What People Who Regret Their Rhinoplasty Anesthesia Have in Common | General vs. Local, and the Pitfalls of Choosing

What people who regret their rhinoplasty anesthesia have in common | General vs. local, and the pitfalls of choosing

There is a survey showing that, among patients who undergo rhinoplasty, very few understood the differences in anesthesia before surgery.

• General anesthesia, local anesthesia, sedation — how large is the difference in risk among the three methods?
• If you "don't want to have a frightening experience during surgery," which anesthesia should you choose?
• Is the post-op "nasal packing" really necessary?

You don't want pain, and you want to undergo surgery safely. These are natural wishes. But choosing without accurately knowing the risks can, on the contrary, make the decision harder. The latest research has made clear that the way you choose anesthesia and post-op procedures greatly changes both risk and comfort.

So — what really is "safe anesthesia"? We explain based on the systematic review byBarone et al., which covered 43 studies.

Wait, isn't general anesthesia the safest? The real differences among the three anesthesias

"General anesthesia is the safest." Many patients believe so. But the latest research overturns that common sense.

The systematic review by Barone et al.shows that, no matter which anesthesia method you choose, there isno major differencein the overall complication risk or safety, such as intraoperative bleeding (bleeding during surgery). In other words, one cannot definitively say "general anesthesia, so it's safe." What matters is to choose afterknowing the risks inherent to each anesthesia.

The pitfall of "general anesthesia," which 72% choose

According to the review by Barone et al.,of rhinoplasties,72%are performed under general anesthesia. In complex surgery it is essential to keep the body completely still and ensure safety — but there is a pitfall here that tends to be overlooked.

Ishii et al.also point out in their guideline that the incidence of PONV (postoperative nausea and vomiting: feeling nauseous or vomiting after surgery) is the highest at11.8%, about three times that of local anesthesia.Perkins et al.report a risk that airway trouble (temporarily being unable to breathe well) occurs with a probability of3.6%.

Behind the reassurance of "it's over while you sleep," postoperative suffering awaits — this is the reality of general anesthesia.

Is local anesthesia reassuring? In fact, the scariest thing is "anxiety during surgery"

So how about local anesthesia?In the report by Ishii et al.,the risk of nausea is3.6%, the smallest of the three. The burden on the body is also light. Recovery afterward is also fast. It sounds attractive.

However,in the same report by Ishii et al.,the proportion who feel fear or anxiety during surgery is11.3%, the highest among the three methods.

General anesthesia, which is hard afterward but over while you sleep, vs. local anesthesia, which is light on the body but has strong fear during surgery. This contrast is precisely the core of choosing anesthesia.

That is precisely why a "third option" is now attracting attention.

According to the review by Barone et al.,local anesthesia combined with intravenous sedation (anesthesia that drowsily puts you to sleep via a drip) is already chosen in21%of cases, and is rapidly spreading as a "best-of-both-worlds" method that suppresses nausea while also easing fear during surgery.

Is the post-op hell of "nasal packing" already outdated?

People who have undergone rhinoplasty say in unison that it is "harder than the surgery" — that is the post-op nasal packing (a procedure of packing gauze and the like into the nose after surgery).

So what if that "common sense" is now about to be overturned from the root?

In the study by Kridel et al.,it is reported that routine nasal packing is gradually tending to be avoided. The reason is clear.According to the review by Barone et al.,when removing non-dissolving packing,up to 70%of patients feel strong pain, and it also becomes a cause of sleep disturbance in the 24 hours after surgery. And, surprisingly —in the study by Kridel et al.,it is also reported that even without packing, no significant increase in postoperative bleeding risk was observed.

"But what happens if packing is absolutely necessary?"

Please rest assured. Even in that case, there is a solution.van Egmond et al.report that, if absorbable packing such as CMC (packing that dissolves naturally) is used, a removal procedure becomes unnecessary, and because it is naturally absorbed in3 to 5 days, you can spend the time comfortably. Furthermore, these dissolving materials are also said to have the effect of preventing nasal synechiae (the mucosa inside the nose sticking together).

The "common sense" of pain has already changed.

Conclusion: "So in the end, which should I choose?"

So how do you judge which anesthesia suits you?

Barone et al.also point out that you should choose to match the patient's surgical content and situation. The guideline for judgment is simple.

• For a major surgery, general anesthesia, which can firmly manage the airway,general anesthesia.
• To balance the burden on the body and comfort,local anesthesia with sedation.
• For a minor revision,local anesthesia only.

In other words, the starting point for choosing anesthesia is not "what you fear" but "what kind of surgery you will have."

Summary of this article

• In the review by Barone et al.,there is no difference in serious danger by type of anesthesia, and with an appropriate choice any of them is considered safe.
• General anesthesia has "postoperative nausea," and local anesthesia has "fear during surgery" — each has its own inherent risk.
• In the report by Kridel et al.,even omitting nasal packing is considered not to raise the bleeding risk.
• According to van Egmond et al.,even when packing is necessary, "materials that dissolve naturally" are becoming the mainstream.

The choice of anesthesia is something to decide together with your physician. Please consult at your examination about "what suits your surgery," rather than "which is the right answer."

If you find yourself thinking, "What about my case?"

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References

1. Barone M, Amenta A, Rossi S, et al. Anesthesia Modalities and Nasal Packing in Rhinoplasty: A Systematic Review of Complications, Postoperative Management, and Safety Guidelines. Aesthetic Plast Surg. 2025 DOI
2. Ishii LE, Tollefson TT, Basura GJ, et al. Clinical practice guideline: improving nasal form and function after rhinoplasty. Otolaryngol Head Neck Surg. 2017 DOI
3. Perkins SW, Hamilton MM. Perioperative management in aesthetic rhinoplasty. Facial Plast Surg. 2021 DOI
4. Kridel RW, Konior RJ. Anesthesia for rhinoplasty: current concepts. Aesthet Surg J. 2014 DOI
5. van Egmond MMHT, Smit AL, de Vries N. Patient experience and satisfaction in rhinoplasty under local anesthesia. JAMA Facial Plast Surg. 2019 DOI