Twilight Sedation Vs General Anesthesia for Rhinoplasty?

Is Twilight sedation a better choice than general for Rhinoplasty?

Doctor Answers (21)

Rhinoplasty is safe and comfortable under sedation or general anesthesia

+3

Rhinoplasty may be performed under general anesthesia with relative ease for the surgeon and anesthesia provider. Sedation is also an excellent choice for rhinoplasty, but I'd much more demanding for both the surgical and anesthesia teams. 

 

In my opinion, an experienced surgeon/anesthetist team can provide an excellent result and experience with sedation or general.  Due to less bleeding and easier recovery, my personal preference is sedation. 


Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 84 reviews

Twilight is Safer!

+3

I respecfully disagree with my colleagues who state that general anesthesia is necessary for performing a Rhinoplasty. I have now done over 2000 procedures under twilight anesthesia and strongly prefer it over general. In my opinion there is less bleeding, no discomfort when done by someone with experience, and much less post-operative nausea. There is no risk of Malignant Hyperthermia and obviously no potential risks associated with use of an endotracheal tube.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Personal anesthesia preference for Rhinoplasty

+2

Hello,

Either general or sedation would be appropriate for rhinoplasty. I personally use sedation/twilight for most of my cases, to include septoplasty and cartilage grafting. Only endoscopic sinus surgery cases in my hands require general. Most patients feel better after a twilight, with less nausea and "ick" feeling. Less vomiting means less bruising and swelling. Overall, though, either is appropriate. It is up to what you are comfortable with.

Catherine Winslow, MD
Indianapolis Facial Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Anesthesia Options for Rhinoplasty

+2

As a result of our own experience, training and philosophy, we all have our preferences when it comes to anesthesia for facial plastic surgery.

Most rhinoplasties today are performed under general anesthesia but this was not always the case.

Personally, I prefer IV sedation, because:

1. I feel that there is less bleeding during the procedure;

2. I feel that it is safer;

3. Patients experience a quicker recovery;

4. There is less nausea and vomiting.

You will certainly find plastic surgeons and anesthesiologists who will disagree with these notions based on their own experiences.

At the end, all involved need to be comfortable with the anesthetic choice: the patient, anesthesiologist and rhinoplasty surgeon!

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 28 reviews

Both are good choices

+2

Harley,

Both twilight sedation and general anesthesia can be a good choice for rhinoplasty surgery. The choice depends on your preferences as a patient, the amount of work that needs to be done, and the practices of the anesthesiologist. I use only board certified anesthesiologists for my patients in either case and leave the choice between them and the patient. Good luck!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 32 reviews

Type of Anesthesia for Rhinoplasty

+2

Etiher twilight or general anesthesia can be used for rhinoplasty surgery. Most importantly, is how comfortable and confident your anesthetist is with either form of anesthesia with rhinoplasty. I do almost all of my cosmetic surgery under a twilight IV sedation and/or epidural anesthesia. In the setting of a major rhinoplasty, I feel that you have better control of the airway with general anesthesia. Thus, for my rhinoplasties, we tend to prefer using general anesthesia for the safety of the airway.

Kent V. Hasen, MD
Naples Plastic Surgeon
5.0 out of 5 stars 32 reviews

Monitored anesthesia care preferred for Rhinoplasty

+1

Sedation occurs on a continuum, from mild sedation to general anesthesia-- where one is no longer breathing and requires a ventilator to assist the breathing. We prefer monitored anesthesia care where the patient is deeply sedated but still breathing on his/her own. A laryngeal mask airway is used to protect the airway. In this method, the surgeon is not competing for the airway and can focus on the rhinoplasty while being confident the patient's airway is protected as he/she is breathing on their own. While conscious sedation is a reasonable option preferred by some surgeons, we find monitored anesthesia care to provide the best combination of patient safety, comfort, and optimizing the surgeon's ability to concentrate on performing the rhinoplasty.

Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

General anesthesia is preferred and more comfortable for patients

+1

Rhinoplasty is always best performed under general anesthesia since there is control of a secure airway. With twilight sedation there is a high likelihood that you may remember having your nose broken, and you may be more apt to get into respiratory issues because of swallowing blood down the back of your throat when you are half awake or half asleep.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Either will work

+1

As some of the other physicians have pointed out, this is best to discuss with your surgeon and anesthesiologist. One of the challenges of rhinoplasty surgery is that you can get bleeding which will pool in the back of the throat. This can sometimes irritate the voice box and cause coughing or difficulty breathing. For this reason, in my experience, some type of airway protection is needed either with an endotracheal tube or an LMA.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 13 reviews

There is no one anesthesia technique for all seasons

+1

There are many factors that go into this decision making process and there is no right or wrong answer but many options depending on the situation. For example a simple rhinoplasty with no septal work can be performed under twilight. However, a reconstructive rhinoplasty with cartilage grafting from the ribs is usually performed under general anesthesia. Surgeon and anesthesiologist preferences and experience will alos play a role.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.