Deviated Septum (Septoplasty)

A septoplasty focuses on correcting the crooked portions of the septum, in order to improve functionality and equalize the breathing passageways through the nostrils.

To successfully perform the procedure, a surgeon may need to center, replace or remove part of the septum; this is done to address sections of cartilage and bone that are causing blockages. Although a severely deviated septum can lead to a crooked nose and cosmetic deformity, most deviated septum procedures do not alter the external shape of your nose.

If you are interested in changing the external appearance of your nose as well as improving airflow, then you should talk to your surgeon about whether you are a good candidate for a nose job (rhinoplasty). Depending on your surgeon’s expertise, they can either evaluate you or refer you to a rhinoplasty expert who can perform both procedures at the same time. (Not all surgeons who are adept at septoplasty have expertise in rhinoplasty.)

If you are interested in having a rhinoplasty and also require septoplasty for breathing issues, it is advisable to have the procedures together since the cartilage from the septum is often critical to both surgeries. Discuss your concerns and desired outcomes with your surgeon to develop a personalized plan of care. Be sure to ask about risks and benefits of all procedures.

To perform a septoplasty, your surgeon will make incisions inside the nose in a scarless fashion and then make the required adjustments to the bone and cartilage that make up the septum, in order to maximize airflow. In some cases, a septoplasty surgery may be so complex that your surgeon needs to make an additional small incision between the nostrils to enhance visibility; this is known as an “open septoplasty.” When performed precisely, these incisions heal extremely well.

When planning for a septoplasty, it’s important to have a thorough discussion with your surgeon about the potential need for complementary procedures, such as turbinate reduction and nasal valve repair. The nasal valve area is a critical zone for airflow in the area of the nostrils, and sometimes requires correction, utilizing rhinoplasty techniques, to optimize breathing.

Turbinate hypertrophy refers to the enlargement of the nasal turbinates, which are structures inside the nose that help filter and humidify the air we breathe. This enlargement can obstruct airflow, leading to difficulty in nasal breathing, congestion, and reduced airflow through the nasal passages. Techniques for turbinate reduction, such as medication, radiofrequency ablation, and surgical procedures, are sometimes performed alone or in combination with a septoplasty to alleviate nasal obstruction and improve breathing. These methods need to be conservative to minimize complications and preserve the turbinates’ essential functions of filtering and humidifying air.

Your surgeon can evaluate whether additional interventions are needed to ensure the best outcome.

Before you go

During a nasal breathing consultation, your doctor will evaluate your nasal passages and overall respiratory function to identify any obstructions or issues affecting your ability to breathe through your nose. A deviated septum is the most common cause of nasal breathing issues, but it is not the only cause. Other anatomical issues, such as problems with the nasal valves (the cartilages controlling the nostrils’ opening) and enlarged turbinates (bony structures inside the nose that help filter and humidify the air), can also contribute to breathing difficulties. Functional issues like chronic sinusitis and nasal polyps may further complicate nasal airflow.

The consultation typically involves a detailed medical history review, a physical examination of the nose using a nasal speculum, and possibly imaging studies like a CT scan or nasal endoscopy. Your doctor must be adept at examining all these structures to develop the best possible treatment plan.

Based on the findings, your surgeon will discuss potential treatment options, including medications, lifestyle changes, or surgical interventions to improve nasal airflow and breathing efficiency. It is possible to combine a septoplasty with a nose job (rhinoplasty) to correct a deviated septum and improve the appearance of your nose at the same time.

It is important to note that some surgeons who excel at septoplasty may not have expertise in aesthetic rhinoplasty. Be sure to review your surgeon’s rhinoplasty before-and-after photos and obtain one or two additional evaluations from rhinoplasty experts to ensure you choose the best specialist.

During the procedure

Septoplasty is usually performed under general anesthesia, so you will be pain-free. You can expect to go home on the same day as your procedure.

To correct the deviated septum, the surgeon will make incisions inside the nose and then make necessary adjustments to the bone and cartilage that make up this internal dividing “wall.” Typically these incisions are closed with dissolvable sutures, so a second visit will not be required for their removal.

Some surgeons will use a plastic splint internally to help with your breathing as you heal. Be sure to ask your surgeon if they use “packing,” gauze put into the nose post-surgery. This was once standard practice, but many surgeons have stopped using it due to patient discomfort.  An external cast is typically not used unless you are also undergoing rhinoplasty or nasal valve reconstruction. However, some surgeons may apply a cast if they use an “open” external incision for a complex septoplasty.

Deviated Septum (Septoplasty) Aftercare 

After a septoplasty, you may experience nasal bleeding for several days and will be provided with gauze to place under your nose. If you encounter excessive bleeding, contact your surgeon immediately.

Significant congestion is common after septoplasty due to internal nasal swelling, crusting, minor bleeding, and mucus formation, so breathing improvements may take several weeks to months. Blowing your nose should be avoided for several weeks following surgery, as this can disrupt healing. Sneezing should be done with your mouth open. Some surgeons will have you irrigate your nose during the septoplasty recovery time. Be sure to follow your surgeon’s instructions for post-operative care, as guidelines may vary based on individual cases and surgical techniques.

You should be able to return to everyday activities about one week after surgery, and exercise two to three weeks after surgery. The final results of septoplasty are usually permanent, but individuals with allergies or sinus issues may need long-term medications or sprays.

The need for a repeat septoplasty is relatively uncommon. Persistent breathing issues after the procedure may be attributed to undiagnosed preoperative conditions such as allergies, sinus problems, turbinate hypertrophy, or nasal valve issues. Additionally, some individuals are extremely sensitive to even minor changes in their breathing, which may not fully improve even if these issues are well-managed. In such cases, comprehensive evaluation and tailored treatment plans are essential to effectively address all underlying factors.