Septoplasty: Surgery for Deviated Septum & Nasal Obstruction

What Is a Deviated Septum and When Is Surgery Needed?

A deviated septum occurs when the thin wall (nasal septum) between your nasal passages is displaced to one side, making one nasal passage smaller. Surgery is recommended when the deviation significantly affects breathing and hasn't responded to conservative treatments like nasal sprays or medications.

The nasal septum is the structure that separates your left and right nasal passages. It consists of cartilage in the front and bone in the back, covered by a thin layer of tissue called the mucous membrane. Ideally, the septum should be positioned exactly in the center of your nose, creating two equal nasal passages. However, in reality, approximately 80% of people have some degree of septal deviation, though many don't experience any symptoms.

A deviated septum can be present from birth (congenital) or develop as a result of injury or trauma to the nose. During childhood and adolescence, even minor injuries can cause the septum to grow unevenly. Contact sports, car accidents, and other facial injuries are common causes of acquired septal deviation in adults. The deviation can also worsen naturally as the nose continues to change shape throughout life.

When the deviation is severe enough to obstruct airflow through one or both nostrils, it can cause a range of symptoms that significantly impact quality of life. Many people with deviated septums experience chronic nasal congestion, difficulty breathing during sleep, recurrent sinus infections, and frequent nosebleeds. The obstruction can also contribute to snoring and, in some cases, obstructive sleep apnea.

Who Is a Candidate for Septoplasty?

Septoplasty is generally recommended for individuals who meet the following criteria: they have persistent nasal obstruction that significantly affects their quality of life, the obstruction is primarily caused by septal deviation rather than other conditions like nasal polyps or allergic rhinitis, and conservative treatments have failed to provide adequate relief. Conservative treatments typically include nasal corticosteroid sprays, antihistamines, and decongestants.

Your doctor will perform a thorough examination, which may include nasal endoscopy (using a thin, flexible camera to visualize the inside of your nose) and possibly CT imaging to assess the extent of the deviation and rule out other causes of obstruction. The decision to proceed with surgery is always made collaboratively between you and your healthcare provider, taking into account the severity of your symptoms, your overall health, and your personal preferences.

Conditions Often Treated Alongside Septoplasty

Septoplasty is frequently combined with other nasal procedures to address multiple issues simultaneously. Turbinate reduction may be performed to reduce enlarged nasal turbinates (the structures that warm and humidify air). Sinus surgery can be added to address chronic sinusitis. In cases where both functional and cosmetic concerns exist, septoplasty can be combined with rhinoplasty in a procedure called septorhinoplasty.

How Should You Prepare for Septoplasty Surgery?

Preparation for septoplasty includes stopping NSAIDs and blood thinners two weeks before surgery, arranging transportation home, and following fasting instructions. Pre-operative photographs are typically taken to compare results, and you'll receive specific instructions from your surgical team.

Proper preparation is essential for a successful septoplasty and smooth recovery. The preparation process typically begins two to four weeks before your scheduled surgery date. Your surgeon will provide detailed instructions tailored to your specific situation, but there are several general guidelines that apply to most patients undergoing this procedure.

One of the most critical preparation steps involves managing your medications. You must stop taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen at least two weeks before surgery. These medications can increase bleeding during and after the procedure. Paracetamol (acetaminophen) is a safe alternative for pain relief during this period. If you take prescription blood-thinning medications such as warfarin, heparin, or newer anticoagulants, consult with your prescribing physician about whether and when to stop them. Never discontinue prescribed medications without medical guidance.

During your pre-operative consultation, your surgeon will likely take photographs of your nose from multiple angles. These photographs serve as a baseline reference point, allowing both you and your surgeon to compare your nose's appearance and function before and after the procedure. While septoplasty typically doesn't change the external appearance of your nose, these photographs are still valuable for documentation and assessment purposes.

