Awake during open rhinoplasty (cartilage/tip only)?

6 years ago I had rhinoplasty, but I'm not satisfied with the tip of my nose. I went for a revision consultation today, and the surgeon told me that he could probably perform the surgery in his office, in about an hour, if I were willing to do it awake under local anesthesia only. I trust my doctor but the idea of being fully awake nauseates me. Is it as simple as he is making it sound?

Doctor Answers 6

Revision under local anesthesia

Injecting the nose is terribly painful. When I was young man, I personally had a revision of my tip, done under local anesthesia. 
I would never do that again.
Get an excellent anesthesiologist in the OR. Its worth it.


Great Neck Plastic Surgeon
5.0 out of 5 stars 6 reviews

Anesthesia for rhinoplasty

Anesthesia for rhinoplasty varies by surgeon preference.  Some surgeons prefer a general anesthetic whereas others will do rhinoplasty under twilight anesthesia/ conscious sedation/ local anesthesia.  If you're feeling anxious about your surgeon's plan, discuss your concerns with him/ her and ask whether a pre-surgery sedative can be considered.  Relaxing medicines before the procedure might work quite well for you.  

Inessa Fishman, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Awake during open rhinoplasty (cartilage/tip only)?

Hello desertrose99,
Thanks for your question.
I perform both primary and revision tip rhinoplasty in my office several times a year.
We are able to make the patient comfortable with Valium, topical anesthesia cream, and long-lasting local anesthesia injections.  
The hardest part are the injections, but they are over fairly quickly.
We allow patients to use their own headphones and listen music to distract themselves during the procedure.
They all do very well and frankly are happier that they avoided the cost and downsides of general anesthesia.
If you can tolerate local anesthesia and do well with getting numb, then you'll do fine with your surgeon's plan.
Good luck,
Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 47 reviews

Awake During Open Revision Rhinoplasty

Without more details it is difficult to answer your question. Very minor revisions can be done using local anesthesia but most time it is safer and more comfortable to do revisions with sedation or some level of light general anesthesia. You are going to have surgery which can be done in the office as long as there is a licensed accredited operating room available.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Revision rhinoplasty under general anesthesia

 Revision rhinoplasty is probably the hardest procedure to perform correctly in the entire field of cosmetic surgery, so it's important to choose your surgeon very wisely based on extensive experience. Rhinoplasty is also a surgical procedures performed in operating room, not in a clinic setting. In our practice we perform all rhinoplasty procedures under general anesthesia by a board-certified physician anesthesiologist for patient safety and comfort. Trying to perform a rhinoplasty under local anesthesia is a bad idea since it would be very painful

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Uncomfortable being awake for nasal tip surgery

Revision rhinoplasty can be a more difficult procedure.  The surgeon many times does not know fully what to expect and occasionally requires additional cartilage from the nose or ears to revise.

This procedure can be performed using sedation, Propofol, anesthesia or general anesthesia.  On occasion, if the surgeon is comfortable, under local.  I rarely use local alone.

Without your pictures and without knowing the exact procedure I cannot fully assess.  If you trust your doctor, bring these issues to him on your per-operative visit.

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 10 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.