Q: What are the pros and cons of a septoplasty?

Pros It’s a relatively quick outpatient surgery (30 to 90 minutes). A successful result can dramatically improve your well-being. By removing the blockage in airflow, you'll be able to breathe better, sleep more soundly, and suffer fewer headaches or sinus issues. Downtime for this reconstructive surgery is pretty minimal—about a week of feeling stuffy and swollen. Most patients report an increased sense of smell post-surgery. Cons You'll need five to ten days of downtime before returning to your normal activities. It won't make your nose look better, since the benefits are all on the inside. It comes with risks like bleeding, infection, and adverse reactions to anesthesia, though serious complications are rare. In rare cases, patients report a decreased sense of smell.

Question 1

What is a septoplasty?

Accepted Answer

Septoplasty surgery reshapes a deviated nasal septum, the cartilage and bone that divides the inside of your nose into two nasal passages.

With a deviated nasal septum, the septum is positioned to one side of the nose. This usually happens due to some kind of trauma, though some people are born with it.

A crooked septum can limit or block airflow in one nasal passage, causing issues like restricted breathing, snoring, obstructive sleep apnea, frequent nosebleeds, facial pain, and headaches. It can also make you more susceptible to sinus infections.

This surgical procedure straightens the septum, making it easier to breathe through the nasal airway.

According to the American Academy of Otolaryngology – Head and Neck Surgery, deviated septums are extremely common: 80 percent of all septums have some degree of deviation.

That said, not every deviated septum case is severe enough to be treated with surgery. Many with septal deviation choose to simply minimize their symptoms with decongestants and nasal steroid sprays.

If symptoms persist and begin to interfere with a person's daily life, this type of sinus surgery is often recommended.

Question 2

What are the pros and cons of a septoplasty?

Accepted Answer

Pros

It’s a relatively quick outpatient surgery (30 to 90 minutes).
A successful result can dramatically improve your well-being. By removing the blockage in airflow, you'll be able to breathe better, sleep more soundly, and suffer fewer headaches or sinus issues.
Downtime for this reconstructive surgery is pretty minimal—about a week of feeling stuffy and swollen.
Most patients report an increased sense of smell post-surgery.

Cons

You'll need five to ten days of downtime before returning to your normal activities.
It won't make your nose look better, since the benefits are all on the inside.
It comes with risks like bleeding, infection, and adverse reactions to anesthesia, though serious complications are rare.
In rare cases, patients report a decreased sense of smell.

Question 3

How much is a septoplasty?

Accepted Answer

Your cost will also depend on the complexity of your procedure, the type of anesthesia you have (general costs more), and whether you’re combining it with an additional procedure, like a rhinoplasty (which won't be covered).

See our complete guide to septoplasty costs

Question 4

Septoplasty before and after pictures

Accepted Answer

The septoplasty photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Will insurance cover a septoplasty?

Accepted Answer

Most insurance plans consider septoplasty medically necessary and offer coverage. However, Dr. Cain notes that "insurance plans vary in the amount of co-pays, deductibles, and out-of-pocket expenses that you might still be responsible for."

Doctors in this RealSelf Q&A recommend asking your primary care physician for a referral and checking with your insurance provider to see which surgeons or practices are covered under your plan. You’ll want to see a board-certified ENT (ear, nose, and throat) specialist, a facial plastic surgeon, or a plastic surgeon specializing in nasal surgery.

Related: 6 Plastic Surgery Procedures Your Insurance Might Cover

Question 6

Who makes a good candidate for septoplasty?

Accepted Answer

Good candidates are healthy nonsmokers who have a deviated septum that causes difficulty breathing, snoring, or sleep apnea.

Chronic conditions like hypertension or diabetes will need to be treated by a healthcare provider before you'd be a good candidate for surgery.

Question 7

Does septoplasty make your nose bigger?

Accepted Answer

Short answer: No. In fact, a septoplasty probably won’t change the shape of your nose at all, unless you pair it will a cosmetic rhinoplasty.

“If the septal cartilage is severely deviated, straightening of the septum might affect the appearance of the nose, but these cases are less common,” says Dr. Matthew Richardson, a plastic surgeon in Frisco, Texas.

Question 8

Septoplasty versus rhinoplasty: what’s the difference?

