Bulbous Nose Tip Correction in Local Anesthesia?

There are various methods of anesthesia used in rhinoplasty and cosmetic surgery. These include general anesthesia, IV sedation, local / topical anesthesia. Different surgeons prefer different types of anesthesia depending on the what needs to be done surgically, but the number one priority during surgery (other than obtaining a good cosmetic result) is the patient's safety.
Discuss your concernes about anesthesia with your surgeon. Then, make your decision about which doctor to go with based on their skill as a rhinoplasty surgeon, not what type of anesthesia would be used.

It is generally best to have your rhinoplasty done under general anesthesia for several reasons.
1. Even though you plan on only having your tip done, it is often necessary to adjust some other part of your nose to keep the entire nose in balance. If only local is being used, then the surgeon will be very limited in what he/she can do to give you a superior result.
2. Most people find it extremely uncomfortable and unpleasant to have any procedure done on their face. When the surgeon is working on your nose, even if it is on your tip, they will need to lean a little on your cheek with their hands. Also, their hands will be hovering over your eyes. They will have a scalpel blade and needles in front of your eyes. Also, there will inevitably be some bleeding. Overall, this is an exceedingly unpleasant experience. In the middle of the procedure, you will probably wish you had decided to have general anesthesia.
For these above reasons, I think local anesthesia is not sufficient. I think the very least anyone should have is local plus IV (intravenous) sedation. This will put you much more at ease and make everything much easier to tolerate. However, I find general anesthesia is best.

Local anesthesia can be administered by itself or in combination with oral or intravenous sedation.
Depending on your surgeon as well as your tolerance level for injections, the tip rhinoplasty can be performed under local anesthesia.
Discuss your desires with your surgeon.

The bulbousness of the tip can be corrected under local anesthesia, but it is difficult to get the entire nasal tip numb. In our office it is usually done under general anesthesia as it is very safe and comfortable for the patients. It is possible to have a tip plasty done under a local anesthesia, but the nose will have to be numbed up completely, which can be quite painful.