Common traits of people who regret anesthesia choice in rhinoplasty | General vs. local anesthesia, pitfalls in decision-making

Common traits of people who regret anesthesia choice in rhinoplasty | General vs. local anesthesia, pitfalls in decision-making

A survey shows that very few patients undergoing rhinoplasty understood the differences in anesthesia before surgery.

• How significant are the risk differences among the three methods—general anesthesia, local anesthesia, and sedation?
• If you "don't want to feel scared during the procedure," which anesthesia should you choose?
• Is post-operative "nasal packing" really necessary?

You don't want pain, and you want safe surgery. A natural wish. But proceeding without accurate knowledge of risks can actually make decisions harder. Recent research shows that anesthesia choice and post-operative care can significantly change both risk and comfort.

So—what truly constitutes "safe anesthesia"? Based on a systematic review of 43 studies byBarone et al., we explain.

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

"General anesthesia is safest." Many patients believe this. But the latest research overturns that conventional wisdom.

Barone et al.In the systematic review, regardless of which anesthesia method is chosen, intraoperative bleeding and other overall complication risks and safety showno major differences. In other words, you cannot simply say "general anesthesia ensures safety." What matters is understandingthe unique risks inherent to each anesthesia methodand choosing accordingly.

The pitfall of "general anesthesia" chosen by 72%

Barone et al.According to the review, rhinoplasty procedures are performed under general anesthesia in72%of cases. For complex surgeries, complete immobilization ensures safety—but there is a pitfall often overlooked here.

Ishii et al.As pointed out in the guidelines, the incidence of PONV (postoperative nausea and vomiting: feeling nauseous or vomiting after surgery) is11.8%the highest, approximately 3 times that of local anesthesia.Perkins et al.report3.6%risk of airway complications (temporary inability to breathe properly).

Behind the peace of mind that "it's all done while you're asleep," postoperative suffering awaits——this is the reality of general anesthesia.

Is local anesthesia safe? The truly frightening "intraoperative anxiety"

So what about local anesthesia?Ishii et al.According to the report, the risk of nausea is3.6%the lowest among the three methods. Physical burden is also light. Postoperative recovery is fast. It sounds attractive.

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

General anesthesia is postoperatively difficult but completed while asleep vs. local anesthesia with light physical burden but strong intraoperative fear. This very contrast is the core of anesthesia selection.

That is precisely why the "third option" is now drawing attention.

Barone et al.According to the review, local anesthesia combined with intravenous sedation (anesthesia administered via IV to induce light sleep) is already chosen in21%of cases, and is rapidly becoming popular as a "best of both worlds" approach that suppresses nausea while alleviating intraoperative fear.

Post-operative nightmare: Is nasal packing (nasal tamponade) becoming obsolete?

People who have undergone rhinoplasty unanimously say that nasal packing after surgery—the procedure of placing gauze and other materials inside the nose following the operation—is "more painful than the surgery itself."

But what if that "conventional wisdom" is being fundamentally overturned right now?

Kridel et al.report that routine nasal packing is gradually being avoided. The reason is clear.Barone et al.According to the review, when removing non-absorbable packing,up to 70%of patients experience severe pain, and it also causes sleep disturbances in the first 24 hours post-operatively. And remarkably—Kridel et al.research also reports that the absence of packing did not result in any significant increase in post-operative bleeding risk.

"But what if packing is absolutely necessary?"

Don't worry. There is a solution in that case as well.van Egmond et al.report that using absorbable packing such as CMC (materials that naturally dissolve) eliminates the need for removal procedures, and3 to 5 daysfor natural absorption, allowing patients to remain comfortable. Furthermore, these absorbable materials also have the effect of preventing nasal cavity adhesion (where the nasal mucous membranes stick together).

The "conventional wisdom" about pain has already changed.

In conclusion, "So which option should I choose?"

How do you determine which anesthesia is right for you?

Barone et al.As also noted, the choice should be made based on the patient's surgical procedure and circumstances. The guideline for judgment is simple.

• For major surgery, usegeneral anesthesiawhich properly manages the airway.
• To balance physical burden with comfort, usesedated local anesthesiawhich properly manages the airway.
• For minor corrections, uselocal anesthesia alonewhich properly manages the airway.

In other words, the starting point for choosing anesthesia is not "what you're afraid of" but "what kind of surgery you're having."

Summary of this article

• Barone et al.According to the review, there is no significant difference in major risks depending on the type of anesthesia, and all options are safe with appropriate selection.
• General anesthesia carries the risk of "post-operative nausea," while local anesthesia carries the risk of "intra-operative anxiety"—each has its own inherent risks.
• Kridel et al.Reports indicate that omitting nasal packing does not increase bleeding risk.
• van Egmond et al.According to current trends, even when packing is necessary, "naturally absorbable materials" are becoming mainstream.

The choice of anesthesia should be made together with your physician. Rather than asking "which is the right answer," please consult with your surgeon during the consultation about "what is best for your specific surgery."

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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. 2025DOI
2. Ishii LE, Tollefson TT, Basura GJ, et al. Clinical practice guideline: improving nasal form and function after rhinoplasty. Otolaryngol Head Neck Surg. 2017DOI
3. Perkins SW, Hamilton MM. Perioperative management in aesthetic rhinoplasty. Facial Plast Surg. 2021DOI
4. Kridel RW, Konior RJ. Anesthesia for rhinoplasty: current concepts. Aesthet Surg J. 2014DOI
5. van Egmond MMHT, Smit AL, de Vries N. Patient experience and satisfaction in rhinoplasty under local anesthesia. JAMA Facial Plast Surg. 2019DOI