Possible to do a rhinoplasty under local anesthesia? (photo)

Question

Hi, i was wondering if it is possible to do a rhinoplasty under local anesthesia for the type of nose i have. I dont want to go under general anesthesia as the thought of it just scares me .

Jeffrey Lisiecki, MD · Answer

It is possible to do rhinoplasty under local anesthesia with sedation, but it's not optimal and not my personal preference. General anesthesia allows you to be more comfortable and positioned in the best way to get the operation done effectively, and ensures that your airway is protected throughout the procedure. If you are medically healthy to begin with, it is extremely safe. If would be helpful to discuss your concerns about general anesthesia with your surgeon and/or anesthesiologist.

Brian M. Harmych, MD, FACS · Answer

Thank you for your question. The short answer is "probably not". Most rhinoplasty operations require at least IV sedation, with the majority being done under general anesthesia. It is normal to be concerned, or apprehensive, about general anesthesia and considering the risks of anesthesia are part of the process of weighing the risks and benefits of the procedure. If your concerns about general anesthesia, or even  IV sedation, is higher than your anticipated benefit from the rhinoplasty, you might consider not having a rhinoplasty.  Keep in mind, every patient must weigh the risks and benefits of rhinoplasty and decide for themselves if the benefits are worth the risks. I hope this is helpful information. Best wishes! Dr. Harmych

Ronald J. Edelson, MD · Answer

Rhinoplasty can be done under local anesthesia with sedation. I’ve done these in the past but only do them under general anesthesia. I’m sure you can find someone to do it under sedation but make sure that surgeon is experienced   in rhinoplasty and does good work.

Robert Ciardullo, MD · Answer

Can a rhinoplasty be performed under local anesthesia? The simple answer to the question is yes. In fact in the past it usually was done under local anesthesia with some sedation. However most surgeons have evolved towards general anesthesia. It is a much more comfortable and civilized way of performing the procedure. In many cases general anesthesia is also safer than local anesthesia with sedation. If someone has straight local anesthesia and no sedation, It should be safe because the fully awake patient can cough and swallow blood and saliva that will drip down the back of the throat. However sedation may dull the gag reflexes and heavy sedation may completely dull them. This is the most dangerous way to perform surgery since the bleeding and saliva excretions may be aspirated which could be a serious problem , even fatal in rare cases. With general anesthesia there is control of the airway and a means of preventing aspiration. So the safest ways are general anesthesia and straight local. Very light sedation in many cases is probably OK but heavy sedation is the most dangerous and ironically more dangerous than general anesthesia. It would also be a very unpleasant experience for most patients unless they were having very limited work such as a limited tip plasty, or nostril tuck which are more amenable to local anesthesia then bridge work involving the bones.

William Portuese, MD · Answer

Since there are lots of nerve endings in the nose it would be nearly impossible for you to tolerate the injections alone to get the nose numb. Shaving down the bony dorsal hump and making cuts in the nasal bones called osteotomies are going to be required for your nose. It would be nearly impossible to get you completely numb during the procedure itself and you'll have conscious awareness. You simply will not be able tolerate that under local anesthesia. In our practice, we use board certified physician anesthesiologists for patient safety and comfort. It's also important have a breathing tube in to protect your airway and preventing blood down into the back of your throat and lungs

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
Although rhinoplasty can technically be performed under local anesthesia, we do not recommend it as you must remain motionless on an operating table for 1 1/2 hours listening to operating room banter and the sounds of a "chisel" breaking through bone. In addition, there may be some intraoperative internal nasal bleeding which may result in respiratory difficulties if aspirated. 
Administration of a general anesthetic is safer and leads to better outcomes. The risk of death from an auto accident is 1/107 during a lifetime. The risk of death following rhinoplasty is less than 1/10,000. I am not afraid of driving!
Best wishes...

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