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.