Rhinoplasty: Q&A

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Is Twilight Anesthesia Safe for Rhinoplasty?

I have considered a surgeon but he only uses twilight sedation. I heard negative stories about this type of anesthesia. I am having a complete rhinoplasty done (nasal bone osteotomy, possible nostril reduction, removal of the hump on the nose, etc). I am a person with a bit of anxiety issues. Is this type of anesthesia okay? Do you hear or wake up or are conscious while the surgery is going on? Thank you for your information.

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20 Doctor Answers | Asked by Heather123 in NYC

Doctor Answers (20)
Community Comments (0)

I prefer general anesthetic for Rhinoplasty Surgery.

Since your nose is part of your airway, I prefer to protect it with an endotracheal tube during Rhinoplasty Surgery. I have never performed Rhinoplasty with "twilight" sedation since operative bleeding will invariably end up in your throat and this may cause coughing. This is my personal preference, and I know that many prominent Rhinoplasty surgeons prefer IV sedation. The good Dr. Persky still has me laughing out loud with his title that includes: "Tap tap tap". This... more

Eric M. Joseph, MD

198 reviews

West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Board certified anesthesiologist is what's important in Rhinoplasty.

Hi. You want to have a board certified anesthesiologist who has done a lot of rhinoplasties together with your surgeon. That way, each knows how the other works, and things go smoothly. You also want to be done in an accredited operating room and accredited recovery room. Those are the important things. In the right hands, both twilight anesthesia and general anesthesia are safe for rhinoplasty.

Sedation versus general anesthesia for rhinoplasty.

Given improvements in general anesthetics and anesthesia monitoring techniques in recent years, most surgeons (I believe)--myself included--prefer general anesthesia versus sedation. Patients, too, enjoy being unaware of the surgery itself. My biggest concerns with sedation anesthesia for rhinoplasty are the following: airway protection: with sedation, patients are breathing without the support of the anesthesia machine. If they're too "deep" inadequate respiration is possible.... more

Twilight anesthesia for rhinoplasty.

I do the majority of my rhinoplasties under general anesthesia, whether intubation or LMA. Most of my patients are somewhat anxious and prefer being totally asleep. How safe twilight anesthesia is depends on how good the anesthetist is.

Toby Mayer, MD

7 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Twilight sedation anesthesia for rhinoplasty

Twilight sedation or general anesthesia are both options for rhinoplasty. Both, under experienced hands, provide acceptable anesthesia to complete a rhinoplasty safely. My only suggestion is that if you are having twilight sedation, that the surgeon is not also the anesthetist. A separate anesthesiologist or nurse anesthetist allows the surgeon to focus only on your surgery, while letting someone else focus on keeping you sedated/asleep and comfortable. If you do have anxiety issues, you... more

Twilight anesthesia for most rhinoplasty is safe

For most rhinoplasty surgeries twilight anesthesia is safe as long as your surgeon and anesthesiologist are comfortable with this approach. Although I did use this technique in the past I now use general inhalation anesthesia for my rhinoplasties. I find it is beneficial for the more difficult, prolonged revision cases, which are a large percentage of my rhinoplasty practice.

Richard W. Fleming, MD

9 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Twilight Anesthesia not as safe as General Anesthesia

Heather, The reason for the above is that the patient's airway is not as protected with twilight as it is with general anesthesia. There are different stages of anesthesia. In the lighter stages breathing continues as normal but the patient is still semiconscious and involuntary movements can make the operation more difficult for the surgeon. A moving target is more difficult to hit than a still target for most people. Also, at this point the patient is still able to talk... more

Twilight anesthesia is safe for rhinoplasty

I would completely agree with the other physicians who indicated that twilight anesthesia for rhinoplasty is safe, but I do prefer some type of airway protection with either an endotracheal tube or at least an LMA. The type of medication then used to keep the patient asleep can be the exact same as with 'twilight anesthesia,' so that recovery and after-effects are minimized.

D.J. Verret, MD

4 reviews

Dallas Facial Plastic Surgeon

innovationsfps.com

Twilight anesthesia works for rhinoplasty

Twilight anesthesia is safe. It is used for all types of plastic surgery procedures. You may have some awareness but you will not remember anything. Personally for rhinoplasty, I prefer to perform it under general anesthesia. It is allows me to help control bleeding (if it occurs) more efficiently. The patient is completely sleep and won't make sudden movements while the surgery is performed. Speak with your surgeon about his/her experience and then trust your gut. Good luck, Dr.ES... more

Rhinoplasty Anesthesia

Your surgeon should try and tailor your Rhinoplasty anesthesia to your case and your personality. In the hands of a competent anesthesiologist / anesthetist both twilight (IV sedation) and general anesthesia are equally safe. That being said, if you are anxious you probably should have general anesthesia to spare you the sounds of the surgery. Dr P. Aldea

Twilight anesthesia for rhinoplasty

There are many factors in deciding which anesthesia is best for each patient and for each procedure. Generally speaking, both twilight and general anesthesia are equally safe for rhinoplasty. This has been proven by multiple non randomized studies. I believe all things being equal, the patient should also have a choice of which anesthetic they prefer.

