Most nasal surgery is done on an outpatient basis with intravenous sedation or general anesthesia. General anesthesia is generally better for more extensive rhinoplasty or septal surgery. Local anesthesia is usually used for small adjustments to the nose or hump removal. Incisions are usually made on the inside of the nose thus hiding the stitches and any resulting scars. Frequently an "open" rhinoplasty is used in order to directly visualize the structures to be reshaped. This leaves a small scar at the waist of the columella between the nostrils which heals almost imperceptibly. This approach has significantly enhanced the predictability of the final result. The surgeon then reshapes the nose by removing bone and/or cartilage. A splint is placed on the nose to protect it and packing may be used to support the nasal structures. The entire procedure generally takes from one to two hours depending on the complexity of the correction to be made.