The Night Before and Morning of Surgery

You will receive specific fasting instructions, typically requiring you to avoid eating or drinking anything after midnight on the night before surgery if you're having general anesthesia. This is crucial for your safety during the procedure. Shower and wash your face thoroughly the morning of surgery, but avoid applying makeup, moisturizer, or other facial products. Wear comfortable, loose-fitting clothing with a shirt that buttons in the front rather than pulling over your head.

Arrange for a responsible adult to drive you home after surgery and stay with you for at least the first 24 hours. You will not be able to drive yourself home due to the effects of anesthesia and sedation. It's also wise to prepare your home for recovery by stocking up on soft foods, saline nasal spray, and any other supplies your surgeon recommends.

How Is Septoplasty Performed?

Septoplasty is performed through incisions inside the nose. The surgeon lifts the mucous membrane, removes or repositions deviated bone and cartilage, and replaces the membrane. The procedure takes 1-3 hours depending on complexity, and silicone splints may be placed temporarily to support healing.

Septoplasty is typically performed as an outpatient procedure, meaning you can go home the same day. The surgery can be done under general anesthesia (where you're completely asleep) or under local anesthesia with sedation (where the area is numbed and you're given medication to relax). Your surgeon will recommend the best option based on the complexity of your case and your preferences.

The procedure begins with the surgeon making an incision inside your nose, on one side of the septum. This incision is hidden within the nasal cavity, so there are no visible external scars. Through this incision, the surgeon carefully lifts the mucous membrane—the thin tissue that covers and protects the septum—away from the underlying cartilage and bone. This membrane is preserved and will be replaced at the end of the procedure.

Once the membrane is lifted, the surgeon can see the deviated portions of the septum. The goal is to straighten the septum while preserving as much of the structural cartilage and bone as possible. Depending on the type and severity of the deviation, the surgeon may remove small portions of bone or cartilage, reposition them, or score and reshape them to achieve a straighter configuration. In some cases, particularly with severe deviations, the surgeon may need to remove larger sections and either discard them or reimplant them in a straightened position.

Types of Septoplasty Procedures

There are two main types of septoplasty procedures, and your surgeon will choose the most appropriate technique based on your specific anatomy and the nature of your deviation:

Septoplasty (septal surgery alone): This procedure focuses exclusively on straightening the internal nasal septum to improve airflow. It does not alter the external appearance of the nose. The incisions are made inside the nose, and the operation typically takes between one and two hours.

External nasal surgery (rhinoseptoplasty): When the external nasal bones or cartilage are also deviated—causing both functional and cosmetic concerns—the surgeon may need to address the outer structure of the nose as well. In this case, before surgery, photographs are taken to compare the appearance before and after. The surgeon straightens both the external nasal bones and the internal septum. Small external incisions may be necessary, and the procedure typically takes two to three hours. A small plastic splint is placed on the outside of the nose and remains in place for one to two weeks.

What Happens at the End of Surgery?

After straightening the septum, the surgeon replaces the mucous membrane and may secure it with dissolvable sutures. To support the septum as it heals and prevent the membrane from separating, thin silicone splints are often inserted on either side of the septum. These splints remain in place for about one week and are removed at your follow-up appointment. Some surgeons also place absorbable packing material inside the nose to minimize bleeding and support the tissues.

Additionally, during surgery, small plastic tubes may be placed in the nasal passages to keep them open and allow for easier breathing while the tissues heal. These tubes are typically removed at your one-week follow-up visit.

What Should You Expect During Recovery?

Recovery from septoplasty involves initial congestion and mild discomfort for 1-2 weeks. You'll have nasal packing or splints that are removed within a week. Avoid blowing your nose, strenuous activities, and swimming for several weeks. Full healing takes 3-6 months, with gradual improvement in breathing.

The recovery process after septoplasty is gradual, and understanding what to expect at each stage can help you feel more prepared and less anxious. Most patients describe the recovery as manageable, with discomfort levels typically lower than anticipated. However, patience is required, as the full benefits of the surgery may not be apparent for several months.

