I'm scheduled for rhinoplasty next Wednesday under local anesthesia. I've read several posts that it's very painful while the local anesthesia is being injected but when the patient is sedated with an IV, the pain lessens. I'm wondering if doctors always sedate patients when performing rhinoplasty under local anesthesia or if there are cases where patients may not be sedated. My purpose of rhinoplasty is to insert the nose bridge with silicon and the tip with my own cartilage(closed technique)
Are Patients Always Sedated with an IV when Performing Rhinoplasty Under Local Anesthesia?
Doctor Answers (5)
Rhinoplasty under sedation
For those who perform rhinoplasty under local anaesthetic it is most often the case that sedation will be used. Injection of the local anaesthetic is painful and the sedation allows this to be done without distress to the patient.
For this reason rhinoplasty under locl anaesthetic alone is uncommon
A rhinoplasty can be performed under general anesthesia, intravenous sedation plus local, or local anesthesia only.
I know very few surgeons who would perform a full rhinoplasty under local anesthesia. Most prefer general anesthesia because the operation is more efficient and probably is safer. I would be worrying more about the operation itself than about the anesthesia.
Best way to perform a rhinoplasty IV sedation vs. general anesthesia
I prefer to do rhinoplasty surgery under general anesthesia, this is not to say that some physicians may prefer IV sedation. I like to have a tube in the trachea to protect the airway from blood that can drip down the back of the throat. It is also more comfortable to the patient to have a general anesthetic.
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Rhinoplasty and anesthesia
Like many other surgery procedures of the head and neck, historically rhinoplasties were often done in the office under local anesthesia. This is not the most comfortable or safest way to undergo this surgery, especially with osteotomies and more complex grafting procedures. I prefer to do major rhinoplasty operations under general anesthesia in the Operating Room. Local with IV sedation is a second best choice when there are medical problems that contraindicate general anesthesia. However, I have successfully performed minor revisions such as smoothing out an irregular hump under straight local anesthesia in the the office, which saves the patient time off work and the additional expenses of general anesthesia.
Anesthesia for rhinoplasty
Although it is possible to do a rhinoplasty under local only, it would be very unusual, and would usually indicated that the procedure is not being done in an accredited facility where anesthesia (iv sedation or general) can be safely done.
Most of these procedures are done with a light general or iv sedation, and that is what I would strongly recommend.