Twilight sedation vs general anesthesia for rhinoplasty

Why are some rhinoplasty procedures done under twilight sedation and others are done under general anesthesia?


F, 29, Massachusetts

A lot of it comes down to the preference of the surgeon and patient, but I personally think general anesthesia is unnecessary when performing rhinoplasty. I have performed numerous procedures under twilight anesthesia and have a strong preference for it over general anesthesia. This option also avoids issues associated with the endotracheal tube as well as the risk of malignant hyperthermia. There is less bleeding, no pain, and less nausea when this type of rhinoplasty anesthesia is used by an experienced plastic surgeon.

Many factors play into this decision but I have a strong preference for general anesthesia when performing rhinoplasty surgery.

Some surgeons urge their patients to go with twilight anesthesia because the surgeon can administer it on his or her own. This makes it more cost-effective for patients when compared to general anesthesia, because the facial plastic surgeon doesn’t need the services of an anesthesiologist.

But I prefer to have an anesthesiologist on hand to monitor my patients’ blood pressure and breathing. This allows me to focus on ensuring excellent results from the surgery. I also believe that general anesthesia is the safer option because the anesthesiologist is able to maintain control of your vital functions throughout the surgery. Sometimes with twilight anesthesia the patient may metabolize the medications slowly, which can pose challenges for the anesthesiologist.

Moreover, the laryngeal mask airway (LMA) or endotracheal tube used during rhinoplasty prevents blood and fluid from making their way to your lungs.

Be sure to discuss all of these factors, as well as any concerns you may have, with your facial plastic surgeon. You and your surgeon should be on the same page before you move forward with surgery.

Dr. Alexander Ovchinsky has 10 Revision Rhinoplasty before & afters:

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There are many factors that determine whether twilight sedation or general anesthesia will be used during a rhinoplasty surgery. It depends on the situation. For example, a standard nose job that does not include septoplasty can often be performed under twilight sedation. In contrast, a revision rhinoplasty procedure that involves harvesting cartilage grafts from the ribs is typically performed under general anesthesia.

Another factor that plays a role is the personal preference of the plastic surgeon, anesthesiologist, and patient, respectively. My personal preference is to perform this type of cosmetic surgery with twilight sedation since it minimizes bleeding, does not require a breathing tube, and usually leads to a faster recovery. Also, rhinoplasty patients typically feel better after receiving twilight sedation than they do with general anesthesia. General anesthesia can lead to nausea and postoperative vomiting, the latter of which is also associated with more swelling and bruising.

In the end the decision is yours to make in consultation with a board-certified plastic surgeon or facial plastic surgeon.

Some rhinoplasty cases are more extensive and require general anesthesia to afford the surgeon and patient control and comfort. It may also be a matter of surgical training, preference, or convenience of the surgeon that twilight anesthesia is used. Thanks for your question.