Why do some surgeons only offer general anesthesia for rhinoplasty & what are the advantages of each method? (Photos)

Question

In my research, I've seen that while certain surgeons provide the choice of IV sedation during rhinoplasty as well as general anesthesia, other surgeons only offer general anesthesia. I am curious as to why this is the case? Personally, I am inclined towards IV sedation as my preferred option to address my dorsal hump (and I guess my drooping tip). Would this be possible for me and could you shed some light on whether one option holds advantages over the other?

Steven M. Denenberg, MD · Answer

If by "general anesthesia" you mean gas anesthesia with a breathing tube down your throat, I can't stand that for a rhinoplasty and just about won't do one under general. About a million times during a rhinoplasty, I'll close the patient's mouth so I can see what the nose looks like with the face in a natural position. If there is a tube sticking out of the mouth, those judgment calls are impossible, and it gets in my way of a good result. There are lots of places inside the nose that must be numb, though, and if the surgeon isn't 100% sure she can get all those areas numb, she must have general anesthesia. General anesthesia, though, is considered safe, however.

But you shouldn't select a surgeon based on his anesthesia preference. There are few true experts in rhinoplasty out there. Select a surgeon based on how well he can give you a good result. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Donald Groves, MD · Answer

Hello and thank you for your question. In short- every surgeon's practice is different. Regarding the anesthesia- although most surgeons prefer putting patients fully asleep under general anesthesia for this procedure, some perform it under IV sedation ("twilight sedation") with local anesthesia, or just under straight local sedation. Generally, most patients would not tolerate such an invasive procedure done under local, and most surgeons feel that it is easier to perform such involved and complex procedures with patients at least sedated if not fully asleep so they can assure the patient remains perfectly still to facilitate all the complex maneuvers and super precise work involved in properly doing a rhinoplasty well. 
My personal preference is similar to most- full general anesthesia to assure the most controlled environment to facilitate the best possible aesthetic results for such a complex procedure. Everything ultimately comes down to surgeon and patient preference, so always have the conversation with your surgeon so you both know exactly what to expect, and so you both feel comfortable with how the procedure will be performed prior to proceeding. I hope this helps! 
Best, 
Dr. Donald Groves 
Plastic Surgeon

Eric M. Joseph, MD · Answer

The reason we prefer general anesthetic for rhinoplasty procedures is to protect our patients' Airways from inadvertent aspiration of blood and other nasal secretions. With general anesthetic, there is a Balloon at the distal end of the breathing tube that lays in someone's windpipe. That balloon prevents blood and other secretions from getting into the lungs, hence preventing aspiration pneumonia. After 24 years of utilizing general anesthetic for rhinoplasty, I do not see any benefit of using intravenous sedation. I hope this helps! Sincerely, Dr Joseph

Zoran Potparic, MD · Answer

Although rhinoplasty without septoplasty may be done in twilight or even local anesthesia, it is very likely that, considering size and shape of your nose, you may need a septoplasty as well. This is done not only to correct underlying septum deformity and obstruction but also as a source for septal cartilage graft which may be needed for tip support. This procedure, septorhinoplasty, is best done in general anesthesia and provides intraoperative  safety and comfort for both patient and a surgeon. Hope this helps.

John Michael Thomassen, MD · Answer

Because you are working in the airway it is easier and safer to do general anesthesia for more complex rhinoplasties.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  There is a wide range of potential for discomfort and bleeding in rhinoplasty surgery.  If someone is having a rhinoplasty under IV sedation and they become more uncomfortable, that sedation amount has to be elevated which also interferes with the normal airway/choking reflexes.  Often times a vicious cycle of more pain, createing more anesthesia, resulting in an airway that is not protected.  As a patient has more pain, the blood pressure goes up and they bleed more.  You can see that this can very quickly result in uncontrolled airway situation. Because of these issues, most surgeons protect the airway with endotracheal tube and the surgery goes very smoothly.  I hope this helps.

Ronald J. Edelson, MD · Answer

Rhinoplasty can be done under either sedation  or general anesthesia.. most surgeons prefer one way or the other. However if the surgeon does all their noses under general anesthesia, don’t try to talk them into sedation instead. Once you’ve decided on the surgeon let the surgeon do the procedure the way they feel comfortable and safest with

Jeffrey H. Spiegel, MD · Answer

We offer IV sedation, general anesthesia, and straight local in the office for a nose like yours.  It really comes down to what the surgeon is comfortable with and what you (the patient) can handle.  There is no substantial advantage to one over the other.

Robert Ciardullo, MD · Answer

General anesthesia versus intravenous sedation for rhinoplasty. while it is true that decades ago most rhinoplasties were performed with intravenous sedation and a partially conscious patient, today most surgeons prefer general anesthesia. There are several reasons for this. The most important reason is that with general anesthesia there is better control of the airway. The extremely rare catastrophe of an intraoperative death or respiratory arrest could occur with intravenous sedation and no control of the airway. Bleeding drips down the back of the throat and the patient can aspirate. The anesthesia dulls the gag reflexes which makes this more possible. With general anesthesia there is control of the airway.. also, with general anesthesia and the patient fully asleep, the surgeon can do what he hast to do to make the end result the best without being inhibited by causing pain or distress to the patient. A Rhinoplasty, particularly one involving a dorsal hump and bony nasal fracture procedures is potentially difficult for a partially awake patient to endure even if the local anesthesia blocks the pain. ironically general anesthesia is safer as well as being much more comfortable.

Andrew Kornstein, MD, FACS · Answer

The answer is an amalgamation of numerous factors including:
1. Surgeon preference
2. Anesthesia availability---some centers are not approved for general, only sedation

Personally I prefer and use general because:
1. Blood pressure is controlled and stable minimizing swelling and bruising
2. The anesthesia tube protects blood from leaking into the patient's throat during surgery, which can be swallowed leading to nausea and possible vomiting or into the airway
3. Most importantly the anesthesia tube always maintains control of the patient's airway and therefore is the safest method in my opinion. The patient can still breath on their own and is "deep" enough to be unaware of the tube's presence

Hope this helps

Why do some surgeons only offer general anesthesia for rhinoplasty & what are the advantages of each method? (Photos)

Answers (12)

More Rhinoplasty Questions

Getting Rhinoplasty with Dermatographia?

Rhinoplasty, Septoplasty and Turbinate reduction (Photo)

Fillers permanently ruined my nose. Do I need a rhinoplasty to fix this? Had 21 dissolving sessions (Photo)

Is redness on the nose tip 6 months after rhinoplasty a sign of necrosis?

Two small fat pockets after rhinoplasty. Do I have to get surgery again?

NanoLaser peel after rhinoplasty?

WE SEND PRETTY
EMAILS