Is it possible for me to get rhinoplasty with twilight/conscious sedation?

Question

I am interested in a Rhinoplasty procedure to address my concerns. Specifically, I have a noticeable dorsal hump and a drooping tip. While my primary focus is on addressing the dorsal hump, I am aware that both areas are interconnected. I have heard of surgeons performing this procedure with twilight/conscious sedation or a similar anesthesia option, as opposed to full general anesthesia. I would like to be offered the same option. Have you heard of Rhinoplasty being done this way?

Donald Groves, MD · Answer

Hello and thank you for your question. In short- every surgeon's practice is different. Regarding the anesthesia- although most surgeons prefer putting patients fully asleep under general anesthesia for this procedure, some perform it under IV sedation ("twilight sedation") with local anesthesia, or just under straight local sedation. Generally, most patients would not tolerate such an invasive procedure done under local, and most surgeons feel that it is easier to perform such involved and complex procedures with patients at least sedated if not fully asleep so they can assure the patient remains perfectly still to facilitate all the complex maneuvers and super precise work involved in properly doing a rhinoplasty well. My personal preference is similar to most- full general anesthesia to assure the most controlled environment and facilitate the best possible aesthetic results for such a complex procedure. Everything ultimately comes down to surgeon and patient preference, so always have the conversation with your surgeon so you both know exactly what to expect, and so you both feel comfortable with how the procedure will be performed prior to proceeding. I hope this helps! 
Best, 
Dr. Donald Groves 
Plastic Surgeon

Eric M. Joseph, MD · Answer

The reason we prefer general anesthesia is because people's noses are part of their Airways. Specifically, there is always blood that drips from the back of the nose into the throat during rhinoplasty surgery. General anesthetic enables a breathing tube with a balloon at the end of it to go into your windpipe and to prevent any blood from going into your lungs. If too much blood gets into someone's lungs during a rhinoplasty surgery, If excessive blood enters the airway during rhinoplasty surgery, a pneumonia may ensue. Thank you for your question! Sincerely, Dr Joseph

Zoran Potparic, MD · Answer

We occasionally do rhinoplasty on twilight or local anesthesia. This is possible for patient who needs small hump reduction and tip surgery, including lateral osteotomies. Whether you are a candidate for that type of anesthesia can be decided only on the basis of in person evaluation. Hope this helps.

Ronald J. Edelson, MD · Answer

Rhinoplasty can be done under sedation. Thirty or more years ago many surgeon were perfectly comfortable doing their rhinoplasties under sedation. Nowadays most prefer general anesthesia so you may find it more difficult to find a surgeon comfortable doing it with sedation only.

Steven M. Denenberg, MD · Answer

Most people think of "general anesthesia" as when they put the breathing tube down your throat and keep you asleep with the anesthetic gasses. I personally won't do a rhinoplasty like that, because the tube in the mouth interferes with judging what the nose looks like. So we use what I call IV sedation: the anesthetic medicines are put into the IV. But you're not conscious. You are out, and you sleep through the procedure. I don't think it's a good idea for the patient to be conscious, but the breathing tube is unnecessary.

William Portuese, MD · Answer

Twilight means you you will not have any recollection, so you're under a very deep intravenous sedation. Conscious sedation means you'll have conscious awareness of any type of surgery. Due to the fact there's lots of nerve endings in the nose, and it's very difficult to get the lidocaine injections performed comfortably, in addition to osteotomies placed in the nasal bones comfortably, it's usually best to perform this procedure under general anesthesia for patient safety, and comfort. It's very important to have a controlled airway since rhinoplasty and septoplasty are airway procedures.

Kenneth R. Francis, MD, FACS · Answer

Dear Loving,
The short answer is yes.  You can have rhinoplasty under sedation anesthesia.  Many surgeons offer this.  Good luck!

Is it possible for me to get rhinoplasty with twilight/conscious sedation?

Answers (7)

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