Insertion of graft to the dorsum/bridge in local anesthesia?

Question

Is it possible to enhance the bridge (height, width, symmetry) in local anesthesia? Is only synthetic graft material usable for local anesthesia or can you also use tissue in local anesthesia? Unsure how to remove in local. If synthetic was used, does it hold for a life time?

Mark G. Albert, MD, FACS · Answer

Hello,
Thank you for your question. This could be done under local anesthesia using the closed / scarless approach. I would not advise placing any synthetics in the nose. I wish you all the best.
Mark G. Albert, M.D., F.A.C.S.New York, NY and Boston, MA

Ajaya Kashyap, MD · Answer

Thanks for your question. It is possible to do many aspects or all of an augmentation rhinoplasty under local anesthesia. A cartilage from the ear or septum can be used for the procedure and can be obtained using local anesthesia. I, however,  always use general anesthesia for obtaining a rib cartilage graft when more augmentation is needed. The choice of anesthesia is upto you and your surgeon, and you should have a detailed discussion with your surgeon regarding the pros and cons of local versus general anesthesia and also his preference before deciding on the procedure. All the best !

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! It is possible to do certain things under local anesthesia only. Bridge work can be tricky because of how far away it is from the entry site within the nostril. The reason many surgeons prefer some form of anesthesia beyond local is for patient comfort and to ensure that the goals can be accomplished. Small grafts can be placed if targeted in approach. Synthetic implants, though I don't use them, would likely be hard to perform under local - especially if a large implant. Synthetics should last for a lifetime though the risk of extrusion and infection can be an issue. Hope that helps.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
Without photos, I cannot specifically evaluate your nose. However, I do not recommend a total rhinoplasty with grafting under local anesthesia, due to potential intraoperative airway problems and limits of patient tolerance during the procedure. Natural tissues fare better than synthetic substitutes which are prone to infection and extrusion....but again, more local anesthetic is required to numb the donor site(s) to obtain fascia, cartilage, or bone from elsewhere. 
The limitations placed on anesthetic choice may affect the quality of the outcome.
Visit a board certified plastic surgeon for evaluation and discussion.
Best wishes...

Insertion of graft to the dorsum/bridge in local anesthesia?

Answers (4)

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