Raffy Karamanoukian, MD
Rhinoplasty Expert Los Angeles

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Double Board Certified Plastic Surgeon - AAAHC Accredited Surgery Center


Dr. Karamanoukian adheres to the highest standards of patient safety

Our office maintains certification by the Accreditation Association for Ambulatory Health Care (AAAHC), also known as the Accreditation Association.  The AAAHC is a private, non-profit organization that has established national and international guidelines for quality of care and safety in ambulatory surgical centers.  Currently, the Accreditation Association accredits almost 5,000 organizations throughout the world through a peer-based approach, which means that medical practitioners act as surveyors to inspect and maintain the highest standards of patient care.

Although accreditation and certification by AAAHC is a voluntary process, Dr. Karamanoukian believes that it is an essential aspect of patient care.  Accreditation allows our facility to maintain peer-reviewed standards for patient care, surgical safety, and anesthesia care.


Choosing Dr. Karamanoukian for cosmetic or reconstructive plastic surgery


Thank you for choosing Dr. Karamanoukian for your cosmetic or reconstructive plastic surgery.  Dr. Karamanoukian is a double board certified plastic surgeon who dedicates the majority of his practice to corrective plastic surgery, including rhinoplasty, facelifts, revision rhinoplasty, and corrective skincare.  He has been featured in numerous television shows discussing innovative approaches to plastic surgery and skin.  His particular focus on skin stems from a realization that plastic surgery cannot be accomplished unless the skin is corrected and improved.  Aging occurs through a combination of cellular sun damage and loss of structural support. Plastic surgery can correct the underlying support of the face and body, but does not correct the overlying skin, which acts as the fabric for the final result. You will find that Dr. Karamanoukian's meticulous approach maximizes the final results and improves your satisfaction. 

Dr. Karamanoukian's background includes training in general surgery and critical care prior to his training in plastic surgery.  To patients, this means that Dr. Karamanoukian has the added background and expertise to make sure that your plastic surgery is done to meticulous aesthetic standards and as importantly, a committment to safety. 

During Dr. Karamanoukian's training, he presented original research in multiple disciplines at academic meetings and internationally acclaimed academic publications. His creative talent focused on integrating new technology to existing techniques in surgery. In fact, he was the first surgeon in the world to discuss options for using robotic technology in complex microsurgical reconstruction for cancer patients. In addition, he presented data at a national plastic surgery meeting to introduce technology that could one day prevent devastating hand injuries that lead to permanent debility. 

After meeting with Dr. Karamanoukian you will find that his compassion and caring is unparalleled. He defines the epitomal role of a trustworthy and dedicated surgeon whose ambition is to provide meticulous and comprehensive care to his patients. 

Options for Anesthesia during Rhinoplasty

Anesthesia is an important part of any surgery.  There are many options to choose from when choosing the type of anesthesia during your surgery.  Above all, always make sure that your operation is performed in an accredited surgery center and that your anesthesiologist is board certified by the American Board of Anesthesiology. 

Dr. Karamanoukian hand-selects anesthesiologists who are board certified and demonstrate professionalism and compassion in the treatment of patients. In fact, Dr. Karamanoukian only performs surgery with anesthesiologists who have experience in the type of surgery being performed, including rhinoplasty.  You will have the opportunity to speak to your anesthesiologist before your rhinoplasty should you wish to do so.  

Depending on the type of rhinoplasty you choose, there are several options for anesthesia.  Please note that although it is important to understand all your options, Dr. Karamanoukian will discuss which anesthesia methods he feels are the safest for your particular rhinoplasty operation.  Some procedures are not suitable for local anesthesia or conscious sedation. 

Local Anesthesia: Topical or local anesthetics are administered to the treatment area before beginning the surgery or procedure.  Although all areas of the face can be anesthetized, this type of anesthesia is more suitable for smaller operations or 'touch-up' procedures of the nose. Local anesthesia is usually not commonly used with rhinoplasty. 

Twilight Sedation: This type of sedation is also known as conscious sedation and can be used for smaller rhinoplasties, provided that the patient meets specific surgical and anesthesia criteria.  Local anesthesia is administered alongside intravenous Valium or a sedative to reduce anxiety.  Patients may awaken sleepy after their rhinoplasty and must have a driver take them home. Usually this anesthesia type is administered by a board certified anesthesiologist and proper monitoring.

General Anesthesia: An anesthesiologist is required for this type of anesthesia in which a breathing tube or LMA is used to administer anesthesia via inhalation.  Unlike general anesthesia of the past, newer techniques and newer drugs make this a very safe method.  Patients may awaken sleepy and tired after their rhinoplasty.  General anesthesia is always administered by a board certified anesthesiologist. 

If you are undergoing rhinoplasty surgery under anesthesia, you will likely require one to two hours of recovery after the rhinoplasty procedure.  During this period after rhinoplasty, a nurse will monitor your blood pressure and vitals in order to optimize your recovery and acclimate you after the surgery.  Recovery is generally one to two hours, depending on how well you metabolize the anesthetics after surgery.  Once recovery is complete, you will be discharged to the care of a family member or friend.  Patients cannot be discharged home alone or given permission to drive after anesthesia. 

Questions and Answers About Plastic Surgery Safety and Rhinoplasty Safety

How important is the anesthesiologist during plastic surgery?
We believe that the quality of our anesthesiologists are of utmost importance during surgery and we have board certified anesthesiologists who are experts in critical care and cosmetic surgery. These board certified anesthesiologists are familiar with newer protocols for anesthesia care that minimize nausea and vomiting after surgery and lead to a quicker recovery.  In addition, they are familiar with LMA, conscious sedation, local anesthesia, MAC, and general anesthesia techniques. During your surgery, the anesthesiologist is in constant communication with the surgeon, Dr. Raffy Karamanoukian, to facilitate the progress of surgery and maximize safety.