Accepted Answer

These two related procedures have different methods and goals. They also vary in terms of insurance coverage.

“The primary purpose of septoplasty is to help a patient breathe more easily,” says West Palm Beach, Florida plastic surgeon Dr. Kris Reddy. “This procedure is generally considered medically needed and may be covered by insurance.”

“A septoplasty is performed only on the inside of the nose,” explains Dr. William Portuese, a plastic surgeon in Seattle, Washington.

If you’re looking to reshape your nose and don’t have breathing problems, you’ll want to have a cosmetic rhinoplasty instead. Rhinoplasty surgery, also called a nose job, can correct a hump, straighten the bridge, raise a drooping tip, and address other aesthetic concerns.

“Rhinoplasty is a purely cosmetic procedure that is designed to improve the appearance of the nose. Insurance generally will not reimburse patients for this procedure,” Dr. Reddy says.

According to Dr. Portuese, 30–40% of the septoplasties he performs are combined with rhinoplasties. Some doctors even have a name for this combined procedure: a septorhinoplasty.

“If you’re considering a rhinoplasty and also need a septoplasty, it makes sense to do the two together, because a surgeon typically needs extra cartilage to reshape the outside of the nose. If the procedures are done together, he can use what was removed from the septum,” explains Dr. Portuese.

Related: Surgical Rhinoplasty vs. Liquid Nose Jobs: Doctors Weigh In on Which Procedure Is Right for You

Question 9

What happens during the surgery?

Accepted Answer

A septoplasty takes between 30 and 90 minutes. It's an outpatient procedure, so you’ll go home the same day. The procedure is performed under general anesthesia or local anesthesia with sedation. The type of anesthesia you’ll need will depend on how complicated your correction is, along with the personal preferences of both you and your surgeon.

Once you’re either sedated and numb or fully asleep, your surgeon will make a small incision inside the nasal cavity to access the septum; or they may make an incision at the base of or across the columella (the strip of tissue separating the nostrils) and lift the skin and overlying mucous membrane, a technique called an open septoplasty.

Your surgeon will then straighten your septum before closing the incision with dissolvable sutures.

Some doctors apply plastic or silicone splints (stents), to maintain the new shape and pack the nose to minimize bleeding. Dr. Portuese says packing is rare today because it can make recovery more uncomfortable for the patient.

Question 10

How painful is a septoplasty?

Accepted Answer

The procedure itself isn't painful because you'll be anesthetized, either very relaxed and sleepy or fully asleep.

You may feel some pain during the first week of recovery, but you should be able to stay relatively comfortable with prescription pain medication or over-the-counter options.

Question 11

How long does it take to recover from deviated septum surgery?

Accepted Answer

Most people need about a week of downtime (home from work with no major social engagements) after surgery.

“For the first week, because of surgical swelling, [your nose is] going to feel very stuffy, like [you have] a bad sinus infection,” warns Dr. Portuese. You may also notice numbness or aching in your upper teeth.

To manage the discomfort, you can use ice packs, saline rinses, and over-the-counter pain medication or whatever your doctor prescribes for you.

“Avoid ibuprofen and aspirin,” warns Dr. Portuese. “They’re blood thinners and can lead to nosebleeds.”

“Most surgeons use silicon based stents (internal splints) for about one week following the surgery. The splints usually have a tunnel, enabling the patient to breathe through them during this recovery phase,” says Dr. Jacob Sedgh, a plastic surgeon in Los Angeles, California. “Most pain and discomfort is reported during the first week while the splints are sutured inside the nose. Many surgeons prescribe an oral antibiotic and a low grade narcotic pain medication during this time.”

After a week, you’ll have the stents removed. This may feel like gentle tugging but shouldn’t be painful.

Keep your head elevated (especially when sleeping) for at least the first week. You'll also need to avoid smoking, hot drinks, spicy food, and alcohol for a week or two. And try not to blow your nose until your surgeon says you've healed enough for it to be safe.

Over these first few weeks, it’s not uncommon to still have some bleeding and discharge. The best way to manage a nosebleed is to tilt your head forward slightly and breathe through your mouth, spitting out blood if necessary. (Any excessive bleeding requires a follow-up with your doctor, who may pack the nasal cavity with gauze.)

