In our practice we do not recommend IV sedation for rhinoplasty. Patients will have conscious awareness of the procedure including breaking the nasal bones as you've described. For patient safety and comfort we recommend general anesthesia. Its of paramount importance to make sure patients have a protected airway so the blood does not accumulate around the vocal cords. please see the link below to our closed rhinoplasty photo gallery where all patients underwent general anesthesia
I have to agree with the first three posts on this subject: I prefer intubation with a heavier degree of sedation for Rhinoplasty. Although IV sedation is usually preferable for elective facial cosmetic procedures, airway protection in the event of bleeding during Rhinoplasty is paramount.
I perform almost all rhinoplasties under general anesthesia to avoid pain and movement during this delicate surgery.
Find a board certified plastic surgeon who performs hundreds
of rhinoplasties and rhinoplasty revisions each year. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results.
Kenneth Hughes, MD
Los Angeles, CA
While I perform many facial cosmetic procedures under IV sedation, general anesthesia is favorable for complete rhinoplasties, for the reasons you describe. However, if your procedure only involves correction of tip abnormalities, we can sometimes do this under IV sedation anesthesia. Speak to your consulting surgeon regarding these concerns.
Over the past 25 years my approach to Rhinoplasty anesthesia has changed dramatically. As both my skills and experience have grow to now having done more than 3000 rhinoplasties; I have been doing all my rhinoplasty work with oral sedation ( Valium, Ambien) and local Xylocaine injecions for the past 4 years. I have no desire to add any anesthesia risk to this relatively easy proceedure which done with oral sedation and local injections has almost zero risk associated with it. My level of confidence, speed and ability to produce the result a patient is looking for, painlessly and safely, is the reason for my change. Patients who are not comfortable with this approach are referred elsewhere. I have had the need to refer very few patients as most opt for the lessened risk and ease of this approach. I have also had no post-operative complaints about how the anesthesia was done. And just as you would expect I have had no anesthesia related complications. With this method there is also much less bleeding, less post-operative nausea, and a more rapid overall recovery.
I personally prefer to perform rhinoplasty using general anesthesia, however some physicians do prefer sedation for their surgeries. It is really a surgeon's preference and having a good anesthesiologist can give sedation that is just about equivalent to general anesthesia. The whole idea with sedation is that they should give you enough medication to make you comfortable (anesthesia) and also medication to make you forget what happened during surgery (amnesia).
I prefer to perform rhinoplasty with general anesthesia for the same reasons mentioned most importantly airway protection. With that said, I have seen many rhinoplasties done under IV sedation and local anesthesia and this can be done comfortably for patients depending on the depth of the anesthesia and the ability of the surgeon to numb your nose with local injections.
There should be no pain under proper IV sedation, however, I would not advise rhinoplasty under IV sedation. I like to protect the airway with general endotracheal intubation. There is always the possibility of bleeding in a rhinoplasty, while it almost never happens, there are large vessels that can release a large amount of blood quickly before they are controlled. this poses no safety risk if the airway is protected, but if it isnt it can lead to aspiration and a host of complications. I am a big advocate of limiting depth of anaesthesia and using local for many surgeries, but I strongly recommend airway protection with rhinoplasty. I hope this helps!
All the best,
Rina A. Maercks M.D.