Video 2.1: Local Anaesthetic Injection Technique in Closed Atraumatic Rhinoplasty

What this video shows

This video shows the local anaesthetic injection sequence that Prof. Dr. Suleyman Tas uses at the start of every closed atraumatic rhinoplasty. The solution is 0.1 cc of 1/100 adrenaline in 20 cc of prilocaine, which gives a 1/200,000 adrenaline concentration, and it is injected slowly because the septum has a very rich blood supply and a fast adrenergic injection can trigger tachycardia and hypertension.

The book also explains how a small bilateral injection at the nasal spine can stimulate the trigeminal reflex and lower the heart rate by 20–30 beats per minute, which is useful when tachycardia occurs during the infiltration.

Key points

• Solution: 0.1 cc adrenaline 1/100 in 20 cc prilocaine (1/200,000).

• Inject slowly to avoid tachycardia and hypertension from the septal vascular network.

• A 0.1 cc bilateral injection to the nasal spine can stimulate the trigeminal reflex when needed.

For patients: this is the numbing and bleeding-control step that makes a bloodless, atraumatic dissection possible; it is one reason closed rhinoplasty patients in this practice have less bruising and a faster recovery.

In the book: Chapter 2 – Closed Atraumatic Rhinoplasty, section 2.2.1 Local Injection, p. 7 of Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques (CRC Press, 2021). About the book and all companion videos.

Surgeon: Prof. Dr. Suleyman Tas, plastic, reconstructive and aesthetic surgeon, Istanbul. This video is part of the surgeon-training material of the book; patients considering rhinoplasty in Istanbul can use it to understand the techniques used at Prof. Dr. Suleyman Tas Clinic.