I want to be awake for my revision rhinoplasty and I'm wondering how much I can change if its a closed rhinoplasty? (photo)

You can certainly have your rhinoplasty performed while you are awake, but it will be quite uncomfortable to get you completely numbed up.  In terms of a closed rhinoplasty being able to accomplish your goals, I think we would need to see some more photographs or evaluate you in person.  We would be happy to see you at the University for a free consultation if you'd like.  Just call the number listed on Realself if you'd like to schedule.Good luck! 

I have done one rhinoplasty under local anesthesia..... in Guatemala on a medical mission.  I can't say it was a pleasant experience for either of us, although the outcome was good.  In the US, especially in our AAAASF certified operating suite, you should know that it is very safe to have surgery with sedation.  This is meant for your safety, comfort and to produce the best possible final outcome.  While nothing is 100% safe, you are much more at risk of being harmed driving to my office the morning of surgery than of having something go wrong in the operating room.  So, in a first world country with modern medicine, I don't see any benefit to having surgery on the nose with local only.    When it comes to open vs closed, the majority of our noses are closed.  You can access the tip, the bridge.... everything with a closed approach.  However, if there is significant scar tissue as you can get with a revision, we will sometimes need to convert to an open approach.  I do what will give you the best result, quickest recovery and most predictable outcome.  This is especially true with a revision.  

Performing a rhinoplasty under local anesthesia is a very bad idea.  The nose has an enormous amount of nerve endings  and it is impossible to get the nose completely numb for  bone and cartilage manipulation during the procedure. Patient's simply cannot tolerate a rhinoplasty under local anesthesia. For patient's safety and comfort, we place patient's under  general anesthesia by a board-certified physician anesthesiologist  in a certified and licensed out patient surgery center.

I occassionaly have patients ask me if they can be awake for a rhinoplasty and my answer is always.....sure, but not in my practice. That's very old school, very uncomfortable and general with an anesthesiologist in attendance on a healthy patient is no more risky than local with heavy sedation.