Local anesthesia nose job is reserved for small touch-ups. You will probably need to have your septum worked on and possibly tip work. These will require an IV sedation type or general anesthesia. This is really for your comfort. (Kyle S. Choe, MD, Virginia Beach Facial Plastic Surgeon)
While it is technically possible to reposition the septum under local anesthesia I would not recommend it. The injections are quite uncomfortable and it will be hard to maintain good numbness and comfort if the problem with your septum should extend far back into the nose.
Finally, while correcting/shortening the septum will help nostril asymmetry, it may not completely fix the problem.
Sometimes it is also necessary to correct the size and shape of the nostril itself. While this procedure does not require general anesthesia, I think you should conscious sedation anesthesia by a anesthesiologist or nurse anesthetist, in a qualified office or out-patient setting. (Brock Ridenour, MD, Saint Louis Facial Plastic Surgeon)
I personally feel that some form of sedation is required for septorhinoplasty. My preference is to protect the airway with the use of an endotracheal tube and heavy sedation for these procedures.
The anxiety that accompanies being awake for such procedures is too much for the majority of patients. Secondly, nose job is a far more complicated procedure than most people realize.
What might seem like a simple change to a patient requires a series of steps for experienced nose job surgeons. (Stephen Prendiville, MD, Fort Myers Facial Plastic Surgeon)
In our practice, septoplasty surgery is performed with general anesthetic.
The asymmetry on the base view of your nose may be due to deviation of your nasal septum. Your septum is an internal, midline wall that separates your two nasal airways. When septoplasty is performed, there is bleeding that could get into your lower airway if it is not protected with an orotracheal tube.
Lidocaine injections into your septum may be painful. For these two reasons, nearly all nasal surgery in our practice is performed with general anesthetic. (Eric M. Joseph, MD, West Orange Facial Plastic Surgeon)
A tip nose job and septoplasty can be performed under local anesthesia in an office facility, but most surgeons would feel that a local anesthesia and intravenous sedation or a general anesthesia will make the experience much more comfortable.
No matter which type of anesthesia is used, the procedures should be performed in an ambulatory facility that is accredited by one of the national organizations like the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF) or in a licensed hospital. If sedation or general anesthesia is utilized, the anesthesia should be administered and monitored by an appropriately trained anesthesia provider.
Occasionally a nose job can be done under local anesthesia only. This is generally uncommon as addressing one part of the nose frequently necessitates other parts to be adjusted anatomically in a cascade type of process. This is for the best results. Seeing a board certified experienced nose job surgeon in person can help determine what’s right for you. (David C. Yao, MD, FACS, Phoenix Plastic Surgeon)
Nose job under local.
It is possible to complete nose job under local anesthesia, however the best might be sedation at least to make the procedure pleasant for you. Your problem is primarily a septal deviation and you might not need anything other than septoplasty to set your nostrild straight. (Peter E. Johnson, MD, Chicago Plastic Surgeon)
Nose job under Local Anesthesia
I have done nose job surgery under local anesthesia but I strongly advise against it when doing an entire nose including osteotomies. Some sedation by the anesthesiologist or nurse anesthetist is recommended for all nasal surgery but the tip can be done with just local anesthesia for most patients. (Richard W. Fleming, MD, Beverly Hills Facial Plastic Surgeon)
I use sedation and local. Why be awake and have to deal with pain and noises and other bothering stuff. My anesthesiologist sedates you, but you are not under general anesthesia for the hour or so the surgery takes. You have a good nap and awake to no pain. Don’t torture yourself with local only. It can be done, but is not fun. (William B. Rosenblatt, MD, New York Plastic Surgeon)
Septoplasty under local anesthesia?
Septoplasty and changing the shape of the nostrils can sometimes be done under local but it is usually much more comfortable for the patient to have this done under general anesthesia. In addition, sometimes the surgery is more extensive even though it may look like a small problem.
Sometimes the septum has to be addressed on the inside of the nose and a procedure done under local might not address those things or might not be tolerated by the patient. Also if for some reason, more extensive work needs to be done, the patient might be stuck getting a second procedure under anesthesia. Since this is such a sensitive area, it would probably be easier for the patient and the surgeon to have this done under general anesthesia or at least with sedation under the supervision of an anesthesiologist. (Daniel A. Barker, MD, Chattanooga Facial Plastic Surgeon)