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Molly Maloof, MD

Director of Clinical Content
@DoctorBase

is it ok to conduct open rhinoplasty under local anesthesia?

i have had 4 consultations:

7yrs, 7yrs, 10yrs, and 27yrs (experience of each dr.)

two stated iv sedation

one stated general anesthesia.

the 26yr doctor stated local. he stated too much risk with iv and general., i guess from experience?

he would have me on ambiean, Valium ect.. 1.5 -2hr it will take.

the 26yr doctor said i have a on a scale of 1-10 difficulity of doing , would be a 4.

the other doctors said difficulty, and it would be an 8.

why would this doctor of 26yrs be so condient he ca
Poster
  • Male | 36 years old

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Featured Answer

3 UpVoted this answer Edward P. Miranda, MD, FACS Plastic Surgeon, San Francisco
General anesthesia is the most common modality for anesthesia for a rhinoplasty for airway safety and patient comfort. Rhinoplasty is a precise procedure and "dumbing" it down, especially with degree of difficulty and local anesthesia may be a sign of over confidence.
3 UpVoted this answer
probably becausz he needs to sell it more than the others. In rhinoplasty, it is best to pick the most experienced surgeon. Look at a lot of pics and make sure the doc dies a lot of those . General anesthesia is my preference . Do not price shop.
Ahmet R. Karaca
2 UpVoted this answer Edward P. Miranda, MD, FACS Plastic Surgeon, San Francisco
It can be done both ways but choose the doctor you are most comfortable with, has the most experience, and has the results you prefer. Trust your intuition regarding the best doctor for you. You may also discuss this with your primary doctor regarding your health status and which would be best for you regarding the anesthesia.
2 UpVoted this answer
At 26 he doesn't know what he doesn't know. At 26 they have clearly not completed plastic surgery training! Medical school is not done until 26 years. For many later. Then residency for 6 more.

Run from the 26 yo. Maybe even report him. The scam of using only local is usually from a doctor without privileges to do the procedure in the hospital or get office certification.

27 years experience here and I only do them under general anesthesia. Very safe.

Good luck
Mark A. Eberbach
2 UpVoted this answer
Rhinoplasty is one of the most difficult facial cosmetic procedures. Only the most minor of nasal tip cases could be performed under local by a very experienced plastic surgeon. Otherwise, rhinoplasty should be done under a general anesthetic because of the bleeding that occurs with drainage into the back of the throat. To suggest that general surgery is too risky is just wrong and this along with the apparent erroneous confidence of this young doctor should throw up red flags... stay away.
2 UpVoted this answer
In general terms, local anesthesia with or without sedation is very safe and effective but when one has surgery on the nose the nasal passages are relatively obstructed and there is the possibility of bleeding into the back of the throat. All this makes it very difficult for the patient to co-operate and be comfortable. Most surgeons, me included, prefer to do major operations involving the nasal septum under a general anesthetic and feel this is a safer approach. However, do not equate years in practice with experience doing a procedure. It depends on the doctor's scope of practice and how many such procedures he does on a regular basis.
Louis Mes
2 UpVoted this answer
Four major open rhinoplasty general anesthesia is preferred because any bleeding which goes down the back of the throat may cause coughing and make it impossible for the surgeon to perform such meticulous and delicate surgery. For major open rhinoplasty using intravenous sedation, the surgery is more challenging for the rhinoplasty surgeon and a small carefully placed sponge near the back or posterior nasal passage can control bleeding and simultaneously provide local anesthesia. I have done this quite successfully however I only felt comfortable after performing hundreds of open rhinoplasties. For minor open rhinoplasty usually performed for nasal tip problems local anesthesia with oral sedation such as Valium is quite acceptable and tolerated by the patient and the surgeon. In my opinion, rhinoplasty should be performed by a board-certified plastic surgeon or a board-certified facial plastic surgeon, and preferably a member of the Rhinoplasty Society with many years of experience and a very good photographic gallery. I cannot speak for the young surgeon you mentioned. His comment may be due to inexperience or it may be due to a very high level of training and surgical excellence. Best of luck in your endeavors.
1 UpVoted this answer
The answers to your questions about a doctor's confidence level is not easy to answer but as all aesthetic plastic surgery goes, rhinoplasty requires the most artistic, mechanical and intuitive skill of any of the procedures we perform. In general, your question reminds me of a mantra that one of my rhinoplasty mentors engrained upon me, "there is no such thing as simple rhinoplasty surgery, only simple rhinoplasty surgeons". With that said, many of us with over 25 years of experience do many revision rhinoplasties and on a relative scale your nasal condition condition is likely much less complicated. The steps proposed should be explained in simple terms so you can determine who seems to have the best plan to fix the problem.

As it relates to anesthesia I would tell you first not to over-think this. In a healthy person, your anesthesia-related serious adverse event risks are statistically less than that of driving your car. Further, anesthesia has two main functions, 1) your safety and 2) your comfort. I trained doing most all of rhinoplasties under IV sedation anesthesia and that was adequate in the right person that is comfortable with having some awareness of the operating room the sounds etc. I would not suggest an "oral-only sedation" as it is difficult to quickly address your comfort and anxiety during surgery should you experience issues with above stated goals of anesthesia.

There is also some middle ground with anesthesia, TIVA total intravenous anesthesia and MDSA. monitored deep sleep anesthesia. If your surgeon is skilled and experienced they will be able to make your nose entirely numb once you are sedated but I personally now like to have an anesthesiologist there watching over your general physiology while I focus on getting your nose corrected. The anesthesia you pick will be both safe and effective with the correct surgeon and anesthesia team. Please see my website and blog for more information on video.
1 UpVoted this answer
In an appropriate setting, rhinoplasty can be safely performed with local, IV sedation, and/or general anesthetic. The extent of a rhinoplasty can vary significantly from one nose to another and will likely play a significant role in estimating the time that will be required and the anesthetic recommended for the procedure. Different estimates for time and different recommendations for anesthetic may reflect differences in treatment plans and experience between the different surgeons. I would encourage you to make sure that you and your surgeon are on the same page in terms of what your goals are and then I would recommend working with the surgeon who you believe will do the best job for you and then trust what they are recommending for your anesthetic.
1 UpVoted this answer
hello , for me the best and safest way to perform a open rhinoplasty is under general anesthesia, the reason why is because if you do it under sedation or local anesthesia you are basically aware that you are getting a surgery and you are consious and it will increase your boold pressure wich can be a risk for you to create blood cloths wich can create another complications after the surgery and your recovery time can be long, for some surgeons is better to perfomr procedures under local anesthesia or sedation because is cheaper for them they save a lot of money by doing this type of proceudres in those conditions, so i will strongly suggest not to do it under local or sedation there is no need to oput yourlself in that risk.

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Mario Alfonso Gonzalez Cepeda