History of migraine with aura and rhinoplasty - should I be concerned about vision loss and can vasoconstrictors be avoided?

My understanding is that a throbbing headache of a migraine is due to vascular dilation, not vasoconstriction. It is true the champ Patience may wake up in the recovery room with a migraine, especially when they have a history of one. Are you sure you have vasospasm? If this is the case, your question should be best answered by your neurologist. I hope this helps. Sincerely, Dr. Joseph

I think it’s highly unlikely you’ll have temporary or permanent visual loss from having rhinoplasty surgery despite your history.
The use of local anesthetics injected for rhinoplasty surgery containing epinephrine tends to have very little systemic effect.
I suggest having multiple in person, consultations with plastic surgeons in your community at which point you can get an assessment and better understanding of treatment options.
That would also be the right time to bring up your medical history and see what each plastic surgeon has to say.
Best,
Mats Hagstrom, MD