Can my nose be safely deprojected under local anesthesia?

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.

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.

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