What Anesthesia is Used for a Rhinoplasty?

Doctor Answers 102

Anesthesia for Rhinoplasty: It Depends!

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Your options for anesthesia are:

1) Local:

You are fully awake and a local anesthetic is injected to numb the nose.

2) Local with sedation

You have been given a sedative in addition to the local anesthesia. Here you may wake up and fall back asleep at times during surgery, but you will not remember.

3) General

You are fully sedated such that your breathing has to be done for you via an endotracheal tube.


You can choose any of these options based upon medical history, your comfort level, and your surgeon's preference. Some aspects of rhinoplasty (such as cutting the nasal bones) can be uncomfortable for some patients. Know your pain/anxiety threshold! But keep in mind, it is easier to recover from those options that involve less anesthesia (perhaps you have a history of bad nausea and vomiting with general anesthesia).

If you are healthy and want general anesthesia, you should not be concerned with the length of surgery. General anesthesia is like flying a plane: the tough part is the takeoff and the landing. Everything in between is automatic pilot.

However, if you are not a healthy patient, it may not be as safe to have general anesthesia because there can be more blood pressure/volume fluctuations that can put a strain on your heart and lungs. Also, if you've been told you are a "tough intubation" that might indicate that general anesthesia has a higher risk for you.

Don't feel that you have to make this important decision on your own! Your surgeon and your medical doctor will work together to determine the safest option for you. Trust them, that is what they are trained to do.

Anesthesia for Rhinoplasty

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For your comfort and safety, plastic surgeons will use either general anesthesia or "twilight" anesthesia (intravenous sedation):

  • General Anesthesia: a breathing tube is inserted into the throat after the patient is asleep.
    • Some prefer this technique because the tube protects the airway from blood and mucus
    • The anesthetist has control of the airway and ventilation (breathing)
  • Intravenous Sedation: medications are given through an IV, while the patient breathes on their own
    • Less invasive, because the patient is breathing on their own
    • The anesthetist monitors to keep the patient completely asleep and unaware of surgery

In all instances, local anesthetic is also given so the area is numb when the patient awakens/

Rhinoplasty can be performed with local anesthesia, IV...

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Rhinoplasty can be performed with local anesthesia, IV sedation or general anesthesia.

Some points worth considering: the definition of 'general anesthetic' is not necessarily that a 'tube' is put down your throat. Very deep anesthesia can be performed without doing so, and could be considered 'general anesthesia'. Having said this, some 'iv sedation' is so deep it may be considered close to 'general anesthesia'. Thus, we are speaking about some gray zones here.

The most important points to consider are 1) safety; 2) comfort; and 3) effects (if any) on final results.

Safety is of course paramount, and in rhinoplasty surgery, the main issue is protecting your airway (breathing tube). In cases of deep iv sedation, the ability to protect your airway (we all do this without thinking about it) may be lost during the anesthetic.

Secondly, you want to make sure your anesthetic makes you comfortable (no need to suffer during this). If you are comfortable and still, the surgeon will be able to concentrate on his/her work at hand.

Because of this, I recommend an iv-only anesthetic with placement of an 'air pillow', or laryngeal mask, on the airway to protect it. Patients recover very quickly (as it's only iv administered anesthetic) and it offers airway protection.

I have had excellent results with this. I advise you ask you surgeon about what techniques provide you with the best safety and comfort. Hopefully the above information is useful.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 65 reviews

Rhinoplasty can be performed using either IV sedation or...

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Rhinoplasty can be performed using either IV sedation or general anesthesia.

I prefer using IV sedation anesthesia because it is safer than a general anesthetic, does not require putting a breathing tube in the throat, and has a quicker recovery.

Anesthesia for rhinoplasty in young patients

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Most of my rhinoplasty patients are young females - they are all in a high-risk group for post-operative nausea associated with general anesthesia. For this reason, I prefer 'IV sedation' or 'twilight sedation' for rhinoplasty surgery - it avoids the use of inhalational anesthesia and breathing tubes.

What Anesthesia is Used for a Rhinoplasty?

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The nose is a sensitive part of the face and rhinoplasty does require some form of anaesthesia. There are three principal types of anaesthesia - local, sedative anaesthesia and general anaesthesia.
Local anaesthesia involves injecting numbing medicine at the area to be operated on. The nose is a sensitive are of the face, and local anaesthesia along is not sufficient for rhinoplasty.
Sedative anaesthesia also known as twilight anaesthesia means an anaesthesiologist gives you some medications that make you sleep during the surgery. I offer sedation anaesthesia for rhinoplasty, which ensures a comfortable experience, as patients have a rapid recovery and go home approximately thirty minutes after rhinoplasty with an escort or chaperone.
General anaesthesia means that the patient is completely is completely unconscious, requires a breathing tube and the recovery is slower taking a minimum of 4-6 hours. For rhinoplasty, general anaesthesia is safe, effective and commonly used.
The ideal choice of anaesthesia for rhinoplasty does differ for each patient, as depending on your medical history, previous experiences of anaesthesia and allergies, different types of anaesthesia are best suited. 

Rhinoplasty anesthesia methods

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Rhinoplasty surgery can be done either under sedation anesthesia or general anesthesia.

Discuss with your plastic surgeon his method of Choice and his reasoning for that.

Rhinoplasty is an art and precision surgery. To get the best results, the patient should be comfortable. In reality most patient have their procedure performed under General or Sedation Anesthesia.

Hope this was helpful.

Dr. Sajjadian

Rhinoplasty Anesthesia

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Anesthesia for rhinoplasty or nasal surgery can be done a number of ways. A common method is with general anesthesia, where the patient is completely asleep. General anesthesia requires a breathing tube (endotracheal tube) placed in the windpipe so that the patient can ventilated while asleep.

Another common method is intravenous sedation with local anesthesia, where patient is almost asleep or very drowsy, but breathing on their own, and there is no need for a breathing tube. Minor nasal cases can be done under straight local, where the patient is awake and is numbed with an anesthetic solution.

The choice of anesthesia is influenced by anesthesiologist and surgeon preferences, combined with any requests from the patient. Often your doctor will decide what is best for your case best on a number of factors, such as your age, health, duration of the case, etc.

All the best to you,

Dr. Vartanian

A. John Vartanian, MD
Glendale Facial Plastic Surgeon

To sleep or not to sleep with your Rhinoplasty

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While many surgeons in the 70s and 80s would perform rhinoplasty with oral sedation and local anesthesia, more surgeons today are offering general anesthesia for their patients. The reason for this that we have become more sophisticated in our techniques which may require a bit more work to be done on the nose. It then becomes important for the patient to be completely pain free, not moving, and the surgeon can focus on the intricate work at hand.

Having said this, there are indications for using local anesthesia (similar to dental shots) only , or local with sedation. Your anesthesiologist needs to be very familiar with sedation techniqus to handle the delicate balance of pain and relaxation versus safety.

A lot of the decision making is done based on your surgeon's preference. However, make sure your surgeon is not providing lesser anesthesia for cost savings and that you get the amount of work necessary for your nose regardless of the anesthesia technique.

Anesthesia for Rhinoplasty

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Depending on the amount of work needed you will range from local only, to local with sedation to general anesthesia. If it is your first time around and you need a regular rhinoplasty then I recommend a general anesthetic where you go to sleep and wake up with everything completed. That's what i would want for myself.

Best Wishes,


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.