Twilight sleep for rhinoplasty - I'm terrified!

Question

I found the surgeon I wish to use for my rhinoplasty. The only problem I have is that he uses twilight sedation for his rhino procedures. I'm terrified and was hoping to be put out for this procedure. Should I look for a different surgeon or is this form of sedation nothing to be worried about? Even though they say I won't remember anything, does this mean I won't feel or experience the surgery?! I'm very anxious about this, though I have confidence in the surgeon and like his results. Help!!!

Eugene Kim, MD · Answer

Thanks for your
question.  The anesthesia that is used is
really dependent on the plastic surgeon. 
I prefer to perform rhinoplasty procedures under general anesthesia just
to make sure the patient is completely comfortable.  You will have to decide if you trust your
surgeon and are comfortable with having the procedure under twilight
anesthesia.  There is no contraindication
with using this method, but if there is any worry, you should really either
discuss it further with your surgeon or find another surgeon who you are more
comfortable with.  I hope this
helps.

Thomas J. Walker, MD, FACS · Answer

Although most surgeons perform rhinoplasty under general anesthesia for various reasons (including myself), there are surgeons who do an excellent job under conscious sedation (twilight anesthesia) only. This heavily depends on the surgical technique utilized, extent of surgery, and surgeon comfort. You should discuss this with your surgeon. However, I would not categorically exclude a surgeon based on the anesthesia administered. We all have the patient's comfort and safety in mind and you should not feel anything in either scenario. Best wishes!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  I perform rhinoplasty using general anesthesia with a board-certified MD anesthesiologist administering general anesthesia.  Particularly if you are having osteotomies performed, I personally believe general anesthesia is better.  However, I am sure there are many surgeons who do this procedure with twilight sedation and have great results.   The
most important aspect is to find a surgeon you are comfortable with.  It sounds like you have found that, so I recommend you stay with your surgeon.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Keith M. Blechman, MD · Answer

Every surgeon has their own comfort level and experience with different types of anesthesia for different procedures. Rhinoplasty in particular can be done under sedation or general anesthesia, and each method has its pros and cons. Ultimately, your surgeon is going to want you to be comfortable, and will choose a type of anesthesia that accomplishes that depending upon your specific situation. Most importantly, in order to get a qualified, expert opinion on your surgical and anesthetic options and expectations visit a plastic surgeon certified by the American Board of Plastic Surgery.

Best of luck,Keith M. Blechman, MDNew York, NY

Best of luck,Keith M. Blechman, MDNew York, NY

Sean Freeman, MD · Answer

star604, I've been doing nothing but facial surgery for over 25 years and can tell you that general anaesthesia is the best approach. Blood and other fluids run down the back of your throat during a rhinoplasty and can get into your airway and cause bronchospasm/vocal cord spasm and lead to airway concerns. Make sure your surgeon does "only faces" and has years of experience. Good luck and see video!

Stephen Weber MD, FACS · Answer

The safety of this approach depends not only on the surgeon but also the anesthesiologist. You need a highly experience team to perform twilight anesthesia safely for rhinoplasty. During my fellowship we performed every rhinoplasty under "twilight" and the cases went beautifully because the anesthesia staff and my mentor worked together well. In my own practice, I've tried this a dozen times in a dozen different facilities and the anesthesia is never as predictable as general anesthesia. The short answer is if you trust your surgeon and they operate in a fully accredited facility using MD anesthesiologist staff and this is their process, you're in good hands. If not or your gut tells you something is not right for you, keep looking.Stephen Weber MD, FACSLone Tree Facial Plastic Surgeon

William Portuese, MD · Answer

Twilight sedation anesthesia can mean many different things, but  since it is not a general anesthesia, so patients usually have some degree of conscious awareness of the procedure. It's also important to know WHO is performing the anesthesia. Placement of the injections in the nose and  the osteotomies can be painful during the procedure.. In our practice, we place all patients under a general anesthesia by board-certified physician anesthesiologist for patient safety and comfort. It's important to have a controlled airway to prevent blood going down into the lungs.

Steven Wallach, MD · Answer

I perform the majority of my rhinoplasties under general anesthesia. You should discuss this with your doctor and anesthesiologist.

Barry L. Eppley, MD, DMD · Answer

Comfort levels with surgeons depend on many factors. Knowing that you are going to have a non-terrifying surgical experience (won't know or remember anything) is an important concern to you. This you need to discuss with your surgeon and see if a general anesthetic can be done instead. While good experiences can be had with sedation in rhinoplasty you want the complete assurance that it will be an operative experience that is one you do not remember.

Reza Momeni, MD, FACS · Answer

Different surgeons will use different types of anesthesia for rhinoplasty, but all good surgeons have the safety and comfort of their patient in mind.   what you have not set is whether or not you discussed the concern with your surgeon and his staff to see what their experiences with patient's likely.  In our practice, we perform all manner of operations under sedation/twighlight, and in the hands of a good experience board-certified anesthesiologist,   twilight anesthesia is not only safe, but also less likely to cause complications such as nausea and vomiting.

Twilight sleep for rhinoplasty - I'm terrified!

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