Twilight Sedation Vs General Anesthesia for Rhinoplasty?

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!

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.

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.