Is piezoeletric rhinoplasty the right option for me & can I have it under local anesthesia? (Photos)

Question

I have deviated septum, (right nostril 80% clogged). I was recommend a piezoelectric septorhinoplasty by one of the surgeons here on this site. Since I am terrified of general anesthesia, is it possible to get a piezoelectic rhinoplasty under local anesthesia, since I would need an osteotomy. Also, I have a mild facial assymetry, could orthodontics fix that as?

Eric M. Joseph, MD · Answer

Since your nose is part of your airway, we believe it's safest to intubate somebody so that there is a balloon to prevent blood and mucus from getting into your lungs during surgery. Some doctors perform septoplasty with intravenous sedation, however, I don't believe it will be feasible with purely local anesthetic. The only other comment I would makers that you appear to have a nice nose. If you are not eagerly looking to change the appearance of your nose, don't do a rhinoplasty. Hope this helps! Sincerely, Dr. Joseph

Ruslan Zhuravsky, DO · Answer

Hi, The piezo is a tool that can be used to cut bone during the surgery. It is somewhat of a misnomer to call the entire rhinoplasty a piezo-rhinoplasty, because it is not the tool that is giving the results. The key to good results is knowing how and where to make the bone cuts, and how to manipulate the cartilage in order to achieve the desired results. It's also important to keep in mind that cartilage makes up approximately 2/3rds of the nose and is the vast bulk of work in most rhinoplasty. As far as using the piezo awake, I would recommend against. I do majority of my rhinoplasties awake with true local anesthesia, very likely more than anyone else. I even do very difficult revisions in this way, but I am concerned about the large amount of water irrigation that is required for the piezo. Although true awake / local rhinoplasty patients are able to protect their airway, this large amount of water would make it very uncomfortable and somewhat risky. In the end, my top advice for you is to choose a surgeon based on their ability to give you good results, not because of a tool or technique that they use. Learn about rhinoplasty and go to several consultations to compare surgeons and their advice. Good luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a Rhinoplasty. Maneuvers for your surgery could include tip refinement, dorsal hump reduction, slight Nasal Tip elevation, nasal tip deprojection, among other maneuvers. For the safest and best results that should be done under general anesthesia.  Piezo or no piezo is much less relevant compared to a true evaluation of your surgeon’s website gallery.  Here is some general advice when selecting a surgeon:  I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results.  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

William Portuese, MD · Answer

When undergoing a septoplasty and a rhinoplasty, it's very important to have a controlled airway, therefore general anesthesia is required. PiezoElectric is only way to cut the nasal bones, and doesn't really offer any advantages. It is Very important to study the before and after photo gallery of your rhinoplasty specialist for results that you like.

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Is piezoeletric rhinoplasty the right option for me & can I have it under local anesthesia? (Photos)

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