Doctors that perform rhinoplasty with twilight sedation or local anesthesia?

Ok so I want rhinoplasty and have wanted it forever.. I am terrified by the thought of general anesthesia. I booked a rhinoplasty once before and the doctor actually cancelled due to family related issues and I was a little relieved... but I'm just unhappy because I want to do it so bad if anyone knows a doctor that does it and how much is too much work on the nose to have twilight sedation or local because my nose isn't terrible but I have a bump and a bulbous tip.

Doctor Answers 10

Rhinoplasty under general anesthesia

  A Rhinoplasty procedure involves placement of injections in the entire nose to make the nose  numb prior to bone and cartilage work.  The nasal bones need to be broken after  the bony and cartilaginous dorsal hump is removed.  Patient's simply cannot tolerate the amount of pain  involved with the injections along with the cartilage and bone work being performed.  Trying to perform a rhinoplasty under local anesthesia is a very bad idea.  In our practice, we perform all rhinoplasty procedures under general anesthesia by a board certified physician anesthesiologist for patient safety and comfort.  The procedure is also performed  in a licensed and certified outpatient surgery center, not in the clinic or doctor's office.  Controlling patient's airway is also critically important when performing a rhinoplasty procedure, since there can be bleeding going down the back of the throat.


Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

What is the best way to perform a rhinoplasty.

This is a very good question, but in my opinion the type and depth of anesthesia is so less of a problem than the skill of the surgeon as well as what the suggestions for surgical maneuvers for the improvement in the overall shape should be!  I perform all of my complete rhinoplasties in an outpatient setting under general anesthesia.  It is always necessary to have a very complete discussion with your surgeon as a patient and feel that your desires and hopes are fully listened to by the surgeon.  Once a plan has been  formulated by the surgeon,  I would hope that a proper choice for technique as well as the choice for anesthesia should be left to the proper judgement  of the surgeon.  I trust my Anesthesiologist to keep you stable and healthy through the surgery, just as you should trust your Plastic Surgeon to to perform the best surgery that can be performed.


Good luck to you.


Frank Rieger M.D.  Tampa Plastic Surgeon

Rhinoplasty with Twilight Sedation

Years ago I was on a committee set up by the California State Legislature and the California Medical Association to draw up standards for private outpatient surgery centers. We defined general anesthesia as any technique that took away a patient's life preserving reflexes. Therefore the twilight sedation that is used in rhinoplasty surgery is actually a form of general anesthesia. Surgeons and anesthesia providers can debate all day about which is safer but that will depend on many factors such as the procedure, the length of the operation, and the health of the patient. I strongly suggest you consult with an experienced rhinoplasty specialist, picking the surgeon not the technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Nasal Surgery under sedation

Great question. It is very important.

When we have a fear (terrified) that is potentially against what is in our best interest, we call it a pathological fear.

The greatest risk from nasal surgery under twilight sedation is even a small amount of blood dripping back down on the vocal cords causing spasm or coughing, followed by a vicious life-threatening downward spiral of events.

A general anesthetic with a tube protects you from such a potential disaster. Personally, I would never have nasal surgery for myself or a member of my family under "twilight" IV sedation. The risk may be small but huge to the people who fall into the percentage. Safety first.  

I suggest that you speak with a board certified anesthesiologist, with no ax to grind, about what is the safest option.

Good luck

Richard Sadove, MD
Gainesville Plastic Surgeon
4.8 out of 5 stars 20 reviews

Doctors that perform rhinoplasty with twilight sedation or local anesthesia?

I am not an advocate of twilight anesthesia for Rhinoplasty. Safety is the first priority. Next is- comfort for the patient. Both of these are- required in order for th eDoctor to perform his surgery and get the best result. If you are uncomfortable during the procedure- you will then be converted to General Anesthesia 

Doctors that perform rhinoplasty with twilight sedation or local anesthesia?

Sounds like you are a nervous, anxious patient therefor I would ONLY recited local + general anesthesia combination fir your rhinoplasty. Why would you want to hear the cutting and bones breaking?

Rhinoplasty under sedation

I perform almost all of my rhinoplasties under sedation. See the video to learn why I prefer it over general!

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 171 reviews

Doctors that perform rhinoplasty with twilight sedation or local anesthesia?

Thank you for your question.  Many plastic surgeons are willing to do rhinoplasty under local anesthesia with sedation.  I recommend that you recall the offices of board-certified plastic surgeons in your area and ask if the plastic surgeons to rhinoplasty under local anesthesia.

General anesthesia is not required for a rhinoplasty.

I use twilight sedation for 99% of my rhinoplasties, like the rhinoplasty pictured in the short video above. Pleasant recovery. 

I usually make a morph when I'm answering questions like this, to show the changes that are possible for your nose with a rhinoplasty, but you didn't post any photos. See the "Web reference" link, just below my post. At the *very* bottom of that page is a link to instructions on taking photos that are most useful for online consultations like this.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

General anesthesia with rhinoplasty

Dear destinylpine, You will want to have a rhinoplasty under the safest type of sedation for your surgery and that is a general anesthesia. I have performed rhinoplasty for thirty years with multiple cases every week in my private fully accredited surgical center with an anesthesiologist and I have never had any complications related to anesthesia in this time and the likelihood of a problem is rare. I would speak with the anesthesiologist and have a better understanding of what medications are used and the safety of the procedure to ensure that you are comfortable with a decision. In my  opinion rhinoplasty under twilight sedation is not comfortable for the patient or safe due to the inability to protect the patients airway. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 199 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.