Introduction: Functional endoscopic sinus surgery (FESS) under local anesthesia (LA) is performed as a day-care procedure as an alternative to general anesthesia (GA). Aim: This study assesses the outcomes of FESS performed under LA in two tertiary centers over a 15-year period by the main author. Materials and methods: A retrospective data collection was conducted. All adults who underwent FESS under LA for a 15-year period from 2008 to 2022 in the Department of ENT (ORL-HNS), Dr Kamakshi Memorial Hospital and Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India, were included in this study. Data and information on preoperative assessment, surgical indications, sinuses operated on, intraoperative findings, postoperative complications, and follow-up were recorded. Results: A total of 1,600 patients, among which 1,200 who met the inclusion criteria, were added to the study. The most common indications include chronic rhinosinusitis (CRS), nasal polyps, septal correction, turbinoplasty, dacryocystorhinostomy (DCR), and posterior nasal neurectomy. All paranasal sinuses were operated based on the pathology. In all cases, LA was used along with intravenous sedation. The majority of patients (90%) were discharged home the same day. Conclusion: Functional endoscopic sinus surgery under LA is a safe, cost-effective, and feasible alternative to GA and is well tolerated by patients. Complications of GA can be avoided.