Twilight sleep for rhinoplasty - I'm terrified!

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!!!

Doctor Answers 12

Nose and anaesthesia

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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!

Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews


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Dear star604, I would check with your surgeon and see if you are having your procedure performed in a fully accredited operating facility. Sometimes surgeons who use twilight anesthesia only and do not offer general anesthesia as an option do so because they can not use general anesthesia due to their facility not being accredited. I personally would not perform a rhinoplasty under twilight anesthesia and always require general anesthesia with a board certified anesthesiologist in order to provide comfort and safety to the patient. My anesthesiologist uses very short acting medications and no gas allowing the patient complete comfort, a protected airway, and the ability to wake up feeling alert and well.  Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Twighlight Sleep for Rhinoplasty

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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. 

Eugene Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 67 reviews

Twilight sleep for rhinoplasty - I'm terrified!

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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

Twilight sedation anesthesia

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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.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Consisous sedation versus general anesthesia in rhinoplasty

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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!

Thomas J. Walker, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Anesthesia and rhinoplasty

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

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews


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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.

Anesthesia for rhinoplasty

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 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.


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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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 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.