Risks of epinephrine injections to the nose during rhinoplasty

Question

I’m considering rhinoplasty, however I’m concerned about potential risks associated with epinefrine injections. How dangerous are epinephrine injections to the nose during rhinoplasty? Is there a risk of injecting epinephrine to the blood vessel particularly one supplying the eye? What would be consequences to the vision considering epinephrine is a vasoconstrictor?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Lidocaine with epinephrine is a critical step in performing in Rhinoplasty as it is injected before the surgery begins in order to decrease bleeding during the surgery so your surgeon can visualize the structures better. I have personally performed thousands of rhinoplasties using epinephrine and never once had an issue with vision in the way you describe. 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

Best wishes and good luck.

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

Ronald J. Edelson, MD · Answer

Although I have heard of fat or other  fillers injected causing blindness I have never heard of epinephrine injected around the eye causing it

Eric M. Joseph, MD · Answer

Many times, while we are injecting the nose with lidocaine and epinephrine, our patients will experience a temporary elevation of their heart rates. If somebody has a personal history of heart disease or hypertension, medical clearance may be indicated before pursuing rhinoplasty surgery with general anesthesia. I hope this helps. Sincerely, Dr Joseph

Zoran Potparic, MD · Answer

Epinephrine has been part of local anesthetic compound for over 70-80 years. Its function is to provide vasoconstriction and increase visibility in surgical field. It is so diluted and given in such a limited quantity that it is considered absolutely safe when given in rhinoplasty. Hope this helps. Good luck.

Jeffrey H. Spiegel, MD · Answer

Injecting epinephrine (with anesthetic lidocaine) is a standard part of rhinoplasty.  There is very little concern for a problem. This is standard.  However, if you are worried about these details of surgery, perhaps surgery is not for you.  You will need to trust that your surgeon is safe and uses appropriate measures. This is done by reviewing her/his qualifications.

Brian L. Scott, MD · Answer

Epinephrine is injected alongside lidocaine in nearly every facial procedure, including rhinoplasty. Injecting epinephrine can slightly raise blood pressure, which is usually inconsequential but can also be easily treated by the anesthesia provider during the surgery. I would not worry about epinephrine injections for your rhinoplasty, they are very safe. I am not aware of any instance of vision complications from epinephrine injections during rhinoplasty.

Shabnam Ghazizadeh, MD · Answer

Excellent question! Epinephrine in small amounts is used in the local injection for every surgical procedure to decrease bleeding associated with surgery. While this can increase your heart rate depending on the amount used it does not have risks to vision specifically when used correctly. I recommend a consultation with a rhinoplasty specialist. Best of luck, Dr. Ghazizadeh

William Portuese, MD · Answer

Epinephrine mixed with lidocaine is essential to performing rhinoplasty procedure to control the bleeding during the procedure itself. Without it, you could have a significant hemorrhaging. In our practice we also perform rhinoplasty under general anesthesia so you do not feeling any effects of the epinephrine which is worn off by the time you wake up.

Williams Bukret, MD · Answer

Certainly, while complications such as temporary or permanent vision loss resulting from injections during rhinoplasty are rare, it's still vital for patients and healthcare providers to prioritize safety and awareness. Experienced surgeons typically employ precise techniques to minimize risks, and occurrences of such complications are indeed infrequent.

Patients can take reassurance in the fact that adverse events like vision loss are highly unlikely, especially when procedures are performed by qualified and experienced professionals. However, even with the low likelihood of complications, thorough preoperative discussions should occur between patients and surgeons, covering potential risks and ensuring informed decision-making.

Continuous vigilance during and after the procedure, along with prompt recognition and management of any complications, further enhance safety. By prioritizing safety and maintaining open communication, patients can approach rhinoplasty procedures with confidence in their healthcare team's ability to minimize risks and ensure optimal outcomes.

Kind regards,
Dr Bukret

Mats Hagstrom, MD (license on probation) · Answer

If you have chosen a provider, then I suggest you bring up your concerns to your Provider and have him or her Address your concerns.
If you haven’t selected a provider that I suggest having multiple in person consultations with plastic surgeons in your community who have extensive experience with rhinoplasty surgery.
We don’t inject epinephrine during the procedure.
We inject local anesthesia containing epinephrine.
This is no different than what dentists do every time they numb up patients which happens millions of times every year.
All surgery has risk. Those who are risk averse should maybe consider not having cosmetic surgery.
I suggest, focusing on the two most important variables which tends to be understanding your own candidacy for the procedure and provider selection.
Best,
Mats Hagstrom MD

Risks of epinephrine injections to the nose during rhinoplasty

Answers (10)

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