Immediately after surgery, you'll be taken to a recovery area where medical staff will monitor you as the anesthesia wears off. You may feel groggy, nauseated, or confused—these are normal effects of anesthesia that typically resolve within a few hours. Your nose will feel congested and blocked, which is expected due to swelling and any packing or splints that were placed. Breathing through your mouth will be necessary initially.

Most patients can go home a few hours after surgery once they're stable and alert. You must have someone drive you home and stay with you for at least 24 hours. Light bleeding and mucus drainage from the nose are normal in the first few days. Your surgeon may give you a small gauze pad to place under your nose to catch any drainage—this is sometimes called a "drip pad" and may need to be changed frequently in the first day or two.

The First Week After Surgery

The first week of recovery is typically the most challenging. You'll experience significant nasal congestion due to swelling of the mucous membranes. This swelling is a normal part of the healing process and will gradually subside over the coming weeks. Pain is usually mild to moderate and can be managed effectively with paracetamol (acetaminophen). Your surgeon may also prescribe stronger pain medication for the first few days if needed.

During this first week, you should keep your head elevated, even while sleeping, to help reduce swelling. Use extra pillows or sleep in a recliner if possible. Apply cold compresses to your face (avoiding direct contact with the nose) for the first 48 hours to help minimize swelling. Avoid any activities that increase blood pressure or blood flow to the head, including bending over, heavy lifting, and strenuous exercise.

Critical: Do not blow your nose for at least one to two weeks after surgery. Blowing your nose can disrupt the healing tissues and cause bleeding or other complications. If you need to sneeze, do so with your mouth open to release the pressure. Once your nasal packing or splints are removed (typically at your one-week follow-up), you'll begin gentle saline rinses to help keep the nasal passages clean and moist.

Weeks 2-4: Gradual Improvement

By the second week, most of the initial discomfort has subsided, and many patients feel well enough to return to work or school. However, some swelling and congestion will persist. You may notice that your breathing begins to improve, though it's common to still feel somewhat blocked. This is due to residual swelling inside the nose, which can take four to six weeks to fully resolve.

Continue to avoid strenuous activities, contact sports, and swimming for at least four weeks after surgery. You should also avoid situations where your nose could be bumped or injured. Glasses wearers may need to tape their glasses to their forehead or use special glasses supports to avoid putting pressure on the nose bridge.

Long-Term Recovery and Final Results

The internal nasal tissues continue to heal and remodel for several months after surgery. While many patients notice significant improvement in breathing within the first month, the final results of septoplasty typically become apparent at three to six months post-surgery. The tip of the nose may feel tender or slightly numb for several months—this is due to minor nerve irritation and resolves on its own.

You'll have follow-up appointments scheduled at approximately one week, two weeks (if needed), and six to twelve months after surgery. At these visits, your surgeon will assess your healing, remove any sutures or splints, and address any concerns you may have.

What Care Is Needed After Septoplasty?

Post-operative care includes daily saline rinses once packing is removed, taking prescribed medications, avoiding nose blowing, keeping your head elevated, and attending follow-up appointments. Proper aftercare is essential for optimal healing and preventing complications.

Proper aftercare plays a crucial role in your recovery and the ultimate success of your septoplasty. Following your surgeon's instructions carefully can help minimize complications, reduce discomfort, and ensure the best possible outcome. While the specific instructions may vary based on your surgeon's preferences and the details of your procedure, there are several key aspects of post-operative care that apply to most patients.

Nasal hygiene is one of the most important aspects of post-septoplasty care. Once any nasal packing has been removed (typically within the first week), you'll need to keep your nasal passages clean and moist. Crusting and dried blood can accumulate inside the nose, which can delay healing and cause discomfort. Your surgeon will instruct you to perform saline nasal rinses several times daily—usually two to three times per day initially.

