Rhinoplasty under local anesthesia or general anesthesia? I have a phobia of being awake during surgery .

Hello and thank you for your question about rhinoplasty and anesthesia. We identify three key factors in the selection of what type of anesthesia to have while undergoing rhinoplasty — comfort, cost and safety. Of these three factors, safety is the most important. General anesthesia, if administered by a qualified and competent professional, will not pose more substantial risks than local anesthesia. Further, general anesthesia will reduce other risks an individual might face during any surgery. In addition, general anesthesia will provide you with greater comfort. Unless cost strictly prohibits you from having general anesthesia, you should strongly consider having general anesthesia for your surgery. Discuss this issue with your board-certified facial plastic surgeon and get his or her opinion during an in-person consultation. Good luck! 
- Jacqueline T. Cheng, MD

It really depends on the extent of surgery.  In my opinion, a well-executed and thorough rhinoplasty that  will maintain its shape over time and address any airway issues is best performed under general anesthesia.  This is because many airway issues are in the posterior portion of the nasal airway.  In addition, cartilage from the septum is typically removed from the posterior portion of the airway.  This cartilage is often necessary as graft material to provide long-term stability to the cosmetic enhancement of the nose.  Manipulation in the posterior airway can be painful and difficult to anesthetize with local anesthesia.  In addition, fluid drainage into the back of the nose during surgery can trickle down the back of the throat and lead to coughing during surgery, or potentially aspiration of fluid.  This is typically not an issue when a breathing tube is in place with general anesthesia.  This is an issue of safety as well as an issue of you remaining still and not moving during surgery.  Rhinoplasty is a surgery of millimeters, and must be done in a very well-controlled environment with an emphasis on patient safety.  Minor changes can certainly be made under local anesthesia, but if more significant surgery is planned, I typically use general anesthesia.     

The quality of the surgery should not matter, whether you have local or general. With a competent anesthesiologist, there is virtually no health risk. The nose is very sensitive.  Numbing with local may be very uncomfortable. If no bony work needs to be done, local would be adequate. It would be less expensive with local than with general.