Tip plasty with local only. Is this reasonable?

Question

I want to get a tip plasty to fix a wide tip that is slightly crooked. I had a rhinoplasty before and then a revision while I was awake, but it was closed. I was fully awake without any meds and did fine. However, I am going to a different doctor because it is still crooked! He wants to do a open one and said its fine with me awake. However he will give me Valium, norco and Benadryl to prevent itching. Is this reasonable?? I avoid iv meds at all cost.

Thomas Romo, III, MD · Answer

You have already had two rhinoplasty's and you now want a third. This is a high risk procedure due to your prior surgeries. The next operating surgeon has to explore the nose at the time of surgery. Make determinations on what has to be done,eg.remove or add cartilage or bone, harvest grafts to do this from the septum or ear and at the same time prevent you from moving because you'r under local anesthesia. Be sure you and your surgeon understand your ultimate goals and that they can be obtained while you are under local anesthesia.

Paul M. Parker, MD, FACS · Answer

A crooked nose can be caused by a number of things and a challenging problem to correct, particularly since this is your third rhinoplasty. Not something to be taken lightly! While anything is possible, I would think you are safest having the procedure performed under general anesthesia with an endotracheal tube to protect your airway. This would allow your surgeon to completely evaluate your nose and hopefully give you the best result possible.

Afshin Parhiscar, MD · Answer

Dear jjklopjgfIn my experience, if your tip is still deviated after two rhinoplasties, there is a high likelihood of missed etiology for your deviation. This often includes caudal septal deformity, alar base asymmetry, ...  These cases often require exposing the entire cartilage framework and reshaping it with cartilage grafts and repositioning structures. I would find it unwise to take short cuts in your third rhinoplasty. Look for an experienced surgeon who will do the right procedure, the right way and avoid a fourth rhinoplasty. Look for a surgeon, certified by by the American Board of Plastic surgery who is an expereicned rhinoplasty surgeon.

William Portuese, MD · Answer

In our practice, we perform all rhinoplasty procedures under general anesthesia by a board-certified physician anesthesiologist for patient safety and comfort. A revision rhinoplasty for a crooked nose may require osteotomies in the nasal bones, cartilage harvesting and cartilage grafting techniques to straighten the nose. All this cannot be performed under local anesthesia comfortably. Trying to perform a rhinoplasty under local anesthesia is a bad idea

Richard W. Fleming, MD (retired) · Answer

In general I have my anesthesiologist present during nasal surgery so the pt is comfortable regardless of the level of anesthesia necessary. Having said that , over the last 35 years I've done many nasal procedures such as a tip-plasty under local anesthesia.

Tip plasty with local only. Is this reasonable?

Answers (5)

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