To perform a saline rinse, use a dedicated nasal rinse bottle, neti pot, or nasal syringe filled with sterile saline solution. You can purchase pre-made saline packets or make your own by mixing one-quarter teaspoon of non-iodized salt with eight ounces of distilled or previously boiled water. Lean over a sink, tilt your head slightly, and gently squeeze the solution into one nostril while allowing it to drain from the other. Repeat on the opposite side. This process helps remove crusts, reduces bacterial growth, and keeps the healing tissues moist.

Managing Discomfort and Swelling

Pain after septoplasty is typically mild to moderate and can usually be managed with over-the-counter paracetamol (acetaminophen). Avoid ibuprofen, aspirin, and other NSAIDs for at least two weeks after surgery, as these can increase the risk of bleeding. If your surgeon prescribed stronger pain medication, take it as directed. Most patients find they only need prescription pain relief for the first two to three days.

Swelling inside and outside the nose is a normal part of healing. To help minimize swelling, keep your head elevated above the level of your heart as much as possible during the first week. This is especially important at night—use extra pillows or sleep in a recliner. Cold compresses applied to the cheeks and around (not directly on) the nose can help during the first 48 hours, but check with your surgeon before using ice.

Activity Restrictions

Protecting your nose during the healing period is essential. For the first several weeks after surgery, you should avoid activities that could result in a bump or injury to the nose. This includes contact sports, rough play with children or pets, and any activity where you might fall. Even a minor bump during the early healing period can disrupt the delicate tissues and affect your results.

Avoid strenuous exercise, heavy lifting (anything over 10-15 pounds), and activities that significantly raise your blood pressure for at least two to four weeks. Increased blood pressure can cause bleeding and increased swelling. Light walking is encouraged as it promotes circulation and helps prevent blood clots, but avoid anything more vigorous until cleared by your surgeon.

Swimming should be avoided for at least four weeks, as pool water can introduce bacteria into the healing nasal passages and chlorine can irritate the tissues. Similarly, avoid saunas, hot tubs, and steam rooms during the initial recovery period.

What Are the Potential Complications of Septoplasty?

Complications from septoplasty are uncommon, occurring in less than 5% of cases. Possible complications include bleeding, infection, septal perforation, changes in smell, and the need for revision surgery. Contact your doctor immediately if you experience fever, heavy bleeding, or severe pain.

While septoplasty is generally a safe procedure with a high success rate, it's important to understand the potential risks and complications. Most complications are minor and resolve on their own or with simple treatment. Serious complications are rare, especially when the surgery is performed by an experienced otolaryngologist (ENT surgeon). Understanding what to watch for can help you identify problems early and seek appropriate care.

Bleeding is one of the most common concerns after septoplasty. Some oozing of blood-tinged mucus is normal in the first few days. However, significant or persistent bleeding that doesn't stop with gentle pressure may require medical attention. In rare cases (less than 1%), a blood clot (hematoma) can form between the septal cartilage and the overlying membrane. This is called a septal hematoma and requires prompt drainage to prevent damage to the cartilage.

Infection is uncommon after septoplasty, occurring in fewer than 2% of cases. Signs of infection include fever, increasing pain (especially after the first few days), foul-smelling nasal discharge, and increasing redness or swelling. If you experience these symptoms, contact your healthcare provider promptly. Most infections can be treated effectively with antibiotics.

Less Common Complications

Septal perforation is a hole in the nasal septum that can occasionally occur as a complication of surgery. Small perforations may cause no symptoms, while larger ones can cause whistling sounds during breathing, crusting, nosebleeds, and nasal obstruction. Most perforations are discovered during follow-up examinations. Treatment depends on the size and symptoms—small, asymptomatic perforations may not require treatment, while symptomatic perforations may need surgical repair.

Changes in sense of smell can occur temporarily after septoplasty due to swelling and inflammation of the nasal tissues. In the vast majority of cases, smell returns to normal within a few weeks to months as healing progresses. Permanent loss of smell is extremely rare (less than 0.1% of cases).

Numbness in the upper front teeth, gums, or tip of the nose can occur due to temporary irritation of small nerves during surgery. This sensation typically resolves within a few weeks to months without treatment.

