When a patient flinches while under twilight deep sedation during rhinoplasty, do they feel pain? Why or why not?

During a rhinoplasty with twilight and deep sedation anesthesia, when a patient flinches, Does that mean that they feel pain? If not, why would the patient flinch during surgery?

Doctor Answers 4

Rhinoplasty and anesthesia

I prefer to perform rhinoplasty under general. But there are those who like moderate sedation.  Many different medications can be used to minimize patient discomfort or recall of the procedure.


New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Anesthesia for a rhinoplasty

In our practice, we do not recommend twilight anesthesia for a rhinoplasty due to the fact that it is very difficult to get the nose numb with lidocaine injections, patients will have some recollection of the nose being broken, and the airway must be controlled when deeply sedated, otherwise blood can enter into the lungs. In our practice we perform all rhinoplasty procedures under a light general anesthetic with an LMA breathing tube in place to control the airway for patient safety and comfort. Patients will have no conscious awareness of the surgical procedure and osteotomies when their nasal bones are broken during the rhinoplasty procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Rhinoplasty

Hello and thank you for your question. I perform rhinoplasty under general anesthesia administered by a board-certified doctor anesthesiologist (not a nurse) who is providing one-on-one care throughout the case.  It is very important to discuss with your surgeon who is providing your anesthesia and what their qualifications are.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

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 80 reviews

Does flinching under sedation mean pain?

The answer is "probably not". Just as when you are asleep you can move and shift, the same happens under deep sedation. 
The best practices use a BIS brain monitor to directly measure brain activity during sedation, confirming the patient is sedated appropriately to avoid any sensation of pain.

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