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

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.

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

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