Persistent symptoms or need for revision surgery occurs in a small percentage of patients. Some people may not experience sufficient improvement in their breathing, or symptoms may return over time as tissues change. Revision septoplasty is sometimes needed, though most patients achieve satisfactory results with a single procedure.

What Results Can You Expect from Septoplasty?

Most patients (85-90%) experience significant improvement in nasal breathing after septoplasty. Results become apparent gradually over 3-6 months as swelling resolves. While septoplasty doesn't typically change the external appearance of the nose, patients often report improved sleep quality, reduced snoring, and fewer sinus infections.

Septoplasty has a high success rate, with 85-90% of patients reporting significant improvement in their ability to breathe through their nose. However, it's important to have realistic expectations about the outcomes. The surgery corrects structural abnormalities in the septum, but it cannot address all causes of nasal obstruction. If you also have allergies, chronic sinusitis, or other conditions contributing to your symptoms, these will need to be managed separately.

Improvement in breathing typically occurs gradually as post-operative swelling resolves. You may notice some improvement within the first few weeks, but the full benefits often don't become apparent until three to six months after surgery. During this time, the internal nasal tissues continue to heal and settle into their new position. The final appearance of the nose—if rhinoplasty was also performed—may take up to a year to stabilize.

Beyond improved breathing, many patients report secondary benefits that significantly enhance their quality of life. These include better sleep quality, reduced or eliminated snoring, decreased frequency of sinus infections, and reduced need for nasal decongestants. Some patients notice that their sense of smell improves once they can breathe properly through their nose. Athletes often report improved exercise tolerance due to better nasal airflow.

Understanding the Limitations

While septoplasty is highly effective at correcting septal deviation, it's not a cure-all for nasal problems. The surgery addresses the structural issue of the deviated septum but doesn't treat allergies, nasal polyps, or other conditions that can contribute to nasal obstruction. If you have these conditions in addition to a deviated septum, your doctor may recommend additional treatments.

It's also important to understand that a small percentage of patients (approximately 10-15%) may not achieve the desired level of improvement, may experience only partial improvement, or may have symptoms return over time. In some cases, revision surgery may be recommended if the initial procedure doesn't provide sufficient benefit.

How Can You Participate in Your Care?

Active participation in your care improves outcomes. Ask questions during consultations, understand your treatment options, follow pre- and post-operative instructions carefully, and communicate openly with your healthcare team about any concerns or changes in your symptoms.

Being an active participant in your healthcare journey is essential for achieving the best possible outcomes from septoplasty. This means educating yourself about the procedure, asking questions, following instructions carefully, and communicating openly with your healthcare providers throughout the process.

Before surgery, take the time to understand your condition and the proposed treatment. Don't hesitate to ask your surgeon questions about their experience, the specific technique they plan to use, and what you can realistically expect from the procedure. Understanding the risks, benefits, and alternatives will help you make an informed decision about whether septoplasty is right for you.

After surgery, following your surgeon's post-operative instructions is crucial for optimal healing. This includes taking medications as prescribed, performing nasal rinses, attending follow-up appointments, and adhering to activity restrictions. If you experience any concerning symptoms or have questions during your recovery, contact your healthcare provider promptly rather than waiting for your next scheduled appointment.

Questions to Ask Your Surgeon

Before your surgery, consider asking your surgeon the following questions to ensure you're fully informed:

• How many septoplasty procedures have you performed?
• What technique will you use, and why is it best for my situation?
• Will I need any additional procedures, such as turbinate reduction?
• What type of anesthesia will be used?
• What should I expect during recovery, and when can I return to normal activities?
• What are the potential complications, and how likely are they?
• When will I see the final results?
• What happens if I'm not satisfied with the results?

Remember that you have the right to seek a second opinion if you have any doubts about the recommended treatment. A good surgeon will welcome your questions and take the time to address your concerns thoroughly.