Rhinoplasty under local anaesthesia? (Photo)

I have a deviated septum and so my nostrils are different shapes, I like one side of my nose but detest the other. I was wondering if it is possible to change the shape of one nostril to match the other and make my septum appear to be in the middle of the nose under local anaesthetic? I like my nose in general so it should just be my tip that gets fixed and shouldn't be that invasive.

Doctor Answers 20


Your septal deviation is the reason for your asymmetry of your nostrils. Fixing the deviation should result in more symmetric nostrils. However this is something that I would really rarely consider doing under local anesthesia. It's a very tender part of your face. And your limited in the dissection because manipulation the septum reguardless of how much local anesthesia used will still hurt.  General anesthesia will allow your surgeon to truly fix this problem Betted.
I hope this helps.  Good luck!

Princeton Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

That's a definite "maybe." :-)

If a deviated caudal end to the septum is the ONLY thing wrong with the nose, then it can be corrected under local anesthesia only. I've done such cases and continue to on a case by case basis. This sort of problem can also be done using an endonasal approach (all incisions INSIDE the nose).

However, if there are deviations further back that need to be addressed, it is much better for that to be done under general anesthesia such as at an outpatient surgery center, primarily for reasons of comfort and control of blood and secretions.

All the best,

--David C. Pearson, M.D.
Pearson Facial Plastic Surgery®

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Rhinoplasty under local anesthesia

Yes, you can have rhinoplasty under local anesthesia. In your case the septal deviation is caudal and easily accessible. It can be done with local anesthesia. There are certain pre-requisites though; you have to be healthy without medical problems and not a very anxious person. Watch the video below and see for yourself. 

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 89 reviews

I have performed several septorhinoplasties under local anesthesia

It is definitely possible to perform septoplasty and/or rhinoplasty under local anesthesia. I have done several. In each case, I ask the patient to agree to have an intravenous line in place, and to give permission to allow the anesthesia provider monitor their safety and to use mild sedation only if necessary to complete the surgery with the best outcome I can provide.

So far, every patient has been able to complete the surgery without the sedation intravenously. Even in my normal practice, I rarely use general– only intravenous sedation.

As an aside, I find sometimes people seeking surgery under local anesthesia are doing so mostly as a cost containment effort. I do not discount for rhinoplasty under local with anesthesia standby. Why?

The cost of doing the procedure is the same as when doing it under anesthesia, and the surgical skill level required to perform nasal surgery on an awake patient under local is actually much higher than when treating a patient under general anesthesia.

To date, my patients who have agreed to the treatment plan above and proceeded with local anesthesia alone have been quite satisfied!

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 168 reviews

Rhinoplasty under local anaesthesia?

Sounds like the chosen surgeon is ONLY operating upon the visible deviation of the caudal edge of the cartilaginous septum that is visible in photos. Does not sound like a full septaloplasty operation. Which would be difficult to preform under straight local anesthesia. If I am correct than local anesthesia should be fine... 

Rhinoplasty under local?

While you might want just a conservative rhinoplasty, I would not recommend that it be done under just local. IV sedation or general anesthetic an be done very safely by qualified docs and it will allow your surgeon to concentrate on the surgery and not on you as you become figitiy. 

Local anesthesia is feasible, but it's sooooo... nice to have a little IV sedation.

Local anesthesia is feasible, but it's sooooo... nice to have a little IV sedation. Being a patient undergoing surgery is tough. GIve yourself a little break. It will alos be easier for the surgeon to concentrate on the surgery if you're asleep. Ev en just a little asleep.

G. Gregory Gallico, III, MD, FACS

G. Gregory Gallico III, MD
Boston Plastic Surgeon
3.2 out of 5 stars 7 reviews


Nostrils are always a bit asymmetric.  As for the deviated septum, that can be treated as well. Best of luck with your decision to move forward.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Rhinoplasty is a serious operation

Thanks for your question bumblebee,

One of the traps in rhinoplasty is thinking that trying to make a small change to your nose makes for an easier operation. In many cases the exact opposite is true!!!! Trying to produce a minor change is often the most challenging rhinoplasty because there are so many forces at play: a patient's tissues, scaring, the quality of the skin as well as the patients expectations, which are often higher than when someone has a major problem such as a big bump.

Rhinoplasty is a very delicate operation and to get the best results takes time, patience and finesse. The last thing you want is for your rhinoplasty surgeon to be rushing because you are uncomfortable or agitated on the table under local anaesthetic.

The majority of contemporary rhinoplasty surgeons use an open approach to rhinoplasty. As such every rhinoplasty is equally invasive i.e. there is no minimally invasive rhinoplasty they are all pretty much the same.

I know having something done under local anaesthetic sounds like a safer option or less invasive, but again the very opposite may be true. There are significant risks involved in any operation but a rhinoplasty in particular involves the airways and so having an anaesthetist present who can protect your airway will allow your surgeon to focus on what he or she must focus on which is getting the best result for your nose. 

I hope you find that information helpful

Kind regards,

Richard Bloom

Rhinoplasty under local.

On exam you have a marked septal deviation with the septal cartilage which is the partition between the right and left breathing portions of the nose is obviously off the perpendicular plate of the ethmoid bone. The plastic surgeons who trained me did all of their rhinoplasties under local anesthesia without an anesthesiologist. The invention of pulse oximeters which measures your oxygen level, revealed that these patients were sometimes experiencing very low oxygen levels. Now, the world is watching. Joan Rivers had a rare low oxygen level when her airway wasn't guarded according to the tabloids. I think that local anesthesia although very possible puts the patient at an increased risk.  When you are manipulating very vascular structures like the bones, and having to pack the airways, most surgicenters do not allow straight local anesthesia except for minor tip revisions.Safety first. Young people have the rest of their lives, and with good anesthesiologists I think the fear of anesthesia is very overrated.

Alan B. Pillersdorf, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.