“Most patients resume work and regular activity in the second week,” says Dr. Sedgh. “There’s usually minimal pain at this phase.”

You’ll need to limit your physical activity for several weeks after surgery, to minimize swelling and promote healing, or until your doctor says you’re good to go. This includes most forms of intense exercise, because they may increase your blood pressure and lead to nosebleeds.

It's also smart to abstain from sex for the first week; some doctors recommend waiting three to four weeks simply because you could inadvertently hit your nose.

Check with your doctor before any airplane travel and—until your nose has healed—try to stay away from people who have colds, because you’re at higher risk of developing a sinus infection.

Question 12

Will septoplasty help you breathe better?

Accepted Answer

Once the swelling has gone down, you'll be able to breathe much more freely.

“We tell patients who have functional nasal surgery such as a deviated septum and turbinate reduction that they will not be able to breathe out of the nose for one week,” says Dr. Porteuse. “You’ll have restriction the second week, and you start breathing better by the third week after the surgical procedure."

Question 13

How long does swelling last?

Accepted Answer

How long the swelling lasts depends on the incision type, the details of your procedure, and how your body reacts.

“If the deviated septum was removed with an incision inside the nose, then no swelling should be expected,” says Dr. Anthony Bared, a plastic surgeon in Miami, Florida. “If an incision was made underneath the nose—open approach to septoplasty—in order to sometimes correct a very deviated septum, then you can expect some swelling.”

With the open approach, swelling will go down significantly within the first month and slowly resolve over the next three to six months, as the nose continues to heal.

RealSelf Tip: Avoid high-sodium foods while you’re recovering. “Salt causes you to retain fluid,” says Dr. Bayed, and this can make swelling worse.

Related: 3 Women Reveal What to Expect During Rhinoplasty Recovery

Question 14

How soon will you feel the results?

Accepted Answer

You should start to feel results (easier breathing) within a week, with continued improvement for several months.

By six months post-surgery, you should be mostly healed and breathing much better.

Question 15

How long do septoplasty results last?

Accepted Answer

Results should be permanent, though in rare cases, the septum can revert to its original position. Your nose shape will also naturally change with age.

Question 16

What is the success rate of septoplasty?

Accepted Answer

According to the results of a 2018 study, the success rate "varies from 43% to 85%, indicating more than 15% of septoplasty patients fail to relieve their symptom."

That said, type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el of RealSelf members say their procedure was Worth It. “I can finally breathe through both nostrils!” says jsmith05, a RealSelf member who had a septorhinoplasty to correct her breathing after breaking her nose.

Question 17

What are the septoplasty risks?

Accepted Answer

Septoplasty is considered a safe procedure, and serious complications are rare. However, it does come with risks like bleeding, infection, and adverse reactions to anesthesia.

In rare cases, patients report a decreased sense of smell or a discoloration of the nose.

It's also possible to develop a perforation or hole in your septum. Septal perforation may require additional surgery to repair it.

Question 18

What are the alternatives to septoplasty?

Accepted Answer

Not all nose-breathing issues are solely the result of a deviated septum. Some breathing issues may also be caused or exacerbated by enlarged turbinates, the structures inside the nose that help moisturize the air when we inhale. If this is the case for you, you may consider having a turbinate reduction instead.

“Turbinates are ridges of tissue inside the nose; you have three sets on each side (superior, middle, and inferior),” says Dr. Sapna Patel, a plastic surgeon in Atlanta, Georgia. “The turbinates have bone and then are covered by mucosa. The purpose of these structures is to warm, humidify and filter the air that we breathe.”

If the mucosa swells or is congested due to allergens, pollutants, and other things in the environment, the tissue can become enlarged and make it more difficult to breathe.

“It is common to address the turbinates at the same time as a septoplasty, as both can contribute to nasal obstruction or difficulty breathing out of the nose,” says Dr. Patel.

SEPTOPLASTY

William Portuese, MD

Genevieve Monsma

William Portuese, MD

Genevieve Monsma

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William Portuese, MD

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SEPTOPLASTY QUESTIONS

Over 1 year post op - still having swelling. How can I improve my results? (Photos)

2 years post septorhinoplasty - is the tip of my nose scar tissue? Can this be improved? (Photos)

Will a 90% Vomer Bone Removal be a Problem in the Future? (Photo)

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