaired for a week or more due to narcotics. In contrast, our approach allows many patients to function at a high level almost immediately.

Many of my patients work remotely, and avoiding opioids enables them to resume non-physical tasks, like reading or strategizing, within days. The most common tactic used by my patients is to turn their camera off. For those who can’t work remotely, they often use the recovery period as a time for relaxation, self-reflection, or learning. This turns what could be a lost week into an opportunity for personal growth.

PSP: How does your focus on creating a luxurious and calming environment impact patient outcomes and satisfaction?

Shah: Our field is exceptionally demanding. Not only do we have to deliver impeccable surgical results, but we also need to ensure patients have a positive and memorable experience. Studies have shown that patients who experience higher levels of pain are more likely to be dissatisfied with their rhinoplasty results. By virtually eliminating pain, I’ve noticed that patients are smiling as early as the first week. It’s incredibly rewarding to see them not just satisfied with the results but genuinely happy with the entire journey.