Could rhinoplasty be done under local anesthesia?

In our practice, the majority of our surgical procedures are performed under local anesthesia with moderate sedation.  Patients who have severe and uncontrolled reflux are intubated to protect their lungs.  Local anesthesia with moderate sedation has been found beneficial for patients as they recover from the sedation quickly with less nausea than general anesthesia.  However, our anesthesia team is highly experienced in this type of sedation, which is most important for your safety and comfort.  If you would like to have a rhinoplasty under local anesthesia, I highly recommend you find a surgeon with a routine anesthesia team experienced in working with these conditions.

I do not recommend rhinoplasty surgery with tip revision to be done under local anesthesia. General anesthesia is preferred as it allows the surgeon to gain better access to the anatomical structures while not focusing on issues of patient comfort, etc.  In addition, with general anesthesia, the patients vital signs can be monitored closely in a controlled setting of an operating room with qualified anesthesia providers.

It would be important, though, to have *some* sedation to relax you: you don't want to be lying there on the table completely awake for the duration of the operation! Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
Finally, I usually make computer morphs when I'm answering questions like this, to show the changes that are possible for a nose with a rhinoplasty, but the one tiny photo you posted isn't adequate for making morphs. At the *very* bottom of the "Learn more" page is a link to instructions on taking and sending photos that are comprehensive and useful for an online consultation like this, in case you'd like a more complete evaluation.

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty.  Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose.  For the best results and safety, I recommend general anesthesia administered by a board-certified MD anesthesiologist.  Make
sure you specifically look at before and after pictures of real patients
who have had this surgery performed by your surgeon and not just a computer
animation system. 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. FACS
Harvard-trained plastic surgeon

Hello,
Thanks for your question. Yes, a tip rhinoplasty can be performed under local anesthesia. That is the most common way I perform isolated tip surgery in my practice. We use oral sedation with Valium, topical anesthesia, and local anesthesia to make a patient comfortable enough to tolerate surgery. It makes tip surgery quite affordable and safe. I would recommend that you consult with a rhinoplasty specialist for more information.
Good luck,
Dr. Shah

Yes rhinoplasty surgery can be performed under local anesthesia and sedation. While the surgery is not technically difficult, the artistic component is quite challenging and therefore it is important for you to be comfortable and for your surgeon to be comfortable. For this reason, most rhinoplasties are performed under light general anesthesia, which is very safe when patients are healthy. 

Thank you for your question Miss.Tina. I can often do small procedures on the nose under local anesthesia, but I would not recommend doing any extensive surgery with anything other than general anesthesia. It can be very uncomfortable especially doing bony or aggressive cartilage and soft tissue work under local since you feel pulling, tugging, and vibrations of the equipment that local anesthesia does not target. I also don't like conscious sedation for what you would need as well because there is a risk of aspirating blood into your windpipe during the procedure. Being completely asleep will reduce operative time and keep your airway completely safe.
Best of luck to you!
Sarah Saxon, MD

Yes, absolutely ....I have been doing rhinoplasty with local anesthesia and twilight sedation for 40 years ....[.Haven't done one under general anesthesia in 25 years] ---avoids all the problems of coming out of general anesthesia ... .works just fine in the right hands of both surgeon and anesthesiologist---it takes a little more time and patience on the part of the surgeon --
Armand Simone, MD  FACS
Board Certified Plastic Surgeon,  New York, NY

  Trying to perform rhinoplasty under local anesthesia is a  very bad idea, since its very painful in order to try to get the nose numbed up and a break the nasal bones.  In our practice,  all rhinoplasty procedures are performed  under general anesthesia monitored by a physician anesthesiologist for patient safety and comfort.  The majority of patients must undergo a full rhinoplasty, not just the tip plasty to ensure that all the components of the nose are balanced with themselves, and the new nose balances with your facial features

I will do a limited tip rhinoplasty under local anesthesia.  However I do encourage patients to consider light sedation by my anesthesiologist so the anxious patient is relaxed during the procedure.