The short answer to this question is yes. However, I do not recommend it to anyone who is serious about getting the best result? Remember the best time for the best result is the first surgery. Local anesthesia may not be adequate to achieve the best complete comfort for the patient. The rhinoplasty requires detailed bone cartilage and often skin surgical procedures.
I use general anesthesia because, in my opinion, it is the safest and most reliable for me to achieve the best result. With local alone, the patient may have persistent discomfort requiring additional injections. As the volume and dosage of injectable anesthesia increase, the likelihood of complications from the injection also increases.
There could be blood and secretions falling back into the throat making it challenging for the patient to get adequate oxygenation. The main objective of cosmetic and any surgery is safety for the patient. I believe for these reasons local anesthesia alone for rhinoplasty should be avoided. As stated, I can deliver my best results with the patient asleep and their airway completely controlled and complete monitoring all through the surgical procedure.
It is certainly cheaper and attractive to discount surgical facilities to offer cosmetic surgery, particularly rhinoplasty under local. These clinics generally are staffed by less than optimally qualified surgeons. The adage you get what you pay for is applicable. So, the combination of discount surgical facilities and rhinoplasty under local with unqualified surgeons in my opinion should be avoided.
Primary and revision rhinoplasty are works of art. It requires detailed knowledge of anatomy and a creative capacity to visualize and achieve the best possible nose on that particular patient and should be performed in the safest possible fashion. In my opinion, this is general anesthesia.