Any nose can be reduced under local anesthesia, but in my opinion and in my operating room and based on years of experience, twilight anesthesia is the most prudent choice. I have board-certified anesthesiologists who work in concert with me to get the best and most precise result. Often, people are afraid of anesthesia without truly understanding it. Anesthesia has evolved enormously, and patients wake up quickly and seamlessly since medications are now given through an IV line as compared to the gasses that caused nausea, vomiting, and disorientation in the past. Anesthesia allows for the most precision because it guarantees that the patient will not move. Imagine, for example, if in the midst of a surgery, a patient sneezed while under only local anesthesia! While I am operating, all aspects of a patient are monitored: breathing, blood-pressure, temperature, heart rate etc. Although it is more costly to have a fully staffed operating room with board-certified anesthesiologists, in my opinion it is absolutely safer for the patient and ensures the conditions for a superior aesthetic outcome.