Rhinoplasty 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.

Rhinoplasty can dramatically impact the appearance of the nose.  When this procedure is performed with local anesthesia alone the response varies from patient to patient.  Unfortunately, we frequently see patients who have significant pain and discomfort during the injection process when local anesthesia is used alone.
            For this reason, many surgeons supplement local anesthesia with I.V. sedation or general anesthesia to minimize pain and discomfort during the procedure.  When utilizing this approach the procedure is more comfortable and there’s less break through pain for the patient.

            It’s important to realize that all surgical procedures and anesthesia techniques have risks.  This is true whether local anesthesia, I.V. sedation or general anesthesia are utilized.

            The vast majority of rhinoplasty surgeons prefer general anesthesia when performing this procedure.  They realize that when this approach is utilized patients seem to have a better overall experience.  Exceptions do exist, and for this reason it’s important to thoroughly discuss anesthesia with your surgeon before proceeding.

            If you’re considering rhinoplasty surgery it’s important to consult a board certified plastic surgeon.  This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals. 

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, FACSAustin Plastic Surgery Center

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.

Local anesthesia may initially sound like a good idea for Rhinoplasty, but it's not necessarily the safest, nor the easiest circumstance for you or for the surgeon. As other posters have noted, anesthetic techniques are very safe in healthy patients. I routinely use General Anesthesia for Rhinoplasty (usually with LMA).
As far as evaluating for your nose, I would recommend a consultation with a local Rhinoplasty surgeon; your picture is not adequate to give any meaningful advice. New York City has many qualified surgeons who match this description.

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,
--DCP

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.

I have used primarily general anesthesia for more than 30 years without any problem. However, if a patient wants the nose done under local anesthesia with sedation, that can be done as well. As to what desires you have regarding the look of the nose, you should discuss this with several surgeons who are experienced and go with the one whose noses you like the best.

The nose is a very sensitive region of the face. Although local only anesthesia is feasible, it is a very unpleasant experience for both the patient and the doctor. Even giving the numbing injection can be too much for most patients. At a minimum I would suggest local with sedation (twilight anesthesia). As opposed to full general anesthesia, patients tend to have less nausea afterwards and recover a little quicker (1 hour versus 2 hours for general). Other than that, there is no real benefit. If you have significant anxiety about the procedure then you should really consider full general in order to ensure that you will be comfortable.
With regards to your nose, it is hard to tell from a single picture. Overall, you have a long and thin face, which would balance well with a thinner nose throughout. Although your nose should be shortened a little bit by lifting the tip, it should not be overdone, as it would be out of balance with the rest of your face. Narrowing of the tip can be done at the same time as lifting it.
Personally, I would not recommend fillers to build up the bridge. These products are temporary and will have to be re-injected, depending on the filler used, in 1-2 years. Although patients are often afraid of getting the bone work done, they realize afterwards that it was not a big deal. If you have a bump on your profile (which it does not appear that you do) bone work is often mandatory to avoid creating a space between the bones that can produce visible lines. At the time of rhinoplasty, cartilage from your septum can be used to add height to the bridge.
Even without bone work, it is not uncommon to have swelling and bruising. Having bone work to narrow the bridge only makes it a little more bruised and swollen in the first 3-5 days, adding maybe 2-5 additional days of healing. In my opinion, this is well worth a result that will last a lifetime.
Best of Luck!

I initially trained by doing rhinoplasty under sedation (drowsy) and did so for over 15 years. Anesthesia drugs and monitoring has improved to the point where light general anesthesia is safer and with just as fast a recovery as sedation. The drugs used are actually the same with just a teeny bit more given so you don't feel (or remember) a soft device called and LMA that sits on top of your voicebox. Patients really don't want to hear us working on their noses. If you ask any anesthesiologist, LMA anesthesia is safer than sedation.
As for what procedure is best for you? It is helpful to see other views in addition to the front. A personal consultation with a rhinoplasty expert will help determine what is best for you and what needs to be done to the bridge of your nose in addition to treating the tip.