I have considered a surgeon but he only uses twilight sedation. Is Twilight Anesthesia Safe for Rhinoplasty?

I have considered a surgeon but he only uses twilight sedation. I heard negative stories about this type of anesthesia. I am having a complete rhinoplasty done (nasal bone osteotomy, possible nostril reduction, removal of the hump on the nose, etc). I am a person with a bit of anxiety issues. Is this type of anesthesia okay? Do you hear or wake up or are conscious while the surgery is going on? Thank you for your information.

Doctor Answers 20

Board certified anesthesiologist is what's important in Rhinoplasty.

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You want to have a board certified anesthesiologist who has done a lot of rhinoplasties together with your surgeon. That way, each knows how the other works, and things go smoothly. You also want to be done in an accredited operating room and accredited recovery room.

Those are the important things. In the right hands, both twilight anesthesia and general anesthesia are safe for rhinoplasty.

Manhattan Plastic Surgeon

Sedation versus general anesthesia for rhinoplasty.

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Given improvements in general anesthetics and anesthesia monitoring techniques in recent years, most surgeons (I believe)--myself included--prefer general anesthesia versus sedation. Patients, too, enjoy being unaware of the surgery itself.

My biggest concerns with sedation anesthesia for rhinoplasty are the following:

  • airway protection: with sedation, patients are breathing without the support of the anesthesia machine. If they're too "deep" inadequate respiration is possible.
  • movement: patients tend to move around under sedation if they are too "light" or if they get restless.
  • focus: I like to focus on the surgery and not be distracted by patient comfort (under general, they are unconscious and thus have no discomfort)
  • swallowing blood and secretions: nasal surgery can be at least a little bloody. Under sedation, patients are swallowing these secretions, which can be uncomfortable or nauseating.

Hope this helps,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Twilight anesthesia for rhinoplasty.

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 I do the majority of my rhinoplasties under general anesthesia, whether intubation or LMA. Most of my patients are somewhat anxious and prefer being totally asleep. How safe twilight anesthesia is depends on how good the anesthetist is.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

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Twilight sedation anesthesia for rhinoplasty

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Twilight sedation or general anesthesia are both options for rhinoplasty. Both, under experienced hands, provide acceptable anesthesia to complete a rhinoplasty safely. My only suggestion is that if you are having twilight sedation, that the surgeon is not also the anesthetist. A separate anesthesiologist or nurse anesthetist allows the surgeon to focus only on your surgery, while letting someone else focus on keeping you sedated/asleep and comfortable.

If you do have anxiety issues, you should be frank with your surgeon. Most surgeons understand that there are variations in all of us that may require a different course of treatment in some patients.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon

Twilight anesthesia for most rhinoplasty is safe

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For most rhinoplasty surgeries twilight anesthesia is safe as long as your surgeon and anesthesiologist are comfortable with this approach.

Although I did use this technique in the past I now use general inhalation anesthesia for my rhinoplasties. I find it is beneficial for the more difficult, prolonged revision cases, which are a large percentage of my rhinoplasty practice.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Twilight Anesthesia not as safe as General Anesthesia

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The reason for the above is that the patient's airway is not as protected with twilight as it is with general anesthesia. There are different stages of anesthesia. In the lighter stages breathing continues as normal but the patient is still semiconscious and involuntary movements can make the operation more difficult for the surgeon. A moving target is more difficult to hit than a still target for most people. Also, at this point the patient is still able to talk although he/she may not remember it but an occasional patient may remember hearing the docotor talking to him/her and hearing the "bang, bang, bang" when the bones are broken.

As the anesthesia gets deeper the movements and talking will stop along with the memory but the respirations start becoming depressed and more shallow. This is the level that is usually best for the patient and doctor because at this level the blood oxygen is still at an adquate level. However, if too much mediation is given the respirations get weaker and can even cease. If this should happen and there is an endotracheal tube is in place, as is the case with general anesthesia, this situation can be easily reversed by breathing for the patient and giving more oxygen thought the endotracheal tube. But if there is no tube in place, as with twilight anesthesia, this becomes an emengency situation and oxygen must be passed to the lungs immediately with a portable oxygen bag or an endotracheal must be inserted.

As you can tell I am not an avocate of twilight anesthesia because of my experiences,and the experiences of others, with it in the past. Fortunately, the worse case senerio that I mentioned above doesn't happen often but it has happened. One other safety factor I forgot to mention was that when there is an endotracheal tube in place and inflated it prevents blood from running down the back of thenose into the throat and into the lungs which can also cause problems.

Hope this is helpful.

Jack P. Gunter, MD (retired)
Dallas Plastic Surgeon

Twilight anesthesia is safe for rhinoplasty

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I would completely agree with the other physicians who indicated that twilight anesthesia for rhinoplasty is safe, but I do prefer some type of airway protection with either an endotracheal tube or at least an LMA. The type of medication then used to keep the patient asleep can be the exact same as with 'twilight anesthesia,' so that recovery and after-effects are minimized.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Twilight anesthesia works for rhinoplasty

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Twilight anesthesia is safe. It is used for all types of plastic surgery procedures. You may have some awareness but you will not remember anything.

Personally for rhinoplasty, I prefer to perform it under general anesthesia. It is allows me to help control bleeding (if it occurs) more efficiently. The patient is completely sleep and won't make sudden movements while the surgery is performed.

Speak with your surgeon about his/her experience and then trust your gut.

Good luck,


I prefer general anesthetic for Rhinoplasty Surgery.

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Since your nose is part of your airway, I prefer to protect it with an endotracheal tube during Rhinoplasty Surgery. I have never performed Rhinoplasty with "twilight" sedation since operative bleeding will invariably end up in your throat and this may cause coughing.

This is my personal preference, and I know that many prominent Rhinoplasty surgeons prefer IV sedation.

The good Dr. Persky still has me laughing out loud with his title that includes: "Tap tap tap". This is the exact verbage I use to guide my nurse through the process of nasal-bone osteotomies.

I've attached a link to my Rhinoplasty photos for your perusal.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Rhinoplasty Anesthesia

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Your surgeon should try and tailor your Rhinoplasty anesthesia to your case and your personality. In the hands of a competent anesthesiologist / anesthetist both twilight (IV sedation) and general anesthesia are equally safe. That being said, if you are anxious you probably should have general anesthesia to spare you the sounds of the surgery.

Dr P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.