Can my nose be safely deprojected under local anesthesia?

Question

Hello, I had a rhinoplasty done in Dec 2023. I’m now 11 months post op but my bridge is not straight like I wanted. The tip has a bump (button) because of its projection. My surgeon offered to deproject my nose in office under local. Is that safe?

Andrew Miller, MD · Answer

Based on your photos, you are a good candidate for revision rhinoplasty with tip deprojection. This can be fairly complex and is much better done under general anesthesia. The only thing we would do under a local is to shave down a small bony bump if one forms after primary rhinoplasty. I would see a few rhinoplasty specialists about this before rushing into anything.

Steven M. Denenberg, MD · Answer

Frankly, I have never understood the idea of doing a "touch-up" procedure under local only in the office. After a rhinoplasty, there is a layer of scar tissue covering everything inside the nose, and it's quite complicated to even get under the skin to take a look and see what needs to be done. Even just shaving down more of a bump can become a nightmare if done under "local" only, without preparing for a complete, formal revision rhinoplasty.
De-projecting a tip, even in a primary operation, is a complex undertaking in my universe, and I can't imagine what the surgeon would do that would a) be effective, b) would be possible under local in the office, and c) wouldn't get you in more trouble and make a definitive effective predictable de-projection later a much bigger problem.
Just my two cents, but it's a pretty clear two cents. And further, any operation on the nose should only be undertaken if the chances of success are very very high. If your surgeon tries, and does nothing, and it fails to deproject your tip, it's not the case that you're back where you were and you've lost nothing. Rather, there's more scar tissue, more damage to the cartilages, and it's harder to get a real result later in a third operation.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you will benefit from a revision with nasal tip deprojection. This should definitely not be performed under local anesthesia. That is not a good idea in my opinion. This is a very complex maneuver when done the right way. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

Trying to perform a rhinoplasty under local anesthesia is a very bad idea. There's lots of nerve endings in the nose, and it'll be very difficult for you to tolerate the injections to make the nose numb in order to do the entire surgery. It would also be best to post a full set of facial photographs from all angles, since it appears from your photographs that you may have an overly projecting nose, and an under projecting chin. If you indeed have an under projecting chin, strongly consider placement of a chin and implant at the same time you're performing a revision rhinoplasty. Placement of a chin implant can accomplish projecting the chin more than a rhinoplasty can with de-projecting the nose. Both of these procedures performed together should be done under general anesthesia monitored by a physician anesthesiologist or a nurse anesthetist.

Can my nose be safely deprojected under local anesthesia?

Answers (4)

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