Is twilight anesthesia safe for Rhinoplasty? Tap Tap Tap

Hi Heather, Depending upon your anesthesiologist and surgeon, yes, twilight anesthesia for rhinoplasty is safe. Sounds like you should have a deeper anesthesia unless you will be able to tolerate hearing a little "tap tap tap" during your osteotomies. For years we performed our rhinoplasties under "twilight", but with the advent of safer anesthetic techniques, we now perform almost all of our rhinoplasties under a light general anesthesia (IV diprovan with an LMA... more

Michael A. Persky, MD

21 reviews

Los Angeles Facial Plastic Surgeon

drpersky.com

Rhinoplasty Anesthesia: LMA General

Virtually all of my Rhinoplasty patients have general anesthesia using LMA. This helps protect the airway and maintain a deep enough plane of anesthesia so that the patient is comfortable. This has been my preference for the last 9 years and has worked well for my patients. However IV sedation in the right hands is very safe for Rhinoplasty.

General anesthesia is safer for Rhinoplasty

I would reguest general anesthesia if I was going to have rhinoplasty. There are many great surgeon who do rhinoplsty under twilight sedation and have great results,but the main concern is the bleeding and loss of air way. This is even more important in a patient with anxiety. The anxiety will cause higher blood pressure and this will lead to higher risk of bleeding and airway loss. Please find a surgeon that you trust and if he feels that he can give you good result, then trust him to... more

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Twilight vs. General Anesthesia for Rhinoplasty

Anesthesia is one of the main causes of concern and anxiety for many patients considering rhinoplasty. These days, there is not a huge difference between general anesthesia (being completely asleep) and twilight anesthesia (deep sedation). Under twilight anesthesia, patients are breathing on their own and the anesthesiologist is monitoring the amount of medication given to keep them unaware and comfortable. Under general anesthesia, slightly more of the same medications are given to make... more

Twilight Sedation vs. Deep Sedation

Hi Heather, There are different depths of sedation. If you have deep sedation, administered by a well trained anesthetist or anesthesiologist, you will not feel or remember anything. The key is find an anesthetist that is comfortable and experienced performing this type of anesthesia. If the anesthetist is not experienced with this type of anesthesia, you may experience a roller coaster ride of waking up and going to sleep. In that case, You would prefer the general anesthetic. I don't think... more

Sedation for nasal surgery

I have been doing this for over 35 years using mostly sedation or "twilight". For me, it is the comfort of using the same anesthesiologists for years and our working together to make sure the patients have a comfortable and safe surgery. Make sure the doctor is doing this in a Certified office or facility.

Twilight anesthesia is safe for rhinoplasty but I prefer general anesthesia

I have performed over 1000 nasal procedures under sedation anesthesia. It is safe for most patients. However sometimes patents may get "antsy" and require more sedation and some may be very sensitive to the sedation. In that case a more secure airway is needed. I now avoid that condition by using LMA for general anesthesia. This device is much less irritating to the airway than the old intubation method. So the amount of anesthesia drugs used is only slightly more than sedation. If... more

General anesthesia is safer than twilight

Twilight sedation is not as safe as general anesthesia for rhinoplasty surgery. The nose is a difficult structure to completely numb with a local anesthetic. With twilight anesthesia there is no control of the airway and if extensive bleeding occurs this would pass through the vocal cords, into the trachea and compromise the airway. In twilight anesthesia you are partially awake and conscious while the surgery is going on. If nasal bone osteotomies (breaking nasal bones) have to be... more

Rhinoplasty and different types of anesthesia

Rhinoplasty can be safely performed under general or twilight anesthesia. The advantages of twilight anesthesia is faster recovery but the big downside is possible recollection of the surgery and having some knowledge of what's going on including possibly pain or noises associated with bone scraping, etc. If you are anxious about it, general anesthesia is an excellent safe way to proceed especially if an anesthesiologist is involved. I prefer for my patients who are anxious to have it done... more