A reasonable evaluation technique is to trisect the nose into an upper bony third, a cartilaginous middle third, and the tip complex. The most common deformities in the above mentioned areas involve a dorsal hump deformity of the nasal bones and cartilaginous septum, widened nasal bones and a bulbous nasal tip. There is a tremendous variation in nasal shapes reflecting differing anatomic composition of the supporting structures of the nose. Figures 1A . The procedure of rhinoplasty is most frequently performed in the office or outpatient surgery setting under local anesthesia and intravenous sedation.
Some surgeons prefer using a general anesthetic.
After appropriate administration of intravenous sedation the mucosal surfaces are anesthetized with topical xylocaine with epinephrine. Circumnasal blocks with local anesthesia can be performed. Some surgeons prefer a mini-dose of ketamine preceding the blocks. Pretreatment with a benzodiazepam is helpful to prevent side effects of ketamine. There are many variations in technique.