Twilight Sedation Vs General Anesthesia for Septo-rhinoplasty?

Like many areas of medicine, anesthesia has come a long way in recent years. Better and safer drugs and more advanced monitoring technology have really made general anesthesia a much safer and more comfortable approach for patients.
I perform all rhinoplasties and septoplasties under general anesthesia for these reasons. I can be assured that the patient's breathing is adequate, that they're comfortable, and that they won't move unexpectedly.
Besides that, the bleeding during nasal surgery tends to run into the throat. Under sedation, the patient can 1) choke on it, 2) swallow it, which is nauseating, or 3) spit it into the surgical field (and onto me!)...which is also not ideal :-)
I would bet that my anesthesia colleagues would agree with me on all of the above, too.
Hope this helps,
--DCP

A twilight anesthesia can be much more dangerous due to the patient slipping into an unconscious state and not being able to breathe on their own with an unprotected airway. Under general anesthesia, the airway is completely protected from collapsing upon itself when sedated too deeply, along with being protected from the actual blood and secretions itself. It is also important to have a board-certified physician anesthesiologist present, during the surgery.
In addition, at the time of the rhinoplasty, when the nasal bones get broken and reset, this is not something you want to have twilight anesthesia for, or be sedated for, since the patient will have recollection and memory of the procedure.
Twilight anesthesia is usually given with narcotics and valium to relax patients, which is given through an intravenous line, while general anesthesia is started with the I.V. and then converted over to the anesthetic gases while the patients are asleep.

The question of whether to use general anesthesia or sedation is common and not only with rhinoplasty but multiple other types of surgeries. What it boils down to is what type of anesthesia the physician is most comfortable with and additionally what types of anesthesia the physician may or may not be licensed to provide. You should check into the certification of the facility where the surgery is going to be performed. Many surgeons like myself to have a fully accredited operating room and will more often use a general anesthesia. Physicians who work in their office may not have full accreditation and use sedation because this is their only option without going to do the surgery at the hospital, which can be expensive for you and for the doctor. The thing to remember is that general anesthesia is implemented by a second person: a nurse anesthetist or anesthesiologist. This requires the plastic surgeon to pay another provider. If the surgeon is providing the anesthesia himself, which is usually sedation, there is no need for a third party to be involved.
Many older surgeons prefer to use conscious sedation as that is how they were trained and they are extraordinarily comfortable and well educated in how to manage patients under twilight anesthesia. If your surgeon is one of these physicians and feels that here she can adequately provide you with a good anesthesia experience and a good clinical outcome, then this is likely a great way to go. Otherwise my recommendation would be to have general anesthesia for an operation such as this. In this case is the physician can concentrate on your rhinoplasty rather than the anesthesia itself which is delegated to a nurse or physician who provides the services and only services on a regular basis.