Can Tip Reduction Be Performed Under Local Anesthesia?

I had my nasal bone rasped about 1 month ago and thought this would solve my issues with my nose; however, I'm realizing now that I need to get my tip reduced to better fit my face. I've read that tip reduction can be performed under local anesthesia, is this true? I have slightly asymmetrical cartilage on the lower part of my nose, would this by a problem? I've posted pictures to help illustrate. Looking at the pictures would you be able to tell me how involved it would be to reduce my tip?

Doctor Answers 13

Tip Reduction

As long as you mean local anesthesia with sedation in the OR, my answer is yes. I would be comfortable with reduction of your tip.

Gainesville Plastic Surgeon
4.9 out of 5 stars 24 reviews

I would only perform a tip-plasty under general anesthesia

Although technically a tip-plasty could be performed under a local anesthetic I personally would not agree to do so. I find the performance of virtually any aspect of nasal cosmetic surgery under any anesthesia but general anesthesia to be highly problematic. This is due to the common occurrence of blood inevitably running down the back of the patients throat causing them to involuntarily cough and therefore move their head. Rhinoplasty and specifically tip-plasty is extremely delicate surgery and any sudden unsuspected head bob by the patient can be disastrous. In addition, sometimes tip-plasty requires a cartilage graft for the best result. Oftentimes this cartilage graft is harvested from the nasal septum via a septoplasty technique.  Setoplasty is extremely difficult to perform under anything but general anesthesia. The surgeon should always be prepared to utilize this technique on a moment notice. If the operation is not being performed under a general anesthetic setoplasty may not be possible and the result compromised.


David A. Ross, MD (retired)
Chicago Plastic Surgeon
4.6 out of 5 stars 89 reviews

Can Tip Reduction be Performed under local Anaesthesia

The straight answer is yes, any facial cosmetic procedure can be performed under local anesthesia. However, it's not recommended or wise. A little sedation, such as 5mg of Versed, makes a  big difference.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 274 reviews

Nasal tip reduction

Your lateral photographs show very nice tip anatomy.  The frontal view shows a little extra width at the tip, but this may come down over the next several months as scar matures and the soft tissue settle down.

If you are left with a tip that is still too wide after 6-8 months a revision my be indicated.  I don't see how this can properly be performed under local anesthesia.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 46 reviews

Can Tip Reduction Be Performed Under Local Anesthesia?

Yes it can be done. But based on your posted photos you need to allow the rhinoplasty surgeon you used to do a complete corrected operation. If you are directing the operation by first having a rasping than now wanting a tip plasty. YOU NEED a combination under local/sedation at best. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Tip rhinoplasty under local anesthesia

I would personally not perform a tip rhinoplasty under straight local anesthesia.  The tip is the most difficult portion of a rhinoplasty and you do not want your surgeon to be limited in what he or she can do because you might be experiencing pain or become anxious.  Best to consult with a board certified plastic surgeon, tell them what your concerns are and let them suggest the best approach to address them.

Jeffrey E. Kyllo, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 12 reviews

Can my tip be thinned under local?

 Technically yes, your nasal tip could be thinned under local but I'm not sure you'd want that done.  I have performed Rhinoplasty and tip plasty for over 20 years and the injections used in local anesthesia are a bit uncomfortable plus the incisions, on the inside of the nose, can and do create bleeding that might go down your throat, while you're lying down, making you choke and be further uncomfortable.

 What you're talking about is still classified as a Revision Rhinoplasty, so you should wait at least 6 months after your previous Rhinoplasty, have a general anesthesia for your own safety and comfort and consider narrowing the upper (bone) and mid (cartilage) sections of your nose as well as rotating up and thinning of the nasal tip.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Revision rhinoplasty for the wide nose with asymmetrical tip.

Revision rhinoplasty for the wide nose with asymmetrical tip can be done to give a better looking nose. You should see an experienced revision rhinoplasty surgeon who does natural noses.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Too Much Rhinoplasty is never good

Conservative rhinoplasties are always better tha overly aggressive rhinoplasties.

You don't need to have your tip-plasty.

If you did need it, it could be done under local anesthesia with sedation or general anesthesia.  

Just local anesthesia without sedation will be very uncomfortable and NOT RECOMMENDED by me.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Can tip reduction be performed under local anesthesia

local with sedation tip modification can be done. do not recommend it under straight local. I would advise however that it seems you are trying to micromanage your surgery. That never comes out well. Pick a good surgeon, one where you like his or her results, and let them do the surgery. If you change only one part of a nose, other parts do not work with other parts that are not touched. An experienced surgeon will advise you of that and avoid revisions after revisions.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.