Many surgeons, including myself, perform minor revisions under local anesthesia with or without an anti-anxiety medication such as Valium. If being awake sounds like it's not doable for you, though, general anesthesia is still an option. Different surgeons will take different approaches to your revision, so I recommend consulting with several doctors to fully understand your options. Best of luck to you.
Anesthesia and revision
It looks like you may need more than a little rasping which I prefer to do under anesthesia. Not just local.
Timing for revision rhinoplasty
Based on your photos you may need more then just rasping of the nasal bump. Correction of dorsum irregularities may require secondary osteotomies, dorsum shaping, nasal tip grafts, etc. It is impossible to give you good idea about extent of revision surgery without detailed clinical exam. Type of anesthesia should be selected based on the extent of correction.
However, despite the fact that you may like to do this ASAP you should give yourself at least 1 year before undergoing revision surgery. You should voice your concerns when talking with your surgeon and make a plan of revision that will address multiple aspects. Possibly a second opinion consult should be considered. Good luck.
Nasal surgery can be done under local anesthesia
Yes, it is possible to do this opeartion under local anesthesia. However in a nervous patient general anesthesia can be used. Discuss your all options with your surgeon and decide between two of you.
Nasal irregularities after Rhinoplasty
The bump on the nose after rhinoplasty could be caused from incomplete removal, callous formation, organized fluid or scar tissue. It is common to do the removal using local anesthesia, especially if an oral sedative is added pre-operatively. It is safer and certainly less expensive than general anesthesia. The flat spot can be corrected during the same procedure with a cartilage graft if necessary. Fillers, non-surgically are better at replacing volume loss than correcting raised bony or cartilage projections after surgery. Discuss your options with your surgeon and choose the best option for you.
John Standefer MD
Revision rhinoplasty candidate
The photographs demonstrated much more than just a small little bump on the bridge. There is still residual convexity to the entire dorsum, a droopy tip, in addition to 2 flat spots and dorsal hump. The nasal bones are also excessively wide, and shaving down the dorsal hump will most likely result in an open roof deformity. In our practice, it's important to wait closer to one year and address all the issues simultaneously under brief general anesthesia. Osteotomies of the nasal bones will most likely be required, which cannot be performed under local anesthesia.
Rasping Nasal Bump Under Local Anesthesia
The irregular fullness of your bridge can be removed using a rasp as long as the patient is comfortable having this done while awake. You can take pre-op medication by mouth for relaxation if desired.
Having some irregularities after the bridge of the nose has been modified does occasional occur. This can be from surgeon error, bone shifting scarring or callous formation. Yours should be corrected with a simple revision. Filing the dorsum (bridge) can be simple done in the office under local. Identifying the full extent of the bump and the flat area can be difficult after the local anesthesia injections, so make sure your surgeon is comfortable with this and does detailed markings pre-injection. Best wishes.
Revision nose surgery
Small irregularities, especially in patients with thin nasal skin, can happen after surgery. Removing these areas or going back to surgery is an option, but injectable fillers can be used to correct small irregularities without surgery. See a surgeon who not only does rhinoplasty but has experience with injectable fillers to see about getting your issue corrected non-surgically.
You will get different answers from different surgeons. This is because these issues are handled differently. My suggestion would be to wait a few more months and go back to surgery. For less significant revisions I would consider treatment under local anesthesia.