How hard is it to find doctors that perform rhinoplasty under local anesthesia? (Photos)

Hello and thank you for your question.

Your question about anesthesia is important. In my experience, the safest way to perform a rhinoplasty, whether it is a full rhinoplasty, a tip rhinoplasty, or some other nasal surgery to address a fracture for example, is to do so with a board-certified anesthesiologist utilizing an endotracheal tube (ETT) to fully protect your airway and reduce the risk of aspiration. If your doctor recommends against general anesthesia for medical reasons, my best advice would be for him/her to communicate with your prospective (board certified) plastic surgeon and anesthesiologist to create a formal surgical plan -- please recognize that one of the options may be to not undergo surgery at all. Always remember that plastic surgery is elective and not urgent. Everyone who undergoes elective surgery must be risk stratified (or cleared) by their primary care physician (or any other necessary specialists) prior to surgery. I like to think of general anesthesia as a marathon -- you have to be fit/healthy and prepared for your marathon. "Going under" puts you at risk for medical complications, especially if you have any baseline medical issues.

As far as the surgical details of your case, it is my experience that a bump from nasal trauma cannot just be simply removed -- "shaving" the bump per se can lead to flattening of your nasal bridge, aka an "open roof defect". This would require osteotomies and other maneuvers to address, all components of a formal rhinoplasty. If it's any consolation, if you have a displaced fracture, which it may appear that you do from your photographs, insurance can cover this and reduce the price of your surgery☝️

The next step for you is to find the right aesthetic plastic surgeon. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome. After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck and please let me know if I can help.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon in Boston and Miami

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. This should be done with general anesthesia for the safest and best results. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Local rhinoplasty can be done but it involves excellent anesthesia by the surgeon and patients with low anxiety. The hardest part is when the bones are broken with chisel (osteotome). It can be accomplished with the surgeon and doctor working as a team.
Regards
Dr. Janjua