In our practice, we prefer General anesthetic for Rhinoplasty Surgery.
You appear to have a wide nasal tip and nostrils. This can be refined with well-performed Rhinoplasty Surgery. You should consult several board-certified, experienced Rhinoplasty specialists with many photos before you proceed.
Although many prominent Rhinoplasty surgeons use local anesthetic with intravenous sedation for Rhinoplasty Surgery, we feel general anesthetic with an orotracheal tube is the safest way to protect your airway from aspiration of post-nasal blood. Even if you only require a tip-plasty, and no bridge work, you may require harvest of a cartilage graft from your septum to be used as a supporting colulellar-strut. This septal work inside your nose leads to post-nasal bleeding that could compromise your airway if you only have local anesthetic, and no breathing tube.
I hope this is helpful for you.
Various anesthesia options exist when performing a rhinoplasty.
It appears, based on your stated goals and attached images, that you may require either a general anesthetic (especially if osteotomies are to be considered), or twilight anesthesia- which is basically intravenous sedation.
I recommend to my patients considering this procedure typically a general anesthesia approach. This is primarily for patient comfort and stability.
As well as, better predictability for the surgeon in the performance of the procedure.
Best wishes with your upcoming plans.
Sergio Pasquale Maggi, MD, FACS
Austin Plastic Surgery Center
Local or General Anesthesia for Rhinoplasty (nose job) or septoplasty
Both forms of anesthesia are possible with well trained anesthesiologists. For tip work or other minor rhinoplasties we do local anesthesia only (meaning no sedation); otherwise we like general anesthesia. Be sure to speak with your surgeon about his/her preferences. I think the main issue here though is what you want to do to your nose and what's realistic. First you have to decide what you want and if you really want to do your nose; the rest of the issues are secondary.
Rhinoplasty under local anesthesia is not recommended
The anesthesia is very safe in today’s standards. It is important that you have your anesthesia administered by a board-certified physician anesthesiologist, not a nurse attempting to do conscious sedation. The nose is extremely difficult to get completely numbed up during a rhinoplasty and we have stopped performing any twilight anesthesia. Patients had recollection and memory of the procedure and it is not a good idea. It is also much safer to have a controlled airway in place so that when there is bleeding it does not get trapped into the trachea and below the vocal cords, which can be dangerous to the airway and can result in severe complications.
According to the picture shown you will need to have osteotomies performed on your nose since it is quite wide. Avoid fillers in the nose because of the disasters that have occurred with those. Taking the bump and the convexity off the bridge of the nose would enhance your profile and narrowing the nasal bridge would help as well. The depressed tip can be lifted up by surgically releasing the depressor septi muscle that causes the tip to droop when smiling.
Rhinoplasty can be done under local anesthesia
I regularly perform rhinoplasty under local anesthesia. To help patients we usually will give a mild sedative in pill form. The surgery takes 1 to 1 and a 1/2 hours. There is usually less bruising and no nausea with this technique. I suggest it to patients who think they can do it.
Be more nervous about the rhinoplasty than the anesthesia.
While fear of general anesthesia is common, it is largely unfounded. The greater fear--in all seriousness--should be the rhinoplasty itself! Getting a good result from surgery requires a lot of judgment, experience, training, and ability. Find a good rhinoplasty surgeon first, then discuss your concerns/fears about anesthesia with him/her.
Modern anesthesia in properly selected and examined patients is remarkably safe and comfortable compared to years ago. The patient is most comfortable this way and the surgeon can focus more on the work at hand rather than patient movement, airway protection, etc.
As for evaluating your nose, that really does require an in-office exam. A single frontal photo only shows so much.
All the best,
Rhinoplasty - General Anesthesia vs I.V. Sedation
Step number one is to see a nasal surgeon and point out your concerns. He/she will formulate a plan for you. Based only upon the photos you posted it appears you would need a reduction of the bridge of the nose and repositioning of the nasal bones with an infracture of the nasal bones. The tip may require some form of cartilage grafting as well. All of this could be done under sedation with local anesthesia if desired. My personal preference is general anesthesia but there are a number of patients who are fearful of general anesthesia. Although the anesthesia is a significant concern of yours, first make sure you're getting the right procedure by the best doctor you can find - then address the anesthesia issues. Best of Luck
Anesthesia selection in rhinoplasty
Find the right surgeon first and judge him/her by natural appearing results that are aestehtically balanced and pleasing with the other facial features of their patients.
Select them by their training, and hospital priviledges to perform this surgery.
If they only work in their office be a little circumspect. If you like their results (more important than their personality) than you both should select the most suitable anesthesia choice for you. I have done this operation under local, with sedation, and under general anesthesia. The approach and surgery are customized for each patient.
General anesthesia for rhinoplasty is preferred
Rhinoplasty can be performed under local anesthesia without complication. The real issue is whether this is the safest choice for anesthesia and whether your surgeon is compromising your result by minimizing the type of anesthesia. I generally prefer to perform the surgery under general anesthesia as I prefer to meticulously sculpt the nose during rhinoplasty.
Anesthesia for Rhinoplasty
During my training, I used local anesthesia with mild sedation. Over the past 35 years I've usually done the surgery with light general anesthesia because of improved anesthetic techniques. Either approach will provide a safe, pleasant experience. After your consultations you will be able to consider the changes which will be best for your nose.