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 